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Industry Insights

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Rob Galan
Chief Operating Officer, Administrative Services
Advantasure

Reducing Administrative Costs: Three Straightforward Strategies for Health Plans

Payers are under pressure to make strategic investments and control administrative expenses as healthcare costs continue to rise, consumer demands evolve, and new plans flood the market.

In an industry where one size does not fit all, often the most straightforward solution is the right one.

Here are three simple-to-implement strategies that health plans can use to effectively compete for members:

1) Invest in Technology

There are many innovative tools on the market that aim to improve efficiencies and automate processes. An integrated technology platform that easily adapts to change and reduces the potential for error is one of the most comprehensive solutions at a plan’s disposal.

In addition to decreasing expenses related to manual claims adjudication, membership enrollment and reconciliation, automated processes are known to significantly reduce claim status calls from providers and members.

Another tool that enables plans to control administrative expenses is natural language processing. The technology, which analyzes unstructured data, can be used to enhance consistency throughout the clinical documentation improvement process.

2) Focus on Quality

Most payers understand the importance of promoting improvements in patient outcomes.

Embedded provider coordination programs that enhance member visits and accurate documentation, for example, can decrease costs related to medical record retrieval and review.

To avoid incurring unnecessary administrative expenses, health plans should look to partners that are transparent with their total cost of programs and services.

3) Engage a Partner

The “buy more, own less” mentality continues to gain momentum as plans look to strengthen existing operations or enter new markets. Partnerships allow payers and providers to focus more on members and key initiatives while alleviating complexities in their organizations.

Many plans appreciate the ability to take advantage of partners’ innovative capabilities, top talent and integrated programs. Another plus is that quality partners can provide back-office operations more effectively and affordably than most health plans.

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