Report against an expanding set of quality benchmarks. Maintain a credentialled, accurate, adequate provider network. Handle claims, grievances, and appeals within regulatory SLA requirements. And do all of this simultaneously, with administrative teams already stretched and clinical reviewers whose time is genuinely scarce.
The payer organisations that are navigating this tension most successfully are not the ones with the largest operations teams. They are the ones that have deployed intelligent automation in the right places — not to remove human judgement from decisions that require it, but to eliminate the administrative work that surrounds those decisions and obscures the time available for them.