THE 'EDGE REPORT BLOG

Increasing Membership is Top of Mind for Payers

HealthEdge, in partnership with independent market research firm Upwave, recently conducted a survey of more than 220 health plan executives across the country; results revealed that increasing membership is a top organizational goal for payers.

With increasing demands to grow membership, market pressures are changing how health plans invest the resources made available from lowering costs and increasing efficiencies― top responses included consider new partnerships or acquisitions and invest in a new geography or line of business. 

This year especially, payers are facing unique pressures to grow. Many health plans lost a lot of membership due to COVID-19 and businesses closing. As the economy opens back up, health plans will focus on different ways to establish themselves and attract members as consumers re-enter the market. 

We’ll see large nationals strategically entering into new geographies and product lines to expand their market share. As a result of acquisitions, large national plans also often have multiple legacy systems. I also expect to see increased due diligence in potentially consolidating those systems to cut administrative costs and have a best-in-class ecosystem. Provider-owned regional plans, which were particularly hit hard in the last year financially, will also expand new product lines and focus on member retention. Overall, innovation in consumerism will be essential across the board. 

The executive survey also revealed that one of the top challenges to acquiring new members is offering the variety of plans necessary to satisfy members. In order to create new plans that appeal to the consumer, health plans must make strategic business decisions; this requires the ability to model new benefit plan design and quality-based pricing in their system against real-utilization data to understand outcomes and predictability. 

Additionally, with COVID-19 and society in general, we’ve seen an increased emphasis on behavioral health. This increased prevalence will certainly impact benefit design going forward, especially with new models to reach consumers, like telehealth. 

Whether through new geography, line of business, innovative offerings, or acquisitions and partnerships, health plans today want to take advantage of all available resources to expand in the current landscape.

About the Author

David Nesbitt

David Nesbitt, Vice President, Sales Operations
LinkedIn
dnesbitt@healthedge.com

David is a senior executive responsible for sales operations across the HealthEdge solution suite. In his current role, he supports all HealthEdge sales activities including partner relationships. David has more than 25 years of healthcare payer experience and brings a broad background spanning software development, product management, professional services delivery and sales. He has been with HealthEdge for more than 13 years. During this time, David has served as Product Manager designing HealthRules Payor functionality as well as Senior Director of Business Services managing the business consultants and education services in Professional Services. Prior to his tenure at HealthEdge, David held product management and delivery roles at NaviNet and Verisk Analytics. His early healthcare experience was in the role of software development at Healthsource/CIGNA. 

Infographic
Competitive Pressures are Driving Decisions

With increasing demands to grow membership, improve customer satisfaction and strengthen provider relationships, market pressures are driving notable change in the way health plans operate. Download the infographic to learn about the executives’ priorities, current challenges they’re facing, and how they plan to achieve their goals.

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