4 Tips To Achieve Change Management Success And Become A Digital Payer

Change management is a complex process that involves stakeholders across an organization. It’s not just the technical aspects that matter, but how successfully health plan leaders educate and engage the teams that will be impacted by organizational change.

When it comes to implementing a technology solution, some leaders might overlook the human element—getting so caught up in the process and technological details that they forget about the people involved. Methods like the People Process Technology framework can help by encouraging health plans to identify the training, documentation, and skillsets the team will need to be successful. But there are other ways to set your health plan up for change management success.

To demonstrate effective change management, here are the stories of two different health plans as they implemented digital solutions.

What does change management success look like?

Our first example is a health plan that successfully implemented a digital solution and achieved a significant return on investment (ROI).

Health plan leaders identified their current processes and reviewed them alongside their employees to pinpoint opportunities to phase out manual, low-value tasks. To ensure they were making the best choice for their needs, stakeholders investigated multiple solutions. They included middle management in the decision-making process to ensure those who would use the system had a voice in its selection.

This health plan invested substantial effort into the design, testing, and training phases of their new systems. They went live on schedule, within scope, and on budget. This resulted in exceptionally high buy-in and an impressive return on investment.

What does unsuccessful change management look like?

The second example involves a health plan that did not achieve long-term adoption of their chosen digital solution.

In this case, a senior leader new to the organization selected a vendor based on their previous experience, and shared the expectation that the system would help cut costs and make their health plan more competitive. However, despite on-time and on-budget implementation, the project struggled to get buy-in and engagement from stakeholders. This lack of engagement led to an unwillingness to test the new platform and engage in training sessions.

Within two weeks of go-live, the system was abandoned because end users didn’t like the way the platform functioned or how it impacted workflows.

4 Steps to set your health plan up for change management success

There are a few key differences between the two health plans mentioned above. One plan focused on educating their internal teams and getting organizational buy-in, facilitating technology adoption and achieving ROI. The other plan allowed one person to take charge and implement changes from the top down without communicating or sharing information with their wider organization, resulting in low adoption and usage.

How can you develop a change management strategy that sets your health plan up for success? These are four recommendations based on experiences with our customer implementations.

1. Understand and support employees

Knowing the needs and capabilities of your team is crucial. Your health plan could find the perfect technological solution, but it won’t be successful unless you have organizational support. It is important to have clear, open channels of dialogue from the onset so stakeholders and users can understand the value of new technology solutions as well as what will be expected of them. This is a great opportunity to emphasize how the new technology can help automate low-value work and empower your team to accomplish higher-value tasks.

2. Focus on inclusion and transparency

Involve middle management in decision-making and foster transparency with regular updates and opportunities for participation. Getting buy-in from middle managers is essential to gaining widespread organizational support. Give your team an early overview and demonstration of the system as it’s being built and implemented—not when it’s fully formed. Showing the new solution to your team and engaging with them helps garner approval and improve adoption.

3. Answer the question, “What’s in it for me?”

Each member of your team needs to understand the personal benefits that the new solution will offer. By engaging with and educating employees on the new solution, you’re enabling them to have discussions about how they’ll be expected to use this new technology and the value it will bring to their roles. At HealthEdge, our Professional Services team can help facilitate transparency with our customers through continuous dialogue. We show your team how the new system functions and engage a larger group to understand the company’s perspective on the solution.

4. Establish a change management work stream

An important step is establishing a project work stream dedicated to change management. Doing so can help you understand where your health plan stands in onboarding and addressing challenges that surface along the way. It is important to engage with your employees and over-communicate. This can be achieved by using change management methodologies such as: engaging leadership, defining why change is necessary, communicating the vision, obtaining employee buy-in, and reporting progress. To be successful, your health plan must lean into change management—you know your organization best and can help set the trajectory for success.

Preparing for change in your organization

Change is an inevitable and necessary aspect of growth—especially in healthcare. We’ve seen which strategies work, and which don’t when it comes to implementing a new digital solution. Remember, the more you involve and support your team from the beginning, the more likely your digital solution will be adopted successfully.

Engage with your team, provide them with a clear understanding of what’s to come, and give them the resources they need to succeed, and you’ll have a team ready to leverage new digital tools and embrace digital transformation.


