Gartner Research

Healthcare Payer Administrative Systems Maturity Model

Published: 26 May 2016

ID: G00302699

Analyst(s): Constance Sjoquist


Healthcare payers need to modernize their administrative systems to manage the new and diverging interests of their stakeholders. They should use this maturity model to understand what investments in people and technology they will need to make to support impending industry transformation.

Table Of Contents


  • A View of the Healthcare Payer Administrative Systems Maturity Model
  • Payer Administrative Modernization Attributes
  • Innovation Triggers
  • Operational Intelligence
  • The Mature Payer Administrative System
  • Assessing the Payer Administrative System Maturity Model
  • Attributes of Effective Payer Administration
    • Level 1 — Aware
    • Level 2 — Enabled
    • Level 3 — Managed
    • Level 4 — Intelligent
  • Payer Administrative Systems Modernization Is Inevitable

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