March 20, 2023 – Health plans and third-party administrators (TPAs) face increasingly stiff competition in today’s payer marketplace. According to a recent American Medical Association study of health insurance markets , three-quarters of commercial markets are highly concentrated — and that figure shows little signs of dissipating. To keep pace with their competition and improve their standing among purchasers and consumers, health plans and TPAs must identify areas of weakness to achieve new levels of efficiency and put their organizations in an advantageous position to succeed moving forward. Capabilities gaps are salient in the area of healthcare payments as a result of how health plans and TPAs have adopted point solutions or integrated existing and new technologies due to mergers and acquisitions. The events led to unintended consequences : technology bloat, difficulty maintaining compliance, security risks, and a lack of interoperability. Assessing healthcare payment infrastructure is a critical first step toward payers ensuring that continued digital transformation does not lead to fragmentation, inefficiency, and risk. However, an objective assessment cannot come from the inside. External resources are necessary to determine a health plan’s or TPA’s digital maturation. “Benchmarking is key for a payer to understand its business,” says Zelis […]
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