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Health payers

Tackle healthcare disruption through technology, while prioritizing a member-centric approach to humanize healthcare.

What’s going on

Health payers face an increasingly challenging landscape with growing consumer demands, new forms of competition, expanding costs and fast-paced technology advancements.

The winners will be those who reinvent and reposition to improve access, experience and outcomes.

From traditional to generative, AI increasingly touches every part of the enterprise and comes with financial, legal and ethical implications. Responsible AI (RAI) is a discipline to drive value against organizational goals, compliance, and trust. It is a mechanism to drive value for patients, providers, and operators. Listen to the AHA webcast with executive, clinical and administrative leaders about best practices, challenges and how we can usher in the future of health care together.

5 ways health payers are changing

Cost and revenue pressure

As expectations for cost cutting and revenue growth persist, medical costs continue to escalate. There is an enhanced focus and scrutiny on operating efficiency leading to cost transformation and gen AI adoption. Health payers can streamline operations, improve clinical impact and optimize corporate functions, leveraging technology to drive both cost efficiency and revenue-driving innovation.

Integrated engagement expectations

Although the digital environment is fragmented; members, providers, employers, brokers and employees – want an integrated personalized and engaging experience. People seek secure, integrated channels to navigate health benefits, and access a trusted advocate. Payers need to provide secure self-service, integrated digital engagement and a 360 patient view to maintain and grow patient engagement.

New care models

Standalone health insurance loses ground to integrated care. Leaders drive innovation and growth through primary care, home, specialty, virtual, provider collaborations and value-based care. Members expect care anywhere-physical, home, virtual, and integrated behavioral / specialty care. Payers can expand sites of care and preferred partnerships with providers to coordinate value based care.

Workforce shortages and competition

The competition for people is intensifying, and turnover is increasing. The traditional operating models aren’t sufficient to meet the demands of a digital and data-driven era. The future of work for payers requires a transformation that reinvigorates the workforce by bringing the best of people and technology to streamline tasks, continuously reskill and staff for the future.

Accelerate technology shifts

Winners today shift investment from legacy applications to new data and digital led solutions. The new solutions are powered by enhanced cloud and data foundations to enable shifting to traditional and gen AI solutions. Organizations need to continue to invest and manage strategic ecosystem partnerships to accelerate innovation and meet the security requirements of the new capabilities.

What you can do

Continue to grow and innovate within your core insurance business allowing the organization to experiment and adopt new business models. Collaborate across functions and with outside partners to enable customized, end-to-end experiences within healthcare.

Reduce administrative burden and improve member satisfaction with easier onboarding and reimbursement. Use advanced technologies to automate tasks, streamline workflows and improve data management across core operations and corporate functions.

Enhance your organizational culture to support people in their change journey, career progression and continuous learning — and use AI to boost the value each person brings. Partner them with machines to automate mundane and repetitive tasks.

Unlock the power of digital by using the cloud as the enabler, data as the driver and responsible AI as the differentiator. Rapidly develop new capabilities by securely integrating data, platforms, and AI to break down healthcare silos.

Our leader

Robert Murphy

Managing Director – Consulting, Health Payer Lead, North America

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