• Shifting dynamics are taking automation and cloud deployments up in the form of technology innovations, as health firms embrace new automations to enhance payment capabilities and get comfortable with cloud architectures and embedded banking from financial services.
• Headwinds are sweeping through the healthcare environment, from smaller brokers and advisors brewing up competition against major health plans to expanded usage of Medicare Advantage plans and Affordable Care Act (ACA) exchanges.
• An economic environment in flux adds complexity with a mix of high interest rates, inflation, and tepid returns on market investments, but it has also opened the door to alternative benefits that may reshape the employer benefits landscape in the coming decade. 

These factors do not present a “doom and gloom” situation for healthcare players, but instead they create new opportunities for growth and innovation. The challenge for health plans and payers in 2023 is to identify how digital payment methods, strategies, and services are expanded, both to withstand current pressures and emerge with improved operational efficiencies as an organization.

Aite-Novarica Group has distilled the developments in healthcare payments into 10 top trends that will influence the industry in 2023.

Some of these include:

• Growing interest in digital payment methods streamlines B2B payments: Healthcare payments are dominated by the “Big Three” of paper checks, wire transfers, and ACH transactions, but digital payment options are growing in relevance. Electronic check conversions, virtual cards, and peer-to-peer (P2P) networks like Zelle match, and in many cases exceed, the speed and data reconciliation of ACH payments. Additionally, real-time capabilities offer powerful use cases for healthcare, from automated reconciliations and account-to-account payments to real-time claims and explanation of benefits (EOB) access.
• APIs come to healthcare, making integration (and innovation) easier: APIs swept through financial services and are now making their mark in healthcare and health payments. APIs are bread and butter for cloud deployments, alleviating the financial resources otherwise dedicated to building and maintaining legacy middleware and software. APIs also inject flexibility and interoperability into the tech stack and open the gate for integration with vendors to enable automated payments and increased information exchange with other third-party applications. Ultimately, APIs will be the key to creating new products and services, including embedded banking and financial ones, that can be built on an intuitive, user-friendly portal.
• Brewing competition against health plans: While health plans had strong earnings in 2022, they should be mindful of competition and discontent in their membership base, competitors, and industry partners. While the following factors are not likely to shake health plans from their position of power in 2023, they do reflect important sentiments from health plan members. This may come in the form of narrower networks; incentives to nudge members to high-quality, lower cost providers in the form of steerage; or other creative approaches. 
  • Members continue to be discontent with high premiums and out-of-pocket costs. While lower utilization in 2020 and 2021 due to COVID-19 meant that medical loss ratios (MLRs) freed up some premium payments to be returned to plan members, concerns remain surrounding healthcare premiums.
  • Competitors, particularly small and regional health plans, lament the challenge of competing with mega health plan structures now dominating the market after years of merger and acquisition activity.
  • Industry partners, namely small- and medium-size third-party advisors and some benefits brokers such as those oriented to the Health Rosetta model, are changing course, promoting low- or no-deductible plans and direct primary care plans.
• Focus on Health Savings Accounts (HSA) shifts to savings and card spending: The Fed’s interest rate hikes will impact the bottom line of custodians and revenue share partners in a positive manner. Additionally, stagnation in the market and lukewarm investment sentiments will lead account holders with investments to search for alternatives when allocating their funds. Custodians, banks, and revenue share partners will consider promoting high-yield saving account options and determining how much of the interest rate increases to share with individual account holders. Emphasis on expanding the use of prepaid HSA/FSA cards will also increase.

Areas like member engagement, automated enrollments, and payment integrity are also set for changes, setting up 2023 as a challenging and transformative year.

To learn more about the top ten trends in healthcare that Aite-Novarica Group has identified for 2023, click here to download the full report and reach out at apoindexter@datos-insights.com to share what you think will impact your industry in 2023. You can also watch the recording of our February 16th webinar, where we explored each of these trends in detail. Click here to access the recording.

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Next-gen members’ expectations of their health plan interactions, technology, and telehealth are here to stay. The same goes for the growing number of Medicare enrollees, who are likely to have different and unique needs and preferences when interacting with their health plan. 

Payers now have a prime opportunity to leverage automation and improve member engagement strategy. Adoption of fintech partnerships for open API access can serve as a vital connector to these member groups. Member engagement initiatives at payer organizations would benefit from considering the following to remain relevant and compelling.

1. Enable easy automation at the self-service level.

Automated features and functionality like self-service, starting with appointment reminders and scheduling tools, are a strong first step toward end-to-end member engagement automation. This can add a layer of common-sense automation to laborious manual processes, thus improving accuracy and keeping customers engaged and responsible. Self-service features are a widely available low-hanging fruit ripe for the picking.

2. Utilize APIs for provider directory management.

Realizing that a favorite provider is suddenly out of network or discovering a post-care lapse in covered procedures creates headaches for members, hurting their healthcare experience. According to a forthcoming report from the Aite-Novarica Group’s Healthcare Payments practice on member engagement and satisfaction, a third of surveyed member engagement professionals update their directories quarterly or less, while 14% are unsure of how frequently their directories are updated.