6 Key Strategies for Change Management Success

A few decades ago, change management success boiled down to phrases like, “Just do it!” or “Tough it out!” This kind of energy may have worked for short-term motivation, but it lacks the ability to inspire ongoing effort and address employee concerns. People want to know what’s in it for them when it comes to new workflows and expectations.

Today, change management is about effective listening and communication with your team—a strategy popularized by GE’s Change Acceleration Process. In times of change, employees are likely worried about job security or status and may not see why the change is necessary. Helping your team move from the current state to the improved future state requires managerial and structural support.

There are two questions your organization needs to answer before enacting change management:

  1. Have we listened to employees and understood their pain points?
  2. How will we communicate what we need each team to do?

This process doesn’t happen automatically—it needs to be proactive and intentional. We’ve identified 6 strategies that are essential for change management success.

1. Engage senior leadership.

One key indicator of effective change management is engagement from senior leadership. This is especially true when implementing new workflow technology or replacing a core administrative system. But what does it mean for leadership to be engaged?

To start, company leaders should be talking about the coming changes. Employees need to know why the changes are strategically important. Sharing this information helps them understand why adapting is worth the effort and gives them a sense of purpose beyond simply being told to adapt.

An objective way to measure engagement is by using the “calendar test.” Are executives attending project steering committee or other informative meetings? If not, it’s important to make sure they start. They should be able to speak about the ongoing project and understand how the implementation is progressing. This is also beneficial so senior leaders can see and appreciate the hard work middle managers and other employees are doing to ensure change management success.

2. Outline why change is necessary.

A common misstep that health plans make is assuming that employees know why you’re making this change. Many people won’t understand the need for new technologies or workflows when the original way seemed to work just fine. Your company leaders should be able to articulate the impacts in a way that helps employees feel involved in the decision-making process.

In what areas do you anticipate the most benefit from new systems? That could be paying claims faster or more accurately, complying with state audits, or modernizing legacy systems. Sometimes, the existing technology just isn’t viable any longer and can’t be properly maintained over time. Your employees want to work toward solving an important problem—so give them the information and motivation they need to do so.

3. Communicate the company vision.

Now that your employees and executives understand why change is necessary for your health plan, what is the vision for your organization over the next few years? Paint your team a compelling picture of the future state and where the company is headed. Ideally, your vision contains wording that speaks to both your team’s minds (i.e. intellect) and their hearts (i.e. emotion).

Make sure your team knows that with new technologies comes a chance to improve individual skills and maximize what they’re able to accomplish. In the case of HealthRules Payer, for example, the platform automatically handles adjudication and reviews for errors. This vastly reduces the need for manual reviews, giving employees time to focus on more complex, impactful tasks only they can do.

4. Gain internal commitment.

Encouraging your employees to commit to the change process is about more than education and passive acceptance. Identifying early adopters and internal influencers can be vital for gaining widespread support. These individuals already support the new adoption, which makes it easier for them to be engaged early in the project . They can then become a resource for other employees who have questions or need support during the process.

It is also beneficial to identify who might be resistant to change within your organization. Generally, areas of resistance fall into three categories: technical, political, and cultural. You don’t necessarily need to convert them into supporters, but it’s important to know why they might be hesitant and address their concerns so they’re not constantly pumping the brakes.

To help convince resisters why the change is important, turn to the three D’s:

  1. Data: Use data, such as higher payment accuracy rates, to explain why the new system will be better.
  2. Demonstrate: Show the new solution and share how other groups best utilize the platform.
  3. Demand: Share regulatory requirements and customer expectations that convey why the new technologies are needed.

You do not need everyone at your health plan to be on board. In reality, when approximately one-third of your employees are supportive, the rest will follow and accept the coming change.

5. Adapt underlying systems and structures.

With new tools come new processes. So how can you encourage the change and not force the change?

First, have a plan for how processes will change with the new system and communicate it clearly to your employees. It is possible that the new tools will alter team structure and reporting, leaving some individuals without the support they’re used to. Knowing how they will be expected to work moving forward will help mitigate some of their apprehension.

Changing employee incentives can help with this process. Certain employees might have different goals because the organization can now sell to larger companies with bigger contracts. For others, it may be as simple as removing access to the legacy system and encouraging them to sign in to the modern user-friendly system. Once your team understands the structure of work, they can be more creative and accepting with how they get there.

