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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 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.
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.
In an era of paramount digital transformation, the Trusted Exchange Framework and Common Agreement (TEFCA) emerges as a pivotal beacon for healthcare payers. Established by the 21st Century Cures Act, TEFCA aims to create a standardized methodology for health information exchange across disparate networks.
HealthAxis, a leading provider of Core Administrative Processing Solutions and related software and services to healthcare payors, announced that their corporate office is relocating to the Rivergate Tower. The tower is located along the Tampa Bay Riverwalk at 400 N Ashley Drive, Suite 920, Tampa, Florida. This new space is a remarkable place that will be perfect to collaborate and entertain current and prospective customers.
HealthAxis, a leading provider of core administrative processing solutions (CAPS) and related software and services to healthcare payors, announced that Matt Hughes, former COO of HealthAxis, has been named the new chief executive officer of HealthAxis.
International Women’s Day (IWD), celebrated annually on March 8th, is both a day to honor women’s social, economic, cultural, and political achievements worldwide and a day to rally for progress toward gender equality. Collective action and shared ownership for driving gender parity make IWD impactful.