A new survey finds when it comes to complying with health care reform, meeting medical loss ratio requirements, acquiring and retaining the best risk, establishing cost-effective distribution channels and working with exchanges are U.S. payers' top priorities.

HealthPlan Services, which provides outsourcing solutions to insurers in the individual, small business, association and union trust markets, did an online survey of operational executives representing 26 health plans with a commercial product line and at least 50,000 members enrolled in individual/small group products.

The survey found unanimous agreement about what the top three priorities are for U.S. payers, but sponsors of the survey say they were surprised at how these priorities ranked: Ninety-two percent of all respondents identified compliant risk acquisition and retention as being among their top three priorities, while 58 percent identified both the MLR mandate and cost effective distribution. Another 54 percent gave one of their top three spots to working with exchanges.