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Payers and health plans are at the center of the healthcare industry, which is growing increasingly complex and disconnected. Navigating the industry requires that leaders are aware of the current payment trends that can impact a payer brand and outlook. According to recent data and trends in healthcare payments, payers have significant obstacles to overcome related to operational challenges, payment experiences and provider relations.

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Call Volume Directly Linked to Poor Payment Experience

A poor payment experience can lead to an increase in call volume from both providers and members. Call volume is a direct result of existing tools and channels not meeting the needs of providers and members, and likely an indicator of a poor experience with a payer’s brand. To mitigate this issue, payers should invest in tools and technologies that make the payment process simple and seamless for users. This investment will not only reduce call volume but also improve the overall payment experience and brand reputation.

The Importance of the Member Experience

The importance of the member experience cannot be understated, especially with individual members. Tapping into the growth of the ACA marketplace will require payers to rethink the premium experience. Payers should begin by leveraging digital tools to provide a more personalized and accessible payment experience for their members. Implementing mobile applications, online portals, and chatbots will present a more consumer-centric approach and help payers stand out in a crowded marketplace.

Provider Networks as an Asset

Arguably, provider networks are one of the strongest assets for any payer. To improve the relationship with providers, the payment experience should be closely examined for opportunities to reduce negative experiences. By leveraging payment tools and technologies, payers can offer a streamlined payment experience for providers. Additionally, implementing a single platform for payment processing could lead to a reduction in errors and faster payment timelines, ultimately improving the relationship between payers and providers.

The Rise of Consumer-Directed Health Plans

Consumer-directed health plans (CDHPs) are becoming increasingly popular among employers and consumers. These plans allow employees to make their own healthcare choices and can lead to a decrease in healthcare costs. However, these plans require individuals to be responsible for a larger share of their healthcare expenses, including more upfront payments. To adapt to this trend, payers should incorporate digital payment tools to simplify the payment process for individuals.

The Impact of Changing Regulations

Finally, it’s important to consider the impact of changing regulations on the payment landscape. With the ongoing debate around healthcare reform and the potential repeal of the Affordable Care Act (ACA), payers need to be prepared for potential changes. Payers should keep a close eye on any policy changes and adapt their payment strategies accordingly.


In conclusion, payer organizations need to be aware of the current payment trends that can impact their business and be prepared to adapt. Investing in digital payment tools, delivering a seamless payment experience for members and providers, and staying on top of changing regulations are all critical to meeting the needs of the evolving healthcare industry. By staying ahead of the curve, payers can ensure long-term success and a positive brand reputation.