Have you ever gotten a phone call or meeting request where you were told that you were getting a new boss, being moved into a different role, or even that your entire department was going to be reorganized? The immediate feeling of dread and then so many questions popping into your head about why this is happening or how this will impact your future. We all have experienced these types of situations in the workplace. It feels like a roller coaster ride. Change is inevitable in any organization and can be deeply disruptive, but in the remote work environment we now operate in it can be even more so. People leaders need to recognize the challenges of leading their teams through the change from afar. Read on to find out more about how to create an environment that encourages remote employees to embrace change and watch your change initiatives become easier to execute.

 

1. Be Clear about the Reasons for Change

People leaders must provide clarity when introducing change. Employees need context and details to understand why a change is taking place, what value it will bring, and how they will be affected by it. When this information is shared with employees promptly, they’ll have an opportunity to provide feedback or ask questions BEFORE the changes go into effect. This helps ensure that everyone involved understands the reasons behind the changes, which can help them feel more engaged and motivated throughout the process.

 

2. Encourage Open Communication

Open communication is essential when navigating remote change management. People leaders should make sure their team members understand their expectations and are comfortable communicating with each other and with leadership throughout the process of implementing new changes. Encouraging honest conversations between everyone involved in making decisions can also help ensure that everyone is on the same page. Additionally, ensuring that employees have opportunities to access different avenues of communication such as 1:1, team meetings, email, or other communication platforms such as Slack or Teams can help foster collaboration and allow for smoother transitions during times of disruption.  In addition, communicating change is not just a one-and-done process, it is multiple times in many ways and often repeating yourself. You must remember you have been planning this change for a while and they are just now hearing about it so being consistently repetitive is important. And don’t forget to prepare your managers who are critical to change initiatives being successful.

 

3. Build Trust

People leaders should strive to create an environment of trust throughout the transition period, as well as afterward. This means being transparent about why certain decisions were made and why certain changes are being implemented. Leaders should also take time to listen carefully to their team’s concerns while providing thoughtful answers in response—this helps build trust among team members while fostering a sense of community during times of upheaval. Team members will go through a variety of emotions such as anger, disbelief, disengagement, and acceptance as they experience the change. People leaders should always strive to show empathy towards their team members; this will help them understand that their feelings are valid even if they don’t agree with every decision made by leadership.

 

In conclusion, navigating change in a remote work environment requires patience, understanding, open communication, empathy, and trust—all qualities people leaders must possess if they want their teams to embrace changes without feeling overwhelmed or isolated during periods of disruption. By following these tips and actively engaging with team members during times of transition, people leaders can create an environment where individuals feel supported no matter where they work from!

Technology use among seniors saw significant gains over the last several years, fueled in part by a desire to stay connected during the COVID pandemic. A research study performed by AARP showed 84% of adults over the age of 50 own smartphones, up from 77% in 2019. Ownership of other devices, including tablets, smart TV’s, home assistants, wearables, and smart home technologies, have seen double-digit increases among the same population since 2019.

Technology as a Lifeline

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that nearly one-fourth of adults aged 65 and older are socially isolated. Older adults are at increased risk for loneliness and social isolation because they are more likely to experience the loss of family or friends, chronic illness, or hearing loss.

Living alone, a reality for approximately one in three older adults living in the US, is another factor impacting loneliness and social isolation. Despite this, three out of four of the adults surveyed want to stay in their homes and age in place as told by Susan Beaton, VP of Health Plan Strategy at Wellframe,  in the webinar How health plans can enhance engagement with senior members using technology. For these seniors, technology can help them connect to family, friends and even healthcare providers.

During the COVID pandemic, technology became a lifeline for everyone, but the senior population likely made the biggest strides in usage and adoption. Technology became, and continues to be, a lifeline for aging Americans – whether it’s meeting their emotional needs by connecting with loved ones or helping to enhance their medical care through virtual appointments and other digital interactions with their healthcare providers.

Increased Health & Wellness

The ability for seniors to adopt technology and leverage health-related innovations may lead to positive effects on their health and wellness. The opportunities for these gains, while seemingly small, can add up to make a big impact in overall health.

