The importance of accurate member identity in the performance of payer organizations

George A. Gellert, Mark E. Erwich, Sara Krivicky-Herdman


Objective: To describe perceptions among healthcare payers of the importance of and challenges in ensuring accurate member identity in payer organizational operational performance.
Methods: A survey of 35 US healthcare payer executives evaluated perceptions of the importance of accurate member identity to efficient operations and achieving payer strategic priorities, improved financial performance and member satisfaction, and the associated challenges.
Results: Healthcare payers were highly aware that accuracy of member identity is essential to operational effectiveness and efficiency (90.0%). Leading organizational challenges were managing high risk members (43.3%) and effective member engagement (40.0%), both impacted by member misidentification. A majority (73.3%) indicated that current system capabilities do not enable the capture and sharing of accurate, complete member identity, with 43.0% stating it was extremely/somewhat difficult to add member data sources and remove member record duplicates. Only 10.0% were moderately or highly satisfied with the accuracy of their existing member identity management solutions.
Conclusions: Inability to know “who is who” is perceived by payer organizations as impeding financial performance and growth, operational efficiency, and member engagement/satisfaction. While recognizing that member identity impacts nearly every aspect of payer operations, most payer executives lacked confidence in their organization’s ability and deployed technology to achieve a complete and accurate 360-degree view of members.

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Journal of Hospital Administration

ISSN 1927-6990(Print)   ISSN 1927-7008(Online)

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