Healthcare is an Industry of Change, Are You Prepared?

Many people have said that there has been more change now than ever before within the healthcare industry. However, if one reviews history, healthcare has been this way for decades. One thing we’ve counted on is that this is an industry of change. There are constant regulatory updates and new trends and advancements. Organizations must have the tools and resources to effectively manage the constantly evolving landscape from a technology perspective and a staffing perspective. Change is good and offers job security!

One of the most pressing healthcare security challenges that IT leaders face in this changing industry is how to keep information secure. In fact, in a recent survey of 245 healthcare IT executives, 43% of IT leaders say keeping information secure is their top challenge. There is a lot at stake for everyone across the company. Not only is there a risk of cybercriminals gaining access to sensitive information if there is a security breach, but an organization may also face hefty fines, and its board members could have personal liability. It takes ongoing training to help people at all levels of an organization understand the importance of remaining diligent.

The Importance of Addressing Healthcare Security Challenges

IT teams should always be looking for ways to continually improve security protocols and policies. Phishing attacks still account for a high volume of security incidents.

Regular phishing tests are a proven means of providing ongoing training to change behavior. Even poor results from phishing exercises provide awareness of where supplemental training may be necessary. Approaching training from the perspective of protecting not only company assets but also personal assets at home helps reinforce learning and change behavior, enabling employees to see a tangible personal benefit.

From a personnel perspective, there is significant competition for qualified candidates and employees, and security professionals are certainly in high demand. The loss of a key security expert can be devastating. Turnover can negatively affect a team, and recruitment and training each new hire can be costly. CIOs and other technology leaders must not lose sight of the importance of employee retention.

Even with the most sophisticated technology, no organization should bank on its security being impermeable. It is often stated – “it’s not a matter of if, it’s a matter of when.” There will be incidents, so it’s crucial to have the right protections in place and the ability to react, respond, and resolve quickly and effectively.

How Health Plans Capture New Business in a Competitive Landscape

outdated technology in healthcare | healthedge

Successful health plans are focused on expanding membership, increasing revenues, and controlling administrative costs. However, administration costs attributable to outdated technology and manual processes result in one of the highest sunken costs in healthcare.

Outdated Technology in Healthcare

Health plan operations, especially at smaller plans with limited resources, are pulled in a million directions. They are continually searching for ways to innovate and improve operational efficiency while reducing costs. However, as administrative expenses increase, tighter budgets become, and less money is available to reinvest in crucial differentiators and forward-thinking initiatives. Outdated technology in healthcare and siloed systems can adversely impact operational efficiency, create significant processing challenges, drain productivity, and ultimately impact the bottom line.

For example, Michigan-based McLaren Health Plan’s outdated 30-year-old technology was resulting in a zero percent claims auto-adjudication rate. McLaren’s legacy solution was clunky, hard to configure, not user-friendly, and not scalable.

As Mike Comick described in a blog post, “At some point in time, the amount of road remaining for ‘investment modernization’ of existing organizational structure, use of data/business intelligence, and legacy technology is depleted. Ultimately the risk of minimal maintenance, or worse, doing nothing, is by far greater than ‘taking the big transformational jump.’”

McLaren agreed, as its Vice President of Business Information and Operations, Sara Mavredes, said, “We wouldn’t be in business if we didn’t make a change.”

McLaren decided that it needed to implement new technology that would allow the business to work more efficiently and intelligently, and that would provide it with the margin to implement new strategic initiatives like customer service, care coordination, new lines of business, and other innovations.

McLaren implemented next-generation technology and gained flexibility, transparency, and performance, critical for its success.

Continue reading this case study to learn how HealthRules Payer® enabled McLaren to respond to industry changes, reduce costs, increase efficiency, gain an edge over the competition, and more.