Month: September 2022

Leveraging his experiences as the Chief Information Officer at VillageCare, Stuart Myer discusses successfully attaining executive board buy-in for long-term technology investments.

Issues Technology Partnerships Solve for Safety Net Health Plans

Safety Net health plans face a unique set of challenges in comparison with other payers. These include an acute focus on community health and social determinants of health, an increased demand for complex care and more fragmented workflows.

Safety net health plans have been addressing these challenges while also seeking regulatory compliance, adapting their business models to align with patient demand for improved consumer experiences, and dealing with workforce shortages and the rising cost of labor.

One of the most effective ways to manage costs while comprehensively tackling these issues is through technology investment. By working with IT vendors offering interoperability and the sharing of real-time data among stakeholders, health plans can maintain ownership of their data while:

• Gathering reliable and accurate community health and social determinants of health data
• Fostering business transparency with all stakeholders including patients
• Developing and sharing complex care plans with all stakeholders and manage claims
• Creating digital experiences for patients to interact with and understand their healthcare

In the long run, such technology partnerships are some of the most impactful investments for health plans that intersects both cost and quality of care.

Barriers to Technology Implementation

Executives are highly concerned with cost savings. In fact, according to a 2022 survey of executive health plan leadership, the most pressing issue this year is managing costs.

Thus, it’s no wonder that despite the considerable benefits, upfront technology investment stands as a potential impediment to implementation.

Considering this, how can professionals approach their executive boards as well as internal teams to get buy-in on this important investment?

Tips For Successfully Obtaining Buy-In For New Technology Partnerships

Gain Leadership & Board Buy-In

Executive leaders championing new technology investment is a key driver toward organizational engagement and widespread buy-in.

The arguments for technology partnerships should be so compelling that the partnerships are not just approved for IT to carry out, but that the executive board co-leads the initiatives with IT and other departments.

The c-suite is concerned with every aspect of business and therefore has a finite bandwidth for championing initiatives. How do you make a technology partnership stand out?

Your technology investment cannot be presented as an IT project only. It must drive business strategy and align with blue chip items for the year. For instance, health plans may have long term goals related to risk mitigation and regulatory compliance. By explaining in as much detail as possible how this technology investment will deliver ROI on those goals, you’re more likely to get buy-in. If you’re having difficulty quantifying ROI, vendors often will work with health plans to develop reliable forecasts.

Myer suggests establishing a strong link between technology investment and organizational priorities. This ensures the project gets the attention and resources necessary. Health plan leaders can review their K10 or other strategic documents. Use short and long-term goals to create KPIs for deployment.

Continued support by the executive board is needed. There should be annual updates on progress to the c-suite. This investment should also be included as a component in the annual budget.

Identify Opportunities to Introduce Technology Partners

It takes time and effort to find the right technology partners. Consider how each vendor could grow with your company and the customization available in their solutions. Carefully review RFPs and connect directly to vendors through video calls and meetings. Make sure your vendor understands the unique challenges and opportunities of your health plan. What can they do to help your health plan meet these challenges?

Make sure technology vendors are:

• Cloud-based
• Have automated updates
• Allow for your firm to own your own data
• Offer raw data downloads to easily integrate into your platforms

3 Steps To Maintain Internal Momentum for New Technology Partnerships

1. Plan Strategy & Digital Transformation Initiatives

Health plans cannot fully implement new software to their tech stacks right away. Instead, technologies need to be integrated in phases. Myer suggests creating a detailed plan for when each integration will be deployed.

Start with the integrations most important and easiest to implement. Work your way down to more time-consuming and less impactful deployments.

For VillageCare, Myer prioritized data strategy first, as it was one of the largest pain points for the organization. For any given report, whether clinical or business related, there were multiple sources of information and large variations between statistics. This led to immense costs for VillageCare, in both resources and time, to validate data and discern which source was the most accurate for a given metric.  By leveraging GuidingCare®, Myer was able to consolidate reports and make decisions based on more reliable data.

Myer also recommends deploying cloud-based solutions within the first few months of launch. This allows health plans to take a foundational approach and put data warehouse capabilities at the forefront of technology investments.

2. Establish Governance

When deploying a new technology, it is important to develop a structured and formalized process for IT investments at an organizational level. Part of this process should be ensuring there is strong governance overseeing the implementation project.

One of the most important factors in VillageCare’s success creating patient-facing data portals was Myer’s creation of a governing board of members. These members provide feedback on projects and influenced VillageCare initiatives.

With member feedback, VillageCare captures and documents key needs and challenges of their population before and while developing member tools. This provides assurance that their investments will be received well by patients and minimizes troubleshooting post-deployment.

In addition to member governance, having an internal technology implementation team led by various department stakeholders, ensures the alignment of the investment with strategic initiatives and the company’s budget process.

To create an internal business governance, leadership teams and executive boards must first buy into the project.

3. Define Time Frame

It’s important to be patient with technology deployments. Estimate 2-5 years with key milestones before a strong ROI and organization-wide buy-in is seen.

For example, at VillageCare, Myer is in his 3rd year deploying GuidingCare. The past few months data strategy has taken off and is now part of the overall culture of the organization.

