Month: October 2021

“63 percent of executives report the pace of digital transformation for their organization is accelerating … Big changes today require bold leadership – and prioritizing tech.”– Accenture Research Global Survey 2021.

The healthcare industry is undergoing a period of digital transformation, forcing payers to prioritize their modernization efforts.

As a colleague at HealthEdge, Len Rosignoli, VP of Customer Success, recently noted in a blog post, an increasing number of health plans see value in using technology to meet their business strategies. “That’s why we’re seeing an increased focus on aligning IT and the business – the partnership has become even more essential,” he said.

But without a clear strategy, payers risk wasting time and money building or patching solutions that provide a quick fix for immediate needs, but cannot support the future of digital health.

Even worse, history indicates that when decision-makers insist on building or patching their own solutions, they are likely to underestimate the cost and timeline.

Research shows that among 1,471 information technology projects studied, the average cost overrun was 27 percent, a figure pushed higher by the one in six projects that spiraled completely out of control. The worst of these saw cost overruns of 200 percent and schedule delays of 70 percent. Researchers say IT has a disproportionate number of runaway projects.

There are other costs to consider. A firm developing a proprietary solution absorbs the entire cost of development, where vendor solutions can distribute development costs and innovations across multiple customers. Since a vendor solution has a much shorter and safer timeline, it offers greater cost predictability over time.

It’s easy to be caught up in your do-it-yourself (DIY) ambitions, but being realistic about costs and deadlines may lead you to choose the right vendor instead, avoiding Big Fail #3.

Check out the #4 Big Fail of DIY software in this space soon. Hint: It’s all about the perils of trusting newcomers to healthcare.

Portions of this blog post are excerpted from Ashish Kachru’s Forbes article “Why Execs Should Avoid The DIY Software Trap.” Ashish is President and General Manager of Altruista Health.

We’re two ears, one mouth when listening to customer issues. We are fortunate to work with a variety of health plans ranging from large nationals to small regional plans.

Reducing provider abrasion is top of mind for all plans, particularly for the regional health plans that require cooperation with the providers in their communities to survive.

GuidingCare has made a lot of improvements in provider satisfaction for our regional plans. A big complaint from providers is the time it takes to receive an authorization from a payer. Our prior authorization portal helped solve this issue. With most of our plans using this technology, more than half of the authorizations get auto-approved without human intervention. Providers spend less time waiting for answers with the prior authorization portal; they quickly receive the information they need.

One of our customers is a small regional plan in a state where national plans have a significant presence. Provider satisfaction is critical to ensure our customer can remain competitive. The regional plan came to us with ideas for how to improve the authorization portal. They wanted to bring together their organization, their local health system, and the GuidingCare team to create the best authorization portal in the industry.

As a technology vendor that values our customers, we knew it was an incredible opportunity to hear directly from the health plan and health system to find out what’s important to them then work together to see how our technology can meet their needs.

While this collaboration was not part of the scope of work or implementation plan, we were all in.

We spent three months with a tiger team and built an entirely new best-in-class product. We’ve sold six so far this year, and our customers are finding tremendous success.

For the customer who influenced this innovation, 80% of their authorizations come through the portal, and the majority are automatically approved. They have saved more than 5% of their overall care management budget.

These savings were made possible by listening to our customer’s feedback and innovative ideas, then working together to build them. Collaborating with our customers is a formula for success.

Social Determinants of Health (SDOH) have a significant impact on a person’s overall health. Payers and providers are coming to realize that they can manage risk with highly targeted intervention programs while reducing unnecessary care.

However, managing and predicting SDOH among members continues to be a top challenge among health plan leaders. Furthermore, in a recent survey of 3,000 consumers, when asked if a health insurance company, primary care physician, or a specialist directed them to a community resource to further support their care, 72% of consumers said no. Yet, for those who were referred to a service, 81% engaged with the treatment or resource once they knew it was available. Member engagement is key to addressing SDOH, but there is a communication breakdown.