Building a consistent and accurate provider directory is a key area for payer differentiation. API enablement can help engagement executives rise to the challenge by facilitating real-time connections to a vast number of endpoints in the ecosystem, which keeps directories up to date and lowers member risk.

3. Consider the chatbot.

The stereotypes of bad chatbots are well-known: frustrating to use, clunky and sluggish, hardly conversational and highly artificial. But the country’s largest banks, brokerages, and insurance companies have made the chatbot leap, and most are better for it.

When deployed correctly, chatbots automate large amounts of tasks, ensure data security, and provide members with a streamlined experience. While members may still opt for the human connection when discussing sensitive topics, chatbots provide utility by performing simpler administrative tasks, such as payment method verification, with speed, at scale.

The chief issue with chatbots centers around configuration; automated responses stem from a centralized dialogue tree and must be programmed for high levels of input complexity, along with considering patient privacy.

4. Learn from outside industries.

Banks, financial institutions, and e-commerce giants like Amazon lead the pack in engagement, adopting highly configurable, omnichannel solutions to engage with customers and deliver highly relevant and impactful user experiences. The level of usable customer data here is high, and the stickiness of customer-company relationships tends to be strong.

It is true that healthcare is more personal, expensive, and sensitive than retail or online banking. However, the opportunity is there for payers to tap the automation well and create powerful and meaningful relationships with members through digital channels.

Want more on the latest in member engagement? Read our latest report, Member Engagement and Satisfaction: Payment Harmonization Benchmark, or contact me at apoindexter@datos-insights.com for more information.

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Frictionless enrollment hinges on technology and automation enablement on the front and back end; that much is obvious. But successful frictionless enrollment must leverage technology to develop a comprehensive record of the member, along with reducing manual processes, workflows, and data inconsistencies at the organizational level. Streamlined enrollments enhance the quality of member data and create powerful user experiences.

Benefits administrators should consider the following when building the groundwork for frictionless enrollment.

1. Develop a cloud strategy.

On-premises infrastructures were once standard for healthcare organizations, but the onset of cloud deployments rapidly became differentiators, offering heightened security, enhanced scaling, and a general decrease in operating costs.

Moving to the cloud affords wide degrees of customization for the enterprise, a stark contrast to on-premises deployments with high overhead and a lack of data nimbleness. Whether building a data and security protocol or storing a library of provider contacts, a cloud-native technology infrastructure is a powerful tool for healthcare payers and administrators.

2. Enable real-time processing.

Real-time enrollment processing, enabled via open API connections and cloud-based IT ecosystems, allows members to shop, compare, price, and select their health plans. On the back end, administrators can access member data at scale at a pace far quicker than batch processing allows, creating opportunities for rapid customer engagement and swifter enrollments.

A bogged-down enrollment process can prevent employees from taking full advantage of benefits, leaving unused money and value on the table. Furthermore, a snappy, automated enrollment process enhances overall member experience without sacrificing the detail associated with traditional enrollments.

3. Power up the platform.

Considering the evolving employee landscape and nuanced member needs throughout their life, employers require a nimble set of benefits that meet those needs. A positive enrollment experience may help retention in a tight labor market, and instant access to a wide range of benefits via a clean-cut digital platform is a step in the right direction.  

Digital enrollment platforms must adapt to meet that challenge to remain compelling and viable. Dated platforms mired in clunky document processing, slow download speeds, and unattractive interfaces can impede organizational access to consumable member information, along with creating a negative first impression.

4. Simplify internal data processes.

A range of new challenges arise once real-time enrollment data is accessible. Inconsistent data standards (differences in stored file types, data duplicates, etc.) may lead to processing headwinds, while an excess of low-value manual tasks can exacerbate workflows and flatten productivity levels.

Inconsistencies in member information can quickly turn into a wave of meaningless data that goes nowhere and serves no purpose to advance the employer-employee relationship. Keying in on workflows, developing guidelines for gauging process performance, and automating low-value tasks can keep enrollment fulfillment on track.

5. Focus on a valuable member experience.

Employees have the upper hand in today’s competitive labor market. They do not only want a quick and easy enrollment experience, but a consistently positive relationship with their employers. One channel to build that relationship is through a satisfactory benefits platforms and administrator.

Implementing relevant benefits content personalized for each user, along with single sign-on, live chats, conversational AI, and automated reminders for important information, is a helpful tool to strengthen that relationship. Focus should center on creating a digital-banking-like approach, eliminating member challenges before they occur and facilitating a no-hassle experience.

Want more on enrollments? Register for tomorrow’s webinar on Open Enrollment Trends and Predictions for 2023. Can’t attend? Check out the AHIP webinar from May 2022 in which Aite-Novarica participated on the topic of frictionless enrollment alongside executives from Oracle and PwC.

Have a platform or solution we should have on our radar? Please reach out to arrange a briefing at apoindexter@datos-insights.com.

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