Key Business Drivers and Competencies For Post-Reform Healthcare Transformation

The Situation

One simple word defines the business landscape for U.S. healthcare organizations: complex. With the passage of the Patient Protection and Affordable Care Act (PPACA), the world as healthcare companies have known it has changed forever. Dramatic changes lie ahead in the way healthcare is purchased; how members interact with their health plans; and what organizations must do to be compliant with new healthcare regulations.

Today, Healthcare Payers are facing four key business drivers:

  • Staggering volume and cost increases that will require cost-containment at every level.
  • A far more competitive, consumer-driven market that will require new strategies for attracting and retaining customers.
  • A hyper-speed business environment that demands immediate adaptation and response to new market opportunities, competitive salvos and changing regulations.
  • Significantly increased federal and state regulations that will impose stiff penalties for failure to comply.

The Solution

These factors will require aggressive new approaches to managing operations and new capabilities for channelling innovation. In this paper, we examine how four key business drivers will impact Payer operations and offer recommendations for technology to meet these challenges. With application of the right technology, Healthcare Payers can:

  • Intelligently automate processes to optimize operations and maximize cost efficiency.
  • Engage customers with personalized experiences that provide true differentiation and support the brand across every channel and interaction.
  • Gain the agility required to enable rapid innovation.
  • Automatically embed compliance into every business process.


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