Payers today face evolving and unclear industry regulation and an increasingly competitive landscape. Inevitably, the Affordable Care Act presents a handful of problems to healthcare insurers: evolving mandates, new plan design requirements, emergence of direct to consumer marketing, and profit ceilings — just to name a few.
To mitigate the risks of a changing industry landscape, payers must work to maintain operational advantages and determine how their business will be positioned to compete. Does your business need to change to keep up with the competition, client demands, and industry regulation? Absolutely – and in order to do so effectively, planned, purposeful, and strategic transformation is necessary.
Payers can identify and institute improvement opportunities by conducting a Target Business Model (TBM) workshop. A TBM workshop is an interactive group exercise that outlines the activities, approvals, controls, and supporting technology of current state business processes, including sales, enrollment, benefit administration, claims processing, and customer support. The TBM workshop then leverages and improves current processes to design a “target” future state business model.
An effective TBM workshop includes representation from all departments, which provides clarity to upstream and downstream impacts of activities. Throughout the workshop the business gains visibility to efficiency opportunities by rationalizing and challenging processes, identifying operational synergies, defining system requirements, and eliminating redundant tasks.
Businesses who execute TBM workshops realize both direct and indirect return on their time, resource, and financial investments. TBMs help payers capitalize on improvement opportunities and reduce operating costs through increased employee productivity, quality of service, scalability of staff, competitive advantage, and efficiency of activities.
The payer landscape will continue to evolve, which will require payers to undergo significant transformation in coming years. For these organizations, at minimum, this transformation requires compliance with changing industry regulations, but it could also include marketing to individual consumers, establishing new plan designs, increasing administrative efficiency, and creating a competitive advantage in the marketplace. The payers who take planned, purposeful, and decisive action to develop a competitive business model will differentiate themselves from their competition. Is your business ready to stand out from the crowd?