“It stopped being an IT thing and became an organizational mission” says Myer, “It is now embedded in our employee handbook. We offer a minimum level of training for staff and optional higher levels of training regardless of job function.”

To learn more about organizational buy-in for technology initiatives and VillageCare, view HealthEdge’s ACAP webinar If you’d like to learn more about GuidingCare and its capabilities find out more here.

In 2022, HealthEdge once again commissioned an independent survey of health insurance executives to capture and monitor perspectives regarding current challenges and priorities. There were over 300 responses received – from Directors and above in a variety of types and sizes of health plans.

We’d like to focus on one of the reported Top Challenges Facing Health Plan Executives – operational efficiencies.  The challenge of operational efficiencies came in second place and jumped 33% from 2021 to 2022, from 31% to 41% of respondents. To satisfy your curiosity, ‘managing costs’ came in first place, and ‘member satisfaction’ third in the 2022 study. In 2021, operational efficiencies ranked sixth. Member satisfaction and managing costs tied for third in 2021 behind ‘competitive pressure’ and ‘IT/business alignment’ (fourth and fifth in 2022, respectively).

When we began discussing and evaluating this internally, the comment came up about the pent-up demand for care as some consumers stopped seeking care during the COVID years of 2020 and 2021. It’s a complex dynamic, as the varying impact on payers and providers differ and could also be positive or negative.  Capitated health plan members seeking less care might be good for the provider financially, albeit temporarily. The influx of care may also have a positive or negative impact for payors and providers.  The increase in unemployment caused an increase in uncompensated care – but also an increase in Medicaid membership. It is anything but simple and there are many factors to consider – type of health plan, type of patient, type of reimbursement, conditions, diagnoses, contracts, etc.

Managing costs and operational efficiencies go hand-in-hand, so it makes sense that they both increased significantly in the responses for top challenges.  With the “great resignation”, the need to become more efficient is at play in all types of organizations – and is directly related to operational efficiency.

We’d like to focus on three potential areas to consider related to operational efficiency – auto-adjudication and first pass rate, digital transformation and return on investment (ROI), and staffing.

Auto-adjudication and first pass rate

Most health plans continue to focus on improvements to auto adjudication rate, a key indicator for improving operational efficiency. The obvious benefit here is the assumption that fewer claims will be touched by a human. However, first pass rate is often overlooked or not measured, and is equally, if not more important. For those that are unclear on the difference – the auto-adjudication rate is most often measured by simply calculating the percentage of claims successfully processed without manual intervention. Without more complex calculations, what is sometimes overlooked are claims that had previously suspended – maybe even more than once – and are now processed a subsequent time successfully – then counted as having auto-adjudicated, skewing the results.  Some of those claims were actually touched by a human, sometimes more than once.  First pass rate calculates those claims that were never suspended and successfully processed the first time. However, both measures help with evaluating operational efficiency.

Digital transformation and return on investment (ROI)

The buzz words “digital transformation” have been top of mind for the last several years, and remain a priority for improving operational efficiency.  What IS digital transformation? Each organization must carefully define what this means internally, but in general, it is increasing and improving the efficient use of technology. There is a cost to increasing the use of technology. There is certainly a ROI to come, and it’s critical to not only anticipate the ROI, but to continue to measure it.  The measurement can help to justify future improvements to and investments in technology once ROI calculation and measurement becomes routine and is demonstrated. The simple fact is that money must be spent to eventually save money – just like how converting a home to solar power includes a significant initial investment that pays off over time.

Software vendors are being asked more than ever to justify the cost of technology and demonstrate (in advance) the ROI. In some cases, ROI and/or performance guarantees are being built into software licensing agreements. The software industry should be positioned to explain and develop the ability to measure and commit to stated ROI for purchasers of their technology solutions.

Staffing

Operational efficiency related to staffing also increased in importance as most organizations are now trying to do more with fewer resources. Health plans are trying to become more efficient through higher automation of manual processes where applicable – and somehow enabling a corresponding increase in human efficiency. The so-called great resignation has health plans understaffed and has increased the urgency of this shift. Some did not anticipate the increase in staff productivity while working remotely.  While this is not true 100% of the time and not for 100% of employees, it has been true more often than not. Interestingly, in many cases, working remotely improved work/life balance – and consequently improved productivity.  This turned out to be operationally efficient.

Recruitment and retention are more critical than ever. Alternate staffing methods have become important to defend against this phenomenon. This includes some tried and true options such as 9/80 or 4/40 work schedules, part-time and shift work, full- or part-time remote work, additional paid holidays and/or time off, and other common staffing solutions. In addition, internship programs are increasing, as is the untapped value of the intern.  While many internship programs were and remain focused on the summer, many programs are now year-round. Many colleges and universities offer cooperative education (or co-op) programs – where paid full- or part-time jobs are taken for credit during what would be the typical school term (or longer). Internships are being made available to others, including recent graduates or master’s program graduates.

While the need for operational efficiency may increase or decrease in any given year, it is a continual challenge that can be achieved in many ways. We hope we’ve offered just a glimpse into a few potential contributors.

Read the full report here: Annual Market Survey Reveals What 300+ Health Plan Leaders are Thinking