Health Plan Finances: Rising Costs and Emerging Solutions for Payers

America is facing a reckoning of sorts when it comes to healthcare costs. And while most people understand that healthcare is quickly becoming too costly for many patients, most don’t realize that payers are feeling the squeeze, too.

What’s driving operating losses? There’s no single factor, although general inflation and rising healthcare costs certainly play a role. 

In addition to rising costs and operating expenses, Americans are increasingly grappling with escalating health challenges. The U.S. has the largest disparity between life expectancy and healthy life expectancy (the portion of life unburdened by disease or disability) of any World Health Organization WHO country.

Health insurers also note that the cost of treating people on government health insurance programs like Medicare and Medicaid continues to rise. None of these issues can be solved overnight.

What’s the Solution?

To cut back on spending and return to healthier profit margins, payers need to take a close look at everyday processes and cut back on spending without reducing the quality of service they offer. That might sound like a tall order, but the rise of AI and automation has made doing so faster and more cost-effective than ever.

One process that is particularly worthy of scrutiny is that of prior authorization. While it can reduce costs for insurers (at least when it comes to money actually spent on medical treatments), prior authorization comes with high administrative costs.

That’s where Itiliti Health comes in. We’ve created a fast, simple, touchless solution for prior authorizations that reduces patient and physician frustration while reducing errors and slowdowns. Here’s how our technology does it:

• The streamlined system reduces provider call volume to payer call centers
• We track each step of the process, so you’ll have a clear audit trail
• Because our system reduces unnecessary prior authorization requests, you’ll realize near-immediate ROI
• We create transparency into decisioning for providers and patients, leading to increased trust and decreased angst towards insurers

This is only a brief overview. If you’re interested in learning more, get in touch with us to schedule a demo.

Looking to Improve Your Margins in 2025?

The sooner you start tightening your company’s finances, the better. At Itiliti Health, we offer a variety of solutions to improve the health of your company so you can support your customers’ health. Get in touch with us today to book a demo or ask questions.