• Utilization of wearables might encourage seniors to be more active and can clue them into changes in heart rate, blood pressure, temperature or even sleep quality – alerting them earlier to potential health issues.
• Managing and adhering to medications can be challenging for aging adults, but technology can help to issue reminders and monitor usage and even alert caregivers when a dose is missed.
• Telehealth usage peaked over the last years and continues to be an option for delivering healthcare services to older adults in a convenient and cost-efficient manner. Virtual visits mean fewer trips outside the home, less exposure to Covid-19 and other illnesses, and better chances of being seen sooner.

Increasing Technology Use for Seniors

Engaging seniors through technology can be challenging and requires unique approaches to overcoming hurdles. There may be a learning curve to new technology and some individuals may feel overwhelmed. Seniors living on fixed incomes may not have the financial resources to purchase new technologies. Despite this, many payer organizations who recognize the benefits are finding innovative solutions to ensure the members they serve have the tools they need to engage.

The Right Platform: Wellframe

The Wellframe digital health management platform powers health plans and senior members to achieve their best. It helps organizations extend their reach across more critical touchpoints, uncover, valuable health insights, and deliver modern member services that improve member engagement and experience. Learn more here.

At HealthEdge, we keep a close eye on the market and the drivers that are influencing healthcare. Our team looks to the experts at Gartner and KLAS, surveys our clients to understand what they’re doing, engages with client’s clinical staff to understand how they use our tool set, and monitors the marketplace to meet the needs of our customers.

These are the top 3 care management trends we’re seeing:

1. Doing more with less

Remaining competitive in today’s market means optimizing healthcare operations so clinicians can remain focused on caring for member populations.

One of the trends in the healthcare industry is the decrease in people entering the profession, especially nurses, which is going to lead to a significant shortage. This is further compounded by the Great Resignation and high turnover rates which add to the shortage. At the same time, we’re seeing an increase in the number of people who are developing a chronic illness, which is driving the need for us to make our tools much more efficient so we can care for members. With less staff – especially in a value-based environment – we need tools to help health plans do more with less.

One of the things we’re excited about at HealthEdge is our digital care member outreach platform. This helps your clinical staff be far more efficient by putting some of the work that the care manager does in the hands of the member to enable their own engaged, active participation in managing parts of the care management continuum.

Source: 20% nurse shortage, 171 million people with one chronic condition

2. Increasing Demand for Interoperability

Another trend we’re seeing is an increased demand for interoperability among solutions. Regulatory pressures, the shift to digital health, and new payer-provider business models underscore this growing need.

The main drivers include:

1. Government agencies such as CMS are continuing to push payers and providers to increase the interoperability between their systems. This is to reduce administrative burden and errors, as well as improve the overall member experience.
2. We’re also seeing a lot more collaboration demand between payers and providers. This is driving a lot of data exchange requirements, such as integrating our solutions with electronic health records, and building real-time interfaces with our clients’ data infrastructure so that we can exchange data between these systems in real time.
3. The underpinning of all of this is an explosion of health technology.

3. The Importance of a Modern Platform

Payers are embracing next-level platforms with connected ecosystems and real-time data insights that impact cost and quality outcomes. According to a recent McKinsey article, Cloud capabilities have the potential to generate value of $100b to $170b in 2030 for healthcare companies.

There are five healthcare categories that benefit from cloud technology:

By 2024, healthcare providers that have adopted a Digital Health Platform will outpace competition by 80% in the speed of digital transformation and new feature implementation.

HealthEdge: The Right Platform

To remain viable in the evolving industry, health plans must lean into the above drivers and opportunities, rather than ignoring them. Thus, you need the right platform underlying your systems, and you need to take some steps to build a strong foundation that aligns with where the market is heading.

This is the thesis of HealthEdge and the GuidingCare team – to build a digital health plan ecosystem with best of breed products: core admin (HealthRules Payer®), care management (GuidingCare®), prospective payment integrity (Source), and member experience (Wellframe).

 

 

 

Payer organizations today face significant obstacles as they navigate a new era of member and provider “relationship management.” Members and customers have increased expectations and payers are responding by working towards executing transactions more quickly and identifying incorrect payments and their root causes.

While the spectrum of payment integrity is broad, the goals of all segments are to encourage the affordability of healthcare by preventing poor quality claims upfront, avoiding downstream costs where possible, and recovering improperly spent funds postpay when necessary.

However, trying to achieve these goals is challenging for the average payer organizations due to the following factors:

• Fragmentation within payer organizations requires top-down leadership to break the cultural, technical and organizational silos.
• Quantifying the value of education and prevention is difficult.
• Coordinating workflows across internal organizations is a large challenge.

