How health care payers are focusing IT spending as costs rise

Demographics

• The analyses and findings shared in this report are based on 102 clean and complete responses to the survey from relevant respondents. A clean and complete response is one where the respondent has taken then time to go through the survey and provide thoughtful responses. We screen out any response suspected of straightlining (i.e., selecting the same response option for each question) or those completed significantly under the anticipated time required to complete the survey.

• The survey includes responses from multiple payer entities (national, Blue Cross Blue Shield (BCBS), non-BCBS regional, third-party administrator (TPA) and management services organizations (MSOs), etc.) servicing commercial (self-insured and fully insured), Medicare and Medicaid lines of business. Approximately 70% of the responses came from traditional payers (national, BCBS, non-BCBS regional), while the rest consisted of provider sponsored, new age, and TPA and MSOs.

• Payers were segmented by the primary LoB served (40% or higher of total covered lives), as well as by the size of the total covered lives, as follows:

• Jumbo: 10.0m+ covered lives 

• Large: 3.0m–9.9m covered lives 

• Medium: 500,000–2.9m covered lives 

• Small: <500,000 covered lives

• Respondents included were either the primary decision-maker or played a significant role in the decision-making process for HCIT vendors at their organization.

• Title of respondents surveyed: C-suite (CEO, CFO, etc.), president, executive or senior vice president, director

Methodology

• The survey consisted of ~60 questions on a range of topics pertaining to HCIT investment themes and objectives, both historically and within the near term. Respondents were also asked to reflect on their experience using and evaluating specific HCIT solutions to explore HCIT investments at a micro level.

• The target audience was provided screener questions to identify those who had relevant experience and involvement in selecting

HCIT solutions within their payer organization

• The survey was web based and was fielded over the course of 1.5 weeks. Responses were then recorded and segmented to pull insights from across the payer size, plan type and LoBs primarily served.

Supporting research

• Survey findings were complemented by primary research from KLAS, which conducted outreach phone calls with 22 decision-makers from payers of all sizes and various types (national, regional, BCBS, Accountable Care Organizations (ACOs), provider sponsored) across the US to further understand the rationale behind payers’ HCIT investments and strategies.