Month: March 2022

Over the last 3 years, I’ve helped new HealthEdge clients implement our software. During that time, I’ve learned countless tips and tricks to improve the implementation experience.

There’s the technical software implementation, but today we’ll be looking at the people side of implementation. The team members who will be sunsetting the old software, implementing the new software, and linking it into the ecosystem.

These are my top 3 tips for a smoother software implementation:

1. Create a shared vision of the future

Even with the best possible outcome – change is hard. The people on your team are grappling with all the balls they’re currently juggling plus trying to learn this new system and get it plugged into your ecosystem. It’s natural to resist change and cling to the status quo.

The key is to create a vision of the future that’s so exciting and engaging your team can’t help but get pulled into the possibility of this amazing future state. Make the vision so compelling your team can’t help but be intrigued by the new software – even with the imminent growing pains.

For example, a health plan that implemented our product Source, achieved an amazing ROI after implementation:

• Decrease of 800,000 erroneous claims per year for an estimated savings of $4M/year
• Automated claims process saving approximately $6-12 per claim
• Reduced IT overhead, saving $350-500K annually

By getting your team excited about the possibilities and demonstrating how amazing the future can be AFTER the change, you get them engaged at the onset of the implementation.

2. Begin with the end in mind: workflow & operating procedures

It’s so easy to take a new piece of software and try to adapt it to the old way of doing things. This leads to recreating old systems, riddled with workarounds, and partial functionality. It’s a surefire way to get your team feeling frustrated and disappointed with the new software.

One of the things we focus on in HealthEdge’s Education Services is analyzing business scenarios. And then, we optimize workflow and operating procedures for those scenarios.

Encourage blank space, white board thinking – how can we leverage this innovative technology to optimize and enhance our way of work?

3. Customize training and onboarding

Each of our customers has a different business need for their implementation, and their team members have different roles and responsibilities. Custom instruction that is tailored to your needs is vital to engaging your team because each person who will be interacting with the new software wants to know, What’s in it for me? What do I need to know to be able to do my job well in this new environment? We don’t want to bore experienced analysts or overwhelm team members with less experience.

Unsurprisingly, the confidence gap is a huge barrier to software acceptance. Providing customized training and onboarding helps employees feel confident using the new software. There’s a direct correlation between new software training and new software optimization and acceptance.

HealthEdge Education Services

HealthEdge has a team dedicated to education and implementation success. I’m proud to be a part of our Education Services and help our new customers successfully implement our suite of products. Learn more about our Implementation Services here.

To remain competitive in today’s rapidly changing healthcare market, health plans need a modern solution that can easily integrate across their enterprise to infuse more accurate and timely data into every corner of their organization. There is no better place to expose the implications of bad data than claims payment administration process. This article drills deep into the importance of having consistent, accurate, and transparent data.

The Current State of Data Among Health Plans

Health plan leaders must challenge the inefficient status quo that comes with legacy claims processing systems and invest in modern technology that enables data consistency, accuracy, and transparency, which will result in greater operational efficiencies and more informed business decisions.

Today, bad data is estimated to cost the healthcare industry $314B annually and negatively impact an organization’s revenue by 10-25%. The case for more accurate data has never been stronger, given the rapidly changing dynamics of the Medicaid system and the reality of the waste:

• 5.8% expected annual Medicaid enrollment growth
• 9.5% claims payment error rate
• $25B approximate annual MCO Medicaid spend on admissions functions
• $36B improper Medicaid payments in 2019

Good Data Means Good Business

The implications of having good data flowing into and out of your organization’s systems has implications across the entire business. In particular, the claims payment processing team depends on good data for its daily functions, such as claims edits, audits, pricers, analytics, and even contract terms and negotiations.

In addition to the efficiency gains, good data also drives more informed decisions, because data is the foundation on which business assumptions and decisions are made. Provider relationships improve due to the reduction in payment recovery activities. Plus, when it comes time to respond to a CMS audit, having good data means the difference between dedicating valuable resources for days on end vs. having a few resources respond quickly and confidently to address the requests.