Prepay vs Postpay in Healthcare: Advantages of Shifting Towards a Prepay Model

Moving “left” from postpay to prepay allows payers to have more predictive control and addresses the challenges payer organizations face. While doing so can be organizationally and culturally challenging, there are many benefits and advantages of this shift:

• Increasing accuracy of claims reimbursement and transparency of payments, leading to improved provider relations
• Removing redundant tasks, reducing staff frustration, saving time
• Decreasing claim spend
• Improving claim denial rate
• Reducing the number of claims requiring rework
• Lowering the cost per claim processed
• Reducing the significant claims-related provider inbound call volume
• Improving the member and provider experiences
• Identifying and educating providers by revealing patterns of poor payment integrity practices

An Alternative Approach to Payment Integrity

As the landscape of healthcare payer technologies evolve, an alternative approach to payment integrity is emerging: single, one-stop-shopping solutions. Source, HealthEdge’s payment integrity software, is a single payment integrity solution that offers a centralized repository of data that can be used for multiple functions, such as claims reimbursement, editing, clinical reviews, modeling and analytics. Transitioning to a single-solution system offers payers the opportunity to streamline operations, form authentic vendor partnerships, and take control of a comprehensive approach to their claims payment operations. Learn more about partnering with Source, a transformative, single-solution partner.

Shifting Trends in Healthcare Payments: A Focus on Prospective Payment Integrity

Lately, payers have been making some interesting shifts to better meet their organizational goals such as executing transactions more quickly and identifying root causes of incorrect payments. As member and customer expectations continue to increase in these areas, such as expecting prepay instead of postpay organizations are taking action to address new internal and external pressures.

In the IDC Spotlight: Prospective Payment Integrity: Moving from “Pay and Chase” to Predictive report, 7 key industry trends which positively impact payer challenges were identified:

1. Advancements in Internal Workflow Solutions – Internal workflow solutions are being improved by bringing together different components to streamline efforts. Consolidation of the vendor solutions/IT stack translates to less internal lift for payer organizations.
2. Optimized Ecosystem – Externally interoperable solutions with best-of-breed content and functionality are being acquired, allowing payers can optimize their ecosystem of solutions. Improved workflows externally improve automation so internal efforts can focus elsewhere (e.g., expanding into new LOBs, improving member and provider satisfaction).
3. Vendor Alignment – Payment integrity vendors are aligning and merging to accelerate a “technology push” for various organizations and functions to work together.
4. Claims Digitization – Advancements in claims digitization and adjustment automation are being made to support payment integrity in core administrative processing systems (CAPS). Over 20% of all claims are submitted as physical copies and require high amounts of manual labor to process, drastically increasing costs, errors, and processing time, and leading to potential risks to an organization.
5. Transparency through Open APIs – Payment integrity solutions designed for transparency can work to consolidate and coordinate sound, useful data through open APIs. Centralizing data can help payers understand root issues, make informed business decisions, and effectively communicate with and educate their provider network.
6. Improving Coordination of Benefits (COB) – On average, it takes a plan nearly 5x times longer to settle a COB claim than a regular claim. Improving the coordination of benefits that apply to a person who is covered by more than one health plan has the potential for significant time savings for payer organizations.
7. Administrative Audits as a Tool for Improvement – Organizations are applying administrative audits to medical claims that are complicated and costly if not managed correctly. A claim audit of any kind can identify root causes of errors, find methods for improvement and ensure compliance.

To learn more about key trends in healthcare payments and enhanced processes payers are leveraging, including the application of analytics and coordination of workflows, you can read IDC Spotlight: Prospective Payment Integrity: Moving from “Pay and Chase” to Predictive.

On March 11, 2020, COVID-19 was declared a global pandemic by the World Health Organization. The accessibility of portable, electronic communication technologies had already begun to change our habits, from shopping to personal interactions with our friends, family, and neighbors. But in the three years that have passed since the COVID-19 pandemic struck, the way we live in this world today has changed even more, most specifically in the way we access healthcare. Due to COVID-19 precautions, rather than walking into the doctors’ office many patients saw their providers by way of virtual visits, and many families had to leave loved ones at the hospital entrance in the anticipation of returning to them later. Where is the world heading? Will digital healthcare remain as successful as it was during the initial days of COVID-19? Is the use of digital health and the use of electronics for family support and communication here to stay?

