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Preparing for audits is a year-round priority for healthcare organizations. The ever-evolving regulatory landscape requires health plans to adopt a proactive approach that integrates compliance monitoring, staff education, risk management, and transparent communication with auditors. Achieving audit readiness is essential to streamline processes, minimize risks, and maintain compliance during audits.
As the year comes to a close, healthcare payers face a landscape marked by significant regulatory shifts and evolving compliance demands. New mandates from CMS, adjustments to Medicare Part D, enhanced HIPAA compliance standards, and a push toward value-based care models will all impact how payers operate, interact with providers, and serve members. Staying ahead of these changes is crucial—not only to ensure compliance but also to strengthen operations, improve member experience, and achieve strategic objectives in a rapidly evolving landscape.
Health plans face increasingly complex compliance demands. In this HealthAxis InFocus video, Compliance Officer Milonda Mitchell delves into the six priority areas health plans should focus on to reduce risk and excel in 2025.
In Part 1 of this two-part series, we examined the top five technology areas receiving increased investment from healthcare payers in 2025, according to the 2025 Gartner CIO and Technology Executive Survey. Now, we turn to the next set of high-priority investments aimed at further optimizing payer operations.
The healthcare payer industry is at a pivotal moment. As operational costs rise, consumer expectations evolve, and technology rapidly advances, payers are compelled to reassess their technology priorities to stay competitive and ensure they can scale efficiently while addressing complex regulatory and operational demands. According to the 2025 Gartner CIO and Technology Executive Survey, several key areas are emerging as top investment priorities, all aimed at boosting efficiency, enhancing patient outcomes, and optimizing operations.
Member retention is paramount in a competitive healthcare landscape. A classic Harvard Business Review study revealed that a mere 5% increase in customer retention can boost profits by 25% to 95%. This statistic underscores the critical role satisfied members play in the financial stability and success of healthcare payers and third-party administrators (TPAs).
In an era where technological advancement intersects with critical healthcare needs, standing still is not an option for health plans. The challenge today goes beyond merely adapting; it’s about actively reshaping the way health operations function. From the intricate layers of commercial plans to the nuanced demands of Medicare, Medicaid, and PACE programs, the quest for operational excellence is relentless.