When good data is driving the business, health plans are able to:

• Lower operating costs: Payers reduce FTE time dedicated to overpayment recovery and redirect the resources to more productive analysis.
• Decrease operating risks: Automating claims processing reduces the chance for human error that can occur when using spreadsheets or manually updating data when using disparate systems.
• Improve provider relationships: Increased transparency and fewer overpayment recoveries will help ease provider abrasion, and the partners will recognize clerical time reduction in deadline with payment issues.

A Fresh Approach to Good Data

To achieve long-term goals of consistent, accurate, and transparent payments, successful organizations have focused on:

• SaaS technologies
• Integrated ecosystems
• Centralized data

As a SaaS-based solution, Source is empowering healthcare payers who have Medicare, Medicaid, and commercial lines of business to leverage a single, unified platform that natively brings together up-to-date regulatory data, claims pricing and editing, and real-time analytics tools. These payers have a single source of truth and a single point of accountability.

More specifically, Source’s transformational approach to payment integrity allows payers to deliver accurate, defensible payments to providers in a single pass with precise audit trails and business intelligence tools that help payers model and forecast scenarios with total confidence.

But it doesn’t stop there. Source works seamlessly with a wide range of data and solution providers, including its sister solutions: HealthRules® Payer core administration system and GuidingCare® care management solution, to leverage the power of more accurate data.

The Business Case for Good Data

When evaluating the return on an investment of a recent Source-powered health plan, the results are undeniable:

Financial Impact:

• Decrease of 800,000 erroneous claims per year for an estimated savings of $4M/year
• Automated claims process saves approximately $6-12 per claim
• Reduced IT overhead, saving $350-500K annually

Customer Service Impact:

• Higher regulatory compliance and consistency
• CMS audit support
• Increased transparency on payment results
• Actionable data for improved business intelligence

Learn more about good data

Check out our latest white paper that discusses the complexities of healthcare data and how bad data can lead to inaccuracies and waste. Using technology solutions to address this issue, payers can harness data as a strategic asset and create positive change across their organization and for providers and members. Read now.

Sources:

1 https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2017-2026-projections-national-health-expenditures

2 National Health Expenditure projections, 2017-26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth; Centers for Medicare & Medicaid Services, Office of Actuary, National Health Statistics Group

3 https://www.forbes.com/sites/adamandrzejewski/2019/03/23/federal-agencies-admit-to-1-2-trillion-in-improper-payments-since-2004/?sh=64484646352a

4 https://www.forbes.com/sites/adamandrzejewski/2019/03/23/federal-agencies-admit-to-1-2-trillion-in-improper-payments-since-2004/?sh=64484646352a

The non-profit organization CAQH® has been issuing a steady drumbeat of reports over the years about how much money and time could be saved across the healthcare industry by switching transactions from paper-based to electronic. It’s fascinating to see the progress over the years as the industry transitions, yet despite obvious savings, many think progress is still much too slow. The 2021 CAQH Index is just out in early 2022, reporting that important shifts have taken place in healthcare administrative operations during the pandemic. These are hopeful indicators.

Prior authorization is an area that changed dramatically during the pandemic, as the requirements were mostly suspended or waived during the urgency of providing care to jampacked healthcare facilities. The volume of elective procedures also decreased as consumers shied away, lowering the rate of prior authorizations by 23 percent. Automation of prior authorizations in general also lowered the time providers spend on this process. Overall automation of prior authorizations has increased from 21 to 26 percent, lowering the cost to the system by 11 percent to $686 million.

Prior authorizations help providers and health plan members stay within the rules and criteria governing their plans. They ensure that providers operate within the most up-to-date and respected clinical decision-making criteria. But they do create payer-provider friction that can ultimately filter down to health plan members in some form.