What is Virtual healthcare/Telehealth/Mobile healthcare?

Virtual healthcare is a remote two-way digital conversation between patient and their healthcare practitioner. These exchanges can take place via phone call, email, instant message, or live video chat.

Telehealth is the use of technology (Computers and mobile gadgets like tablets and smartphones) by the healthcare provider to enhance or support healthcare services. This technology can be used from home by the patient, or a nurse or other healthcare professional could offer telehealth services out of a clinic or mobile van. By providing timely care to those who might otherwise postpone it, or who reside in locations with a shortage of providers, virtual care can provide a chance to dramatically enhance patient outcomes.

mHealth (mobile health) is the use of mobile phones and other wireless technology in medical care. It can close gaps in care by enabling patients to speak with their doctor or other members of their care team without physically being present. Users can continuously track and manage specific health data using wearable technology and other mobile technology.

The Rise of Digital Healthcare post COVID-19 – 5 Lessons Learned

1. The rise of telehealth and its adoption

Patients felt that telehealth was convenient and were more satisfied with telehealth than virtual visits and would continue to use telehealth for their healthcare. However, physicians felt that telehealth was expensive, and they had concerns about the effectiveness of telemedicine compared with in-person care, had physician burnouts, and had concerns about protecting their patient’s personal health information.

Nearly half of doctors stated they think telemedicine is a viable option for treating persistent chronic diseases. Remote healthcare enables patients to be treated more effectively, relieving pressure on medical facilities, and lowering operational expenses and common infections associated with healthcare. Expectations seem to differ by age and income level category, payer status, and service type. Higher income earners and those with individual or group insurance through their employers are more likely to use telemedicine. The demand from patients for virtual Mental and Behavioral health is also rising. Chronic care providers were able to do more virtual visits, while Pediatricians, Gerontologists, and Gynecologists were not.

2. Triage of urgent and non-urgent patients can be aided by digital tools

Using Digital Technology, patients can be effectively screened and evaluated where they live, prior to being admitted to a hospital. This protects healthcare professionals, other patients, and the community from exposure, and relieves pressure on the limited resources of the healthcare system.

3. Using eConsults to Expand Access to Specialty Care

Another aspect of telehealth that benefited from the pandemic was the development of applications like electronic consultations (eConsults). While not suitable for emergency care, eConsults offer the opportunity for specialists and primary care clinicians to work together on challenging situations despite distance or time zone issues. They have also improved access to specialty treatment while reducing wait times, according to several studies. eConsults offer the ability to simplify the referral process and give access to specialty expertise that was previously overextended or unavailable by minimizing referrals, enhancing care coordination, and lowering costs.

4. Patient and provider satisfaction with Telemedicine for consultations

Research showed that during the pandemic, patient satisfaction with in-person, video consultation, and telephone visits was comparable. Physicians expressed favorable opinions toward the use of telemedicine, with treatment being on par with in-person consultations. But it all came with its own challenges. Most new caregivers had to swiftly acclimate to this transition to offer secure and exceptional care. It was difficult to try to match the in-person visits with the virtual visits because it had to resemble the customary in-person visits. Being professionally dressed, choosing a quiet environment, employing high-quality webcams, and having a robust internet connection were all vital and were only learned over time through experimentation.

5. Measures taken by the healthcare payers

The COVID-19 pandemic has demonstrated how the American health system’s inefficiencies and disparities are a result of misaligned financial incentives and the dispersion of services across sectors. The pandemic has both accelerated ongoing attempts to restructure payment systems and given fuel to long-overdue improvements in health care delivery, such as flexibility for virtual care. One example is the transition to alternative payment models (APMs).

Notably, COVID-19 has also encouraged new, creative collaborations between payers and other sectors, such as joint projects with the pharma companies to promote biomedical innovation, coordination with community-based organizations to meet patients’ social needs, and collaborative partnerships with public health departments to enhance disease surveillance. Accelerating the shift to value-based payment, trying to extend flexibilities for virtual health services and solutions, rethinking advantage layout using the principles of value-based insurance, aligning incentives and investment opportunities to address health inequities, and developing mechanisms for collecting data on health care spending.

HealthEdge & Digital Healthcare

HealthEdge’s healthcare SaaS software provides payers with a digital foundation that enables them to deliver a transparent and consumer-centric experience at lower cost while offering higher quality and higher service levels to their members, providers and partners. Learn more here.