Payers with intelligent operations want to use diverse data to make decisions, satisfy customers and achieve business outcomes.

The need for intelligent operations

Healthcare payers see a new opportunity on the horizon: intelligent operations. Accenture surveyed operations executives at 150 payers and learned that the pressure is on to support revenue growth, improve the customer experience and increase quality. In short, the back office is now being expected to power the front office.

Amid these challenges (see Figure 1), payers are investing in intelligent operations—and they expect results.

Those pursuing intelligent payer operations anticipate productivity, revenue and quality increases over the next three years.

16%

Productivity increase

17%

Revenue increase

17%

Quality increase

Thinking holistically about operations

Payer operations executives surveyed believe that the explosion of data, digital disruption, customer experience demands and the proliferation of automation solutions are driving forces behind the move to intelligent operations. Many (37%) cite the need to make more predictive decisions based on rapidly accessible real-time data from across the organization as having major impact on the business.

Those pursuing intelligent operations must think about their holistic solution set and see where digital capabilities can yield results across functions. Accenture research shows that applying digital to certain operational areas can yield significant cost savings.1

$1.4B

in managing membership and billing

$1.1B

in managing support reimbursement

$1B

in managing network and providers

Other major drivers of the need to pursue intelligent operations include combating the threat of digital disruptors and building relationships with the ecosystem (see Figure 2).



Five elements of intelligent payer operations

Accenture’s research reveals that there are five key elements to achieving intelligent payer operations (see Figure 3):

Advanced analytics. Using data in decision making was the top-ranking enabler in helping payers achieve business goals (see Figure 4). More than 80 percent of health operations executives believe that the use of data in decision making and in business processes is an important enabler of achieving their business goals.



Intelligent automation. Intelligent automation is viewed as an enabler of business goals and as such, payer operations executives plan to focus automation and AI efforts on the commercial large group and Medicaid businesses (see Figure 5). As commercial large group continues to face compressed margins over the past few years, efforts to automate are key to sustaining business in this segment.

Agile workforce. Payer operations executives believe that lack of the right talent is a barrier to preventing them from achieving their business goals to improve experience, increase profitability and generate new revenues for the future (see Figure 6).



Partner collaboration and reimbursement innovation. Eighty percent of health operations executives believe that working closely with ecosystem partners is an important enabler to achieving their business goals. Intelligent payers tap into ecosystem partners such as pharmacy benefit managers, value-based reimbursement solution providers and large employer groups to bring complementary skillsets, more data, and more diverse data that fosters greater insights and innovation.

Modern technology architecture. Traditional legacy platforms continue to present issues including scalability, high maintenance costs, aging codebases and shrinking institutional knowledge. To enable intelligent operations, payers must deliver a resilient, scalable and extendable ecosystem that supports agile delivery of new capabilities and real-time data for intelligent decision making.

What happens next

With productivity, revenue and quality increases resulting from the move to intelligent payer operations, there is no sense in waiting to transform. Growth trumps costs in driving an intelligent payer operations transformation, but that will require a change from the top. Change in leadership is identified as one of top three triggers for operational transformation among payers, at 39 percent. Payer operations executives must lead by example and invest in the five key elements of a high-performing organization as they aim to drive quality, combat disruption and build competitive advantage.

1 Accenture, The Intelligent Payer Survival Guide, 2018.

Brian Kalis

Managing Director – Digital Health


Michael Kaveney

Managing Director – Health, Lead – Payer Claims


Robert Murphy

Managing Director – Health, Lead – Payer Back Office

MORE ON THIS TOPIC


Subscription Center
Stay in the Know with Our Newsletter Stay in the Know with Our Newsletter