Speed, efficiency, and access to real-time information are required for outreach to connect the right members, to the right treatment, at the right time. Users do not want to have to log into multiple different systems to gather the data they need.

Altruista Health is on a mission to help our customers positively impact members’ health by focusing on proven methods of increasing their engagement. Our open interface supports API-led connectivity and seamless integration with other tools and technology.

For example, we have analytics with the Chronic Illness and Disability Payment System (CDPS), a predictive risk model that analyzes diagnostic and pharmacy data to identify and group populations into more than 60 risk categories.

Our GuidingCare platform also integrates with Aunt Bertha and Healthify, the nation’s leading social services search- and- referral platforms that enable users to quickly access comprehensive, localized listings for hundreds of programs across the country.

Payers and providers are looking for technology solutions to make interacting and engaging with patients easier. Our goal is to make our solutions easy to use for everyone, no matter their experience level, so our customers can stay focused on their business and improving health outcomes for members.

At HealthEdge, we frequently hear from health plan executives struggling with homegrown legacy solutions that have become obsolete. Their users have developed a hodge-podge of manual workarounds to accommodate a growing set of deficiencies, right down to Excel spreadsheets and double-entering data into disparate systems. Add to that the complexity of the healthcare ecosystem today and you have a recipe for dysfunction.

Industry consolidation is a growing trend in the payer space today. The steady stream of mergers and acquisitions results in multiple systems, point solutions, and dissonant architectures jamming up the flow of information in many organizations. With legacy systems, outdated technology and latent data and delays, the quality of care suffers, backlogs pile up, and opportunities to support innovation evaporate.

As the Everest Group noted in a blog post, “The healthcare payer industry is plagued with notoriously old infrastructure. While healthcare payers are working to increase data transparency, offer member-centric solutions, and adopt a value-based care model, they’re obstructed by high reliance on dated, disconnected and non-interoperable systems.”

The disjointed systems and manual processes waste time, introduce manual errors into workflows and can eventually destabilize the software program. Staff and customers eventually bear the brunt of this.

Knowing when to put your legacy system out of its misery is a critical multiplier for success. That’s why letting it hang on too long is Big Fail #2.

Portions of this blog post are excerpted from Ashish Kachru’s Forbes article “Why Execs Should Avoid The DIY Software Trap.” 

Much of the GuidingCare product roadmap has been influenced by our customer’s experience.

We have something called ride alongs, where we go with our clients out into the workplace and see how they use our product. These visits have greatly influenced our product roadmap; we identified significant capabilities that we needed to implement by watching real people work in the real world.

One of those influences was our award-winning Mobile Clinician app.

Whenever you’re driving, and your phone loses connection to a mobile network, think about the people who live there. And there are a lot more places than people think, spanning from remote locations in Hawaii to the rural mountainous regions of the Southeast. We even did a ride-along with a customer in a part of the Navajo Nation in the middle of the desert with no service.

While out in these remote areas, if a clinician is visiting patients and can’t go online to access a web service like GuidingCare, they need the ability to work offline in order to best serve these patients. The Mobile Clinician app solves this challenge. The app allows field clinicians to visit with patients in their homes or communities and use on- or offline on mobile devices to perform care management functions. The offline capability is especially valuable in serving areas without dependable internet or cellular service, where populations need care and social support resources.

In addition to capturing demographic data, conducting health assessments, and making referrals to social services, among other things, clinicians can also build care and service plans in the Mobile Clinician app, which is another process that our ride-alongs helped us improve.

We wanted to reduce the number of clicks that it takes a clinician to build a care plan, so the technology did not get in the way of valuable face-to-face, human interactions with the patient during the visit. We made huge improvements, resulting in single-click care planning—now clinicians can finalize care plans without interruption.

I’ve been with Altruista for more than eight years and was drawn to the company’s mission of improving care through promoting member engagement and access to care. The Mobile Clinician app helps communities overcome barriers to accessing care and better health outcomes, regardless of location.