How Payers Can Thrive Through Automation and Innovation

Cheryl Gibson

How can the healthcare industry adapt and evolve to meet the demands of modern consumers? Political uncertainty, shifting regulations, and rising administrative costs have a tendency to reshape the market faster than most organizations can handle. And while growth is important, many organizations are simply trying to keep up. Add to this the recent legislation, the One Big Beautiful Act (OBBBA), which is being touted as one of the most significant pieces of legislation in years with tremendous implications for healthcare entities. For payers, these changes not only translate to immediate operational challenges, but opportunities to modernize. Payers that take this opportunity to modernize will benefit not only from increased efficiencies and lower administrative cost but will be able to take market share from their peers.

Automation and cost reduction have basically become a survival strategy to determine whether a payer can continue to operate effectively. Efficiency, agility, and member retention aren’t necessarily new ideas, but their importance is rapidly approaching a tipping point. Those who cling to legacy processes risk being left behind by competitors who are rethinking how they work.

What does that look like? In order to thrive, payers need to go beyond the basic, incremental improvements. Organizations need to focus on blending intelligent automation, smarter data use, and innovation across operations, member engagement, and care delivery.

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Strategic and Financial Resistance

It’s tough to predict the healthcare landscape and how to adjust accordingly. Federal and state policy shifts, inflationary pressures, and evolving care expectations are reshaping how payers operate. Recognizing these as inevitable obstacles will allow you to make changes that will ensure long-term success.

Many organizations find themselves caught between strategic resistance and financial constraints. Leaders recognize the need to modernize but often struggle to move beyond analysis to action. Establishing a dedicated team to monitor and interpret new legislative proposals can make all the difference. This team becomes the early-warning system that helps payers anticipate changes, plan proactively, and avoid costly disruptions.

When new regulations take effect, payers that can pivot their operations quickly gain an edge. Adjustments to member communications, benefit design, and compliance workflows can be handled more smoothly when supported by automation and configurable systems. Technology should be leveraged not only to execute these changes faster but also to track their downstream impact.

At the heart of it, resilience comes from agility. Payers that build adaptable operations and empower teams to respond rapidly to change are the ones most likely to thrive in this complex environment.

Related Article: 3 Phases to Better Payer Quoting

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Operational Efficiency and Cost Management

Rising administrative expenses and labor-intensive processes continue to strain payer margins. Many organizations are still relying on outdated systems and manual workflows that slow down operations and increase the risk of errors. To move forward, payers need to shift their focus toward automation, smarter data use, and deeper collaboration with their provider networks.

The goal is simple: reduce waste, improve accuracy, and free up resources for higher-value work. This starts with identifying manual processes that can be automated. Things like quoting and enrollment, to claims management and renewal tracking. Here are a few opportunities to consider:

Automation of repetitive tasks to eliminate bottlenecks and reduce human error
Advanced data analytics to uncover insights about cost drivers, utilization trends, and member behavior
Improved care coordination through closer collaboration with providers to address gaps in care
Real-time dashboards to track performance metrics and identify where costs can be reduced or care outcomes can be improved

When these capabilities come together, payers can gain a more holistic view of their operations. This helps them make faster, more informed decisions while keeping administrative costs in check.

Efficiency is all about creating the operational agility needed to respond to a market that changes by the day.

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Member Engagement and Retention

Winning new members can be an expensive and a time-consuming endeavor. Retaining existing members is far more sustainable. Yet many payers still struggle to deliver the kind of connected, intuitive experiences that foster loyalty. Members today expect the same level of personalization and convenience they get from retail or banking. The unfortunate truth is, when those expectations aren’t met, they’re quick to explore other options.

A stronger member strategy starts with understanding who your members are, what they value, and when they’re at risk of leaving. By using data and digital tools, payers can engage members proactively instead of reactively. Here’s how leading organizations are improving retention:

Personalized engagement: Identify members at risk of disenrollment and reach out with targeted campaigns that address their needs before they decide to leave.
Seamless digital experiences: Offer intuitive portals, mobile tools, and AI-powered support that make it easy for members to find answers, manage coverage, and access care.
Proactive health outcomes: Shift the focus from transactional interactions to long-term wellness by investing in preventive care programs and personalized health recommendations.
Continuous feedback loops: Use surveys, call center insights, and engagement metrics to refine programs and improve satisfaction over time.

By building trust and focusing on meaningful outcomes, payers can strengthen relationships that last. Retention is only possible when you have a focus on proving value to members in every interaction.

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Innovation and Diversification

Stability and innovation don’t have to be viewed as contrasting strategies. In fact, innovation is becoming the key to achieving stability. As member expectations evolve and healthcare models shift, payers that diversify their offerings and embrace digital health solutions will be best positioned to grow.

Many organizations are exploring ways to expand their value beyond traditional insurance coverage. This means investing in digital care delivery, new product lines, and partnerships that address members’ broader health and wellness needs. Some leading approaches include:

Digital health integration: Incorporate telehealth, virtual visits, and remote monitoring to expand access to care and improve convenience.
New product development: Design supplemental wellness programs, preventive care plans, or niche coverage for emerging market segments.
Data-driven personalization: Use predictive analytics to recommend products and services that match each member’s unique health profile.
Non-insurance diversification: Explore partnerships for nutrition, fitness, or mental health services that support holistic wellbeing.

Innovation in this space requires a diligent effort to find sustainable ways to deliver more value to members and strengthen the payer’s role in the broader healthcare ecosystem.

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The Path Forward

Now that you understand the strategy, payers need to implement modern technology and ensure an organization-wide commitment to change. The path forward lies in unifying people, processes, and platforms around the same goals. As we discussed in this article, those can include things like operational efficiency, member satisfaction, and sustainable growth.

Salesforce offers the foundation payers need to build this future. With its powerful data capabilities, automation tools, and industry-specific solutions, payers can streamline workflows, improve decision-making, and gain real-time visibility into business performance.

TELUS Digital helps organizations turn that potential into measurable results. By combining Salesforce expertise with deep industry insight, TELUS Digital enables payers to:

Modernize core operations through automation and analytics
Enhance member experiences with unified data and personalized engagement
Adapt quickly to shifting regulatory, financial, and competitive pressures
Build scalability and resilience into every layer of their business

Transformation doesn’t happen overnight, but with the right foundation and a trusted partner, change becomes a tangible reality.

Partner with TELUS Digital to reimagine your payer operations and build the automation, agility, and innovation needed to thrive in a changing healthcare landscape.

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