Author: Len Rosignoli

A recent survey of more than 220 health plan executives—conducted by HealthEdge in partnership with independent market research firm Upwave—revealed that lack of alignment between IT and the business is a top challenge facing their organizations today. This is a notable shift from our 2018 executive survey where lack of alignment between IT and the business ranked at the bottom (21.9%).

Health plans are starting to see that they are technology organizations at their core, so there has been an increased interest in recent years to take advantage of technology to meet the business strategies. That’s why we’re seeing an increased focus on aligning IT and the business because the partnership has become even more essential.

In my opinion, IT and business have always needed to be in alignment. The most successful IT professionals have a natural desire to learn and understand the business.  Sometimes, IT professionals resist or do not prioritize learning about the business. Still, throughout the years, the most successful technology professionals and leaders have been those that have the interest in and take the time to understand and become part of the businesses they support.

When asked what steps health plan executives plan to take to achieve their organizational goals, 50.2% of payer executives said make a significant investment in innovation―a substantial increase from 2018 when only 19.2% of executives said they plan to invest in innovation.

Investing in innovation is gaining traction, but organizations must first determine how they define innovation to ensure a worthwhile investment. Innovation can be achieved by launching new and differentiating products and services, or new technologies, or ideally both in partnership.

It’s also essential to have a strategic plan that includes innovation. IT must have a corresponding strategic plan that aligns with the business. Some organizations find strategic plan development too burdensome, or, once developed, they are forgotten and collect dust ‘on the shelf’.  Gartner’s one-page strategy concept starts with telling one of three stories: a stakeholder story, a product story, or a process story and committing that strategy to paper. By keeping the strategy to one-page that includes a clear vision, metrics and initiatives, organizations remove complexity and deliver value, and enable the strategy to adjust more freely as business needs dictate.  Aligning IT and business strategies will enable payers to build the right teams and allocate the right resources for innovation.

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.

Technology, especially next-generation technology, plays a massive role in allowing health plans to embrace change, innovate, and remain competitive. However, when it comes to significant technology purchases, in most instances, the decision-making authority does not reside with one person. Major decisions involve a group of key players —c-suite, technology leaders, board members, and more—who, at some point in time, are instrumental in a comprehensive, enterprise-wide investment.

I recently moderated a webinar featuring HealthEdge customers Independent Health and NeuGen.  John Church, VP and CIO of NeuGen, provided some advice for those thinking about moving to a new core administrative processing solutions (CAPS). “When you evaluate a new CAPS, it’s taking what technology best fits your lines of business, your business model, and how quickly, as an organization, you need to push products out into the marketplace. [Next is] aligning those requirements back to which is the best technology out there for you, because with that, you will see longer-term savings in budgets, you will see shorter times to market.”

For Independent Health, Eric Decker, SVP of Information Technology said his organization saw potential in switching to a new CAPs and took time to look at their options.

“About ten years ago, the Affordable Care Act created uncertainty as to whether our legacy system could handle things like member level benefits, or how it would perform and integrate with exchanges,” said Eric. “We closely evaluated different products in the space at the time and immediately realized HealthRules Payer® would enable us to significantly cut down the time of our new product development. Now, what used to take weeks and months actually takes hours or days.”

Although the process can seem daunting at first, the results can be transformational. To get all key stakeholders on board, technology leaders must help the decision-makers understand that moving to a new core system will benefit the organization at all levels.

“Organizations need cross-functional support between IT and the business involved in evaluating the platform to ensure they are aligned,” said John. “As we look at the success we have with our HealthEdge claims processing system, our billing system, and our eligibility requirements; there is shared coupling between IT and the business.”

Eric agreed with the importance of a tight partnership between IT and the business, not only in what the operating model will look like after the organization completes the migration. “Our system configuration teams, operations teams, and IT work closely together to evaluate upgrades, evaluate new products that our sales team wants to implement, and how it will fit into the core administration platform.”

“The long-term operating model of how you’re going to support the system is key,” added John. “In what was traditionally all core IT functions before, now can reside in the business, and there are good reasons for them to….getting the right people together can be successful and have a lot of long-term efficiencies.”

When it comes to efficiencies, both Eric and John mentioned their high auto adjudication rates, both in the low 90s. John gave credit, once again, to the solid understanding and relationship between IT and the business.

“We can’t get to these numbers with just claims, or just IT. Everyone needs to work together, identifying how we’re going to get there, and [within] the timeline we want to achieve it,” said John. “The key thing is to be in lockstep. If you have a partnership, you will get there. Without a partnership, you will struggle.”

The alignment of business and technology, especially in this industry, is becoming increasingly important. To be successful, technology leaders, including CIOs in healthcare, must understand and become a part of the business they support. Effective partnerships outside of IT will strengthen the CIO’s influence.

The IT department is at the center of business decisions and initiatives. Once a need is identified, the IT department will work with the business to deliver a solution. Before delivery begins, technology leaders often must handle the contracting process and act as the liaison between solution provider, procurement, and legal departments.

Because technology leaders work with so many systems and vendors, CIOs can spend significant time on contract negotiations and tracking contract renewals and expirations. This can be time-consuming and reinforces the importance of fostering strong partnerships with departments and leaders throughout the organization. These relationships, or lack thereof, can make or break the implementation of technology to address a business issue.

When it comes to purchasing decisions, technology leaders are also often faced with obtaining support for technology investments from other executives or the Board of Directors. Strong relationships are essential for success in this area as well. There’s ROI that comes into play, too, beyond just keeping costs low. When making new technology investments, there is often an increase in cost before savings are eventually recognized. When a CIO needs to convince stakeholders, who may not be intimately involved with the projects, it’s important to always tie the purchase back to how it drives business value.

With technology implementations, there will be bumps in the road. Technology leaders must acknowledge this reality and share this with their business partners. The goal is to react and resolve quickly. It is essential to be transparent and set realistic expectations from the beginning. Being transparent minimizes surprise and gives the CIO credibility. Sincerity is key to forming successful partnerships with stakeholders. Once stakeholder trust and support are established, work becomes more enjoyable, and relationships thrive.

If a CIO in healthcare is solely focused on technology and does not appreciate the business perspective, it will make the job difficult and more stressful than necessary. Business and technology leaders must work together, share their insights, and form strong partnerships to achieve their organization’s goals.