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Health care payers face many challenges that are shaping strategic priorities — from cost containment to IT spending to member engagement. They have experienced higher than expected medical costs over the last two years, driven by rising demand for health care services that were deferred during the COVID-19 pandemic. Commercial payers see their business model affected as an increasing number of employers move to a self-funded model. Meanwhile, increased health care utilization has been a double whammy for Medicare payers, as the Center for Medicare and Medicaid Services (CMS) announced a lower rate increase compared to prior years (~3% in 2024 vs. ~5% in the prior three years). Likewise, Managed Medicaid plans face about a 15 million drop in member enrollment with the end of the redetermination waiver period.

At the same time, payer business models are being disrupted by provider incumbents that are taking on risk and typical payer health care. Combined, these macroeconomic forces and industry trends are putting pressures on payer margins, forcing them to reevaluate their cost models and growth options.

With these trends in mind, EY-Parthenon professionals and KLAS Research interviewed and surveyed executives across a diverse mix of payer types, sizes and line of business (LoB) coverage to understand their overall strategic priorities, the impact on spend for HCIT variety of players in the health care ecosystem.

• Investors: What are the key trends in payer HCIT? Which areas are ripe for increased investment? What are key investment considerations in the payer tech and tech-enabled services market?
• HCIT vendors: What do payers want from their HCIT vendors? How do payers make decisions? What could be potential solutions to cross-sell (or not)?
• Payers: How are your competitors dealing with market forces? Where are your competitors making investments? How can you up your HCIT game?

† Roche navify POC Operations is formally registered today in most countries as Roche cobas infinity POC solution and will be rebranded to Roche navify POC Operations.

† Roche navify Lab Operations is formally registered today in most countries as Roche cobas infinity lab and will be rebranded to Roche navify Lab Operations.

Note: Research in this report is based on feedback from interviewed payer customers. This report is not intended to compare measured vendors’ technological capabilities.

Note: In this market, vendors that serve only certain types of health plans are designated as component solutions and marked with a [C]. For a complete view of all vendors and their target clients, please see Vendors at a Glance.

The number of shared smart devices (i.e., smartphones and tablets) in use at hospitals has risen dramatically. These devices are small and difficult to manage without strict internal processes. Challenges can include fleet setup, ongoing maintenance, establishing robust yet easy-to-use authentication protocols, infection control, location tracking, and the potential for PHI loss or cybersecurity threats.

A recently announced partnership between Imprivata and Zebra Technologies is intended to help address some of these challenges, integrating Imprivata’s GroundControl solution with Zebra’s fleet of shared smart devices. No healthcare organizations have yet adopted the integrated pairing, but KLAS has historically gathered data on the solutions separately, offering a glimpse of the potential benefits and hurdles.

Innovative partnerships between payers, healthcare organizations, and HIT vendors have the potential to revolutionize healthcare processes and outcomes. KLAS’ annual Points of Light awards celebrate success stories—or “points of light”—achieved by payers, healthcare organizations, and vendors who have partnered to reduce costs and inefficiencies and improve the patient experience.

In total, 25 such collaborations were awarded a 2023 Points of Light award, and their strategies and outcomes are shared in this report to illustrate the art of the possible. It is our aim to help payers, healthcare organizations, and vendors collaborate more effectively to resolve some of healthcare’s biggest points of friction. This report’s Executive Overview provides a high-level summary of the types of challenges these collaborations tackled and the outcomes they achieved; the full report provides an in-depth case study of each collaboration.