Gartner Research

U.S. Healthcare Payer CIOs Optimize Government Program Enrollment and Reconciliation With Vendor Tools

Published: 01 August 2018

ID: G00363534

Analyst(s): Bryan Cole

Summary

Membership turnover and regulatory complexity are increasing in Medicare Advantage, Medicare Part D, managed Medicaid and ACA individual exchange. U.S. healthcare payer CIOs can optimize administration with a combination of vendors that facilitates member enrollment and file reconciliation.

Table Of Contents

Analysis

  • Enrollment and Reconciliation Tools Optimize Member Administration
  • Buy an Enrollment and Reconciliation Tool to Close Operational, Financial and Compliance Gaps
  • Critical Capabilities Are Common, So Focus Purchase Decisions on Ease of Use, Critical Workflows and Error Reporting
  • Make a Long-Term Selection Since Vendor Turnover Is Low
  • Choose Best-in-Class Vendors to Improve Financial Performance in Each Business Line

Gartner Recommended Reading

©2019 Gartner, Inc. and/or its affiliates. All rights reserved. Gartner is a registered trademark of Gartner, Inc. and its affiliates. This publication may not be reproduced or distributed in any form without Gartner’s prior written permission. It consists of the opinions of Gartner’s research organization, which should not be construed as statements of fact. While the information contained in this publication has been obtained from sources believed to be reliable, Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Although Gartner research may address legal and financial issues, Gartner does not provide legal or investment advice and its research should not be construed or used as such. Your access and use of this publication are governed by Gartner’s Usage Policy. Gartner prides itself on its reputation for independence and objectivity. Its research is produced independently by its research organization without input or influence from any third party. For further information, see Guiding Principles on Independence and Objectivity.

Already have a Gartner Account?

Become a client