healthaxis

The healthcare industry is poised for a transformative era driven by artificial intelligence (AI). AI’s role in automating tasks and generating insights has the potential to drastically improve efficiency, accuracy, and, ultimately, health plan member care. However, amidst this wave of technological enthusiasm, it’s crucial to underscore that AI’s effectiveness is contingent upon its foundational principles: ethics, equity, and data quality.

The HIMSS Global Health Conference & Exhibition, held in Orlando, Florida, from March 11 to 15, 2024, provided a profound glimpse into the current and future states of healthcare technology. This pivotal event brings together industry leaders and innovators to discuss, offering a glimpse into the latest advancements and future trends shaping the industry, and this year’s conference was no different.

In Part One of this series, we examined the initiatives Gartner identified as key areas for acceleration,¹ following their extensive evaluation through research surveys and interactions with U.S. healthcare payer business and technology executives.

U.S. healthcare payers and third-party administrators (TPAs) face a complex array of business and technology initiatives driven by evolving market conditions and increasing consumer demands. Successfully navigating this dynamic landscape requires a clear understanding of how to manage these challenges effectively.

We are pleased to announce that our CEO, Scott Martin, will be speaking at the 2024 McGuireWoods Healthcare Private Equity & Finance Conference taking place May 8-9 in Chicago, IL. Scott will be a panelist on the session titled “Investing in Healthcare IT/Payor Services for a Digital Future” on Thursday, May 9th.

April marks an important observance in the healthcare calendar: National Minority Health Month. This month is dedicated to raising awareness about the ongoing health disparities that affect racial and ethnic minorities and American Indian/Alaska Native communities. Health disparities—variances in health outcomes across different groups—are influenced by social determinants of health such as access to healthcare, economic stability, education, neighborhood and physical environment, as well as social and community context.

In the age of big data, healthcare payers and third-party administrators (TPAs) are overwhelmed by vast amounts of information, underscoring the importance of data quality. A robust data quality strategy is essential, as it guarantees the accuracy and relevance of the collected data, thereby informing decision-making and strategic planning processes. This approach not only enhances operational efficiency but also supports the delivery of high-quality member care.

In January 2024, the Center for Medicare and Medicaid Services (CMS) issued the Interoperability and Prior Authorization Final Rule CMS-0057-F, heralding a transformative phase for U.S. healthcare payers effective January 1, 2026. This pivotal rule revises the landscape of prior authorization (PA) processes, especially for Medicare Advantage (MA), Medicaid, Children’s Health Insurance Program (CHIP), and Marketplace plans, signifying a major operational shift for healthcare payers.

In today’s competitive healthcare landscape, member retention is paramount for all health plan types. Retaining existing members is significantly more cost-effective than acquiring new ones. However, achieving high retention rates requires a delicate balancing act between member satisfaction, operational efficiency, and cost control.

We are proud to announce that our CEO, Scott Martin, has been named one of the Top 25 CEOs in Tampa for 2024 by Key Executives. This esteemed accolade underscores Scott’s exceptional leadership and the significant influence he has exerted on HealthAxis.