6. Monitor progress with data.

What gets measured gets done, and what gets rewarded gets repeated. How is your organization measuring progress? What are the key milestones to reaching your goals? Your timeline will be unique based on your company goals, but it’s vital to add checkpoints along the way. Get comfortable with the idea of designing, building, and validating your processes before you go live—and then review and reiterate.

You will also need to know your leading and lagging indicators of project success, as well as how to break them down for iterative measurement. Once the project metrics are agreed on and in place, you can better align your employees to meet them.


Throughout this process, it’s important to remember: if you aren’t adapting and growing, you’re falling behind. Working with the right professional services team can support your organization in defining what change management success means for your organization. This includes steps like project planning to identify scope and milestones, meeting with senior executives to determine measures of success, establishing a steering committee, and enabling your team to continue building toward your objectives.

For more information about the HealthEdge Professional Services team and how it can impact your organization, click here.



Healthcare Payer Digital Transformation: Navigating Change Through Strategic Planning

Digital Health Payers turn to technology to help

If you are reading this blog, you are likely somewhere on your journey to becoming a Digital Payer. In fact, you are likely already a digital payer in some areas and continuously looking to optimize and expand your digital transformation.

Five key Digital Payer characteristics:

1. Improving Member Experience

You are working to improve the end user/member experience through access to information and digital tools, maybe through your member portals, price comparison tools, online PCP selection, etc.

2. Reducing Transaction Costs

You are always looking to reduce transaction costs; increasing your auto adjudication rates, eliminating manual intervention in claims processing, digital authorizations, etc.

3. Improving Quality

You are constantly on the hunt to improve quality; in how you operate the business, ensuring your staff is trained and taking advantage of all the ways they can leverage available technology, managing to key metrics and using data to identify improvement areas.

4. Enhancing Service

You are constantly working on improving your services levels; maybe through digital survey tools that allow you to capture data, analyze feedback, and adjust.

5. Increasing Transparency

You are operating your business with transparency; leveraging platforms and digital tools to provide information, self-service, and online collaboration tools to improve communication and information sharing.

Navigating Change

A key factor to consider, regardless of where you are in your digital payer life cycle (thinking about implementing a change, in the middle of an implementation, or actively running your business on HealthEdge) is that you are transforming your business.

The reality is that if we put our “continuous improvement” hats on we never really reach “the end”. This is why it’s imperative that we talk about how critical planning is to success.

Business Transformation is a Marathon…Not a Sprint

Adopting a “Marathon Mindset” is a critical mindset. When you decide to implement a new enterprise software solution, you are initiating one of the biggest business transformations you might ever be involved in. Typically, a health plan will migrate to a CAPs or Care Management system once in a generation

It’s important to prepare the team for a marathon not a sprint…meaning we have got to start to think “continuous improvement” and this approach will serve you regardless of where you are in your digital transformation.

Six Main pillars of Digital Payer Transformation

There are 6 main pillars of a successful digital transformation:

  1. Define your Success
  2. Plan & Prepare
  3. Design the future state
  4. Execute the plan
  5. Measure key performance metrics
  6. Optimize for continuous improvement

HealthEdge & Digital Transformation

By automating business workflows and seamlessly exchanging data in real-time across the ecosystem, HealthEdge customers experience the business benefits of: 

  • Improved end-user experience
  • Decreased transaction costs
  • Increased quality
  • Increased service levels
  • Increased business transparency

HealthEdge: Healthcare Payer Digital Transformation and Professional Services

HealthEdge’s Professional services provides expertise and support to accelerate your digital transformation. To become a next-generation health plan, you need a digital foundation that enables you to provide a transparent and person-centric experience at lower cost, higher quality, and higher service levels. HealthEdge® solutions provide that foundation – and HealthEdge Professional Services deliver the expertise and support to make the process swift, sure, and effective.

Learn more about HealthEdge Professional Services.

We will be exploring these in depth through an upcoming healthcare payer digital transformation series:

  • Healthcare Payer Digital Transformation: Prepare & Plan
  • Healthcare Payer Digital Transformation: Design Excellence – coming soon!
  • Healthcare Payer Digital Transformation: Execute – coming soon!
  • Healthcare Payer Digital Transformation: 3 Critical KPIs – coming soon!
  • Healthcare Payer Digital Transformation: Optimize – coming soon!