CEO Insight: Obstacle or Opportunity? Three hurdles facing healthcare payers

These are challenging times for healthcare payers. Increasing aging populations, pressure to cut costs, and a focus on quality is requiring everyone to do more with less. By facing these challenges head-on, we can turn these obstacles into opportunity. It is through continued innovation and experimentation that we will improve health care delivery in this country.

We believe the response to these three immediate obstacles will determine if an organization will thrive in the evolving healthcare landscape:

  1. Regulatory Compliance: What is your compliance strategy? Regulatory challenges and their impact on your operations is something you cannot ignore. With weekly, sometimes daily, changes being issued by CMS and state regulatory agencies, costly mistakes are common and can be fatal.
  2. Population Health Management: What tools do you have in place now and what are the next steps for your organization? This foundation will be important as we move away from claims data to clinical data. Important data like social determinants of health will be key in the future and solutions for small to mid-sized payers will be very different than their larger counterparts.
  3. Value-Based Care to Scale: The shift to value-based care is now and it’s happening. Do you have a vision for how your organization will achieve quality outcomes? VBC is a big concept and the undertaking is a challenge for all small to mid-sized payers.

If you’re stilling working on the answers to these big questions, then you’re not alone. Many in the healthcare C-Suite are looking for answers and experimenting. There’s not a one size fits all solution. Successful organizations are leveraging connections and networks of industry professionals to learn from others what has worked and what has not.

HCIM’s Executive Team knows this business and we are committed to making an impact by partnering with organizations like yours. If you’d like more information about how we can support your efforts, complete the contact form on the side bar. I’d encourage you to connect with us by subscribing to our blog or follow us on LinkedIn to stay up-to-date on important industry news.

Michael Wilson, President & CEO of HCIM

Michael Wilson
President & CEO, Co-Founder
HealthCare Information Management, Inc.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.