Last year, the GuidingCare business unit of HealthEdge worked with a valued customer, Priority Health, to develop an automated prior authorization process under a unique set of circumstances. Priority is part of the Spectrum Health System, which means that the GuidingCare® implementation team was able to solicit the direct and specific input of Spectrum physicians as to what would be most helpful in a portal for prior authorization. The teams worked together to create a provider-friendly solution that dramatically reduced the time spent on prior authorizations. The portal allows providers to receive authorizations in a matter of moments, allowing more complex requests to be routed quickly for review of medical necessity. One-click messaging offers document and image upload on both ends. With 80 percent of requests being approved at some point, valuable data is being generated about which prior authorizations could be eliminated altogether.

The power of automation and data are changing the landscape. Payers and providers both need to jump on board and help CAQH turn out an even more encouraging reports in the future.

Learn more about GuidingCare here.

We all know at this point we are experiencing a never-before-seen shift in what employees expect from their employers. These changing expectations are especially true for managers. Belonging and connectedness with other people, primarily one’s manager, is one of  the most accurate predictors of whether someone stays or decides to leave. You expect them to do their absolute best for you, are you giving them your absolute best?

This is not a “how-to” article or a list of the “top ten things” to make you a better leader. This is a call to action to shift how you think and approach managing your team from a lens of humility. Great leaders are humble. But being humble doesn’t mean you are weak. It means you are willing to admit that you still have things you can learn, it means you can ask for feedback from your team, and it means you never want to stop growing and raising the bar for yourself and ultimately for your team.

It has been proven time and again that top performers do not leave organizations as much as they leave…. poor managers! A top performer who reports to a strong and encouraging leader that brings out the best in them will NOT want to leave. Are you that leader? If so then I encourage you to keep reading as I do have some strategies that can help you retain your best people.

400% Better: The secret of high performers

Author, researcher, and coach Dr. Ruth Gotian says “high performers perform 400% more than the average employee.” Let that sink in. This means the employees you rated as “Exceeds” on their performance review are doing 4x as much work as their colleagues who were rated “Meeting Expectations”.  We owe it to them to show up as our best selves and provide the very best employee experience.

Be the example of what you expect. Every day you have an opportunity to show up as the leader with a smile on your face and make sure that you give everyone the same feeling of importance. Create an environment where people feel heard and can contribute.

Motivation & Feedback

Managers often spend time focusing on their underperformers thinking it’s their job to help motivate them to do better. Do not ignore your top performers and think that their level of self-motivation and commitment to excellence is enough and they do not need you. They do! Make it a priority to give them clear and candid feedback about how they are doing and how they can improve.

Purpose & Meaning

Give them a sense of purpose in the work they do. Show them they are important by challenging them, asking more of them, giving them stretch assignments and projects that have clear visibility to higher-ups and key-decision makers.

Make sure your best people feel valued and appreciated by providing timely and meaningful recognition. This is not just about money, which is very important, but often secondary to that sense of pride when you, as their manager, recognize them for great work. This can be as simple as a thank you, an acknowledgment during a team meeting, a call-out on Slack, or special assignments. It’s very important that you understand how someone wants to be recognized as this shows you care about what is important to them.

Autonomy & Flexibility

Workplace flexibility is essential in organizations today and that does not just mean working from home. Where possible, give autonomy when it comes to work schedules, time off, taking breaks, and caregiving leave. Our home lives and work lives are intertwined and finding that balance is necessary for both employers and employees.

Communication

We think we are good communicators but in fact we have a lot of work to do in this area. Working in a remote environment has made the mastering of great communication skills imperative to organizational success.  A recent Harris poll found that 69% of managers are uncomfortable communicating with employees and 37% are uncomfortable giving direct and constructive employee performance feedback. What kind of communicator are you? Don’t know? Ask your team.

Leading people, leading teams is a privilege

If all of this feels like work to you, it is but leading others is a privilege, and you have this incredible opportunity to change someone’s life every single day. It’s time to start showing up like it matters to you. Invest in your development, create a team environment where people feel heard, invest in your employee’s development, take the job of being a leader seriously. We need you!

 

Sources:

Resource: Coaching for Leaders with Dave Stachowiak podcast, How to Lead and Retain High Performers, February 13, 2022

Alan Collins, Success in HR, https://successinhr.com/newhrleader

Blog: Good Managers are Great Communicators