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One of the best parts about working at HealthEdge is how open they are to change.

When asked what makes the company stand out, Manager of Talent Attraction Kelly Finn praised the HealthEdge’s mindset of “just because you’ve done something one way for a long time doesn’t mean we should necessarily keep doing it, and we’re always looking at new ways to look at a process differently.”

As a company with a technological base, we are always moving forward and looking for mechanisms of change to put us ahead of the industry. This shared way of thinking about the world makes working as an intern exciting and unpredictable because everything you say and do can make an impact on the company’s future.

A great example of how open to change the company is can be seen in the evolution of the intern program itself. When it was founded in 2018, the program was scattered. “It was kind of ‘hey does anyone want an intern? Raise your hand, okay we’ll find some people for you’ but we’ve put in a lot more structure around it since then,” Finn explained.

Now, the HR team tailors each position for a specific department, and managers who want an intern must create an onboarding list of things they would assign their intern if they were to receive one, making sure every intern can be engaged.

The intern program has also since employed the idea of having the interns work in teams to complete challenges and earn points throughout the summer, which adds a light, competitive flare to the job as well as opportunities to socialize that the pandemic has rendered so limited. The program is relatively young, as this is only the third summer, but there has already been so much improvement. This is because the heads of the program sat down and reflected on where they were lacking and how they can make it better, and that is something a lot of companies don’t have the maturity to do.

Another way in which HealthEdge’s culture really stands out among the masses are the monthly iBelong seminars founded in June 2020 in response to a racial injustice, where employees meet and discuss a multitude of topics that most workplaces find uncomfortable and untouchable. It is a safe space where people discuss how topics such as racism, sexism, and homophobia have affected them and how we can go about making a change. The seminar opens up with facts and information and then discussion questions guide an open communication between whoever wants to talk or listen, and it is an incredibly progressive event to experience.

You may wonder the benefits of being such a caring, tight-knit workplace, but the team believes it is an integral key to success. “It makes a big difference, feeling that the people that you’re working with are all rowing in the same direction and care about you as an individual, as well as care about the work that they’re doing,” says Katie Conti. Everyone is working together to produce the best work they can, and you can’t ask for much more than that.

HealthEdge was named national Elite Winner in Employee Achievement and Recognition designation for the 2020 Medium-Size Best and Brightest Companies to Work For, Top 101 in the Nation®. We also were named 2020 Top Places to Work by the Boston Globe Media Partners Group. If this work environment resonates with you, consider joining the team.

According to our recent survey of 3,000 consumers, 58% of respondents still trust the current health insurance model over government-run, retailer-led or other private-public ventures. While health plans have retained a majority in consumer trust, it’s starting to take a dip – it’s down from 69% in 2018. So it’s imperative for health plans to continue to focus on member satisfaction to build (or rebuild) consumer confidence in existing models.

One way to enhance member satisfaction is through member engagement and outreach. More consumers today say regular communication through a variety of channels will improve their overall satisfaction (26% today versus 18% in 2018).  And while digital communications and self-service tools have greatly progressed, we still have work to do as an industry to pull all the pieces of the healthcare puzzle together in a highly individualized way. Now that we have much of the technology in place, simplification is the next key step in moving these initiatives forward.

The HealthEdge internship program is designed to set its interns up not only to succeed at this company but in the job world and beyond. This year’s class of 28 interns are remotely learning how to navigate the world of healthcare software as well as working life in general, thanks to the many tools offered by the program and the warm environment that makes HealthEdge feel like home.

HealthEdge understands how complicated the healthcare software industry can be, especially to someone new. To accommodate those feeling intimidated or uninformed, there are HealthEdge101 sessions given by each department and product demonstrations once a week to provide more details on the different divisions and products within the company. They are helpful, informative, and engaging, which helps the interns connect with the material and people behind it. Each week a different department head will present to teach us more about sides of the company we don’t get to see when working in our own bubble.

The HR team helps the interns prepare to be better candidates for future employers through LinkedIn profile-building workshops, resume writing sessions, career coaching, and mock interviews.

When asked what she hopes interns learn during a summer at HealthEdge, Kelly Finn, Manager of Talent Attraction, says, “It’s life skills you carry for a long time going forward. It’s not just what did you learn today; it’s learning how to talk about yourself in an interview, how to present your resume, how to present your LinkedIn profile.”

The LinkedIn workshop taught me how to navigate the platform and make my profile stand out to recruiters. My career coach, Jana Matra, gave me specific tips on how to speak up more during Zoom meetings and prepared me for mock interviews, and those skills will stick with me way beyond this summer.

No two interns will have the same experience, but every intern can agree on how important the tasks we’re given are to the company.

“I am glad my managers have enough trust in me to give me these big responsibilities,” says Customer Success Intern Raquel Simon. She creates onboarding documents to help new employees in each department adjust more easily to HealthEdge.

Tech Writing intern Faith Stynchula creates user guides for the products we sell, and she says the projects she has been offered have allowed her to represent the hard work the company has done, and she’s honored to be given such a big responsibility that’s valuable to her career as a developing professional.

This internship, regardless of which field, puts a conscious effort into preparing us for the real world.

When asked what the biggest takeaways from a HealthEdge summer internship should be, Finn answered, “we want the interns to have something meaningful to put on their resumes, some real-world contributions that they’ve made to HealthEdge as a company that they can share with employers or with their school.”

This is a testament to just how much HealthEdge wants you to succeed, not just for them but for yourself.

There is a lot of uncertainty in healthcare today. Health plans like to know what the risk is and manage the risk. And when that risk is uncertain, it is challenging to run your business in that environment.

Many plans saw a drop in claims in 2020. However, the low level of claims will not continue indefinitely. Now, health plans must prepare for what is coming. Yet, uncertainty remains. It is still unclear how many people put off routine visits, as well as emergency care, and how that will impact healthcare costs post-COVID.

In the Annual Payer Index Survey: 2020 Report from Altruista Health, a HealthEdge company, the majority of the 177 respondents cited improving member outcomes as the top care management priority. And when asked about the effects they see with members who delayed medical care, “Forty-two percent reported member lapses in care for chronic conditions, and 26 percent saw preventable poor outcomes due to lack of routine screenings.” 

Should health plans prepare for an influx of treatment? Will costs go higher than expected due to more emergency room visits or inpatient stays? Or if it will spread out over time.

Industry consolidation is one of the biggest trends in the payer space right now. National health plans might acquire other regional plans or enter a new line of business, resulting in multiple claims systems and different point solutions. The challenge is, how do they serve their core mission with technology that isn’t necessarily made to work together?

There are dozens of steps in the claims processing workflow, and they may all use different software solutions. Suppose a health plan uses a specific solution for pricing, another for grouping and another for editing. In that case, all those applications could update at various times and communicate results differently, putting strain on internal resources to manage the workflow. And if something goes wrong, it’s incredibly challenging to pinpoint where the error occurred.

Health plans want to improve operational efficiency, but they will not get the desired outcomes with different point solutions and applications from separate vendors.

Health plans need a single solution with real-time data and analytics that provides cloud-based delivery of regular updates to ensure they have all the correct information. Take Medicare and Medicaid, for example; at any given time, something is updating somewhere in the country. Health plans need to be aware of the changes and have those codes up to date across all of their solutions.

Without a cloud-based solution, health plans need to figure out all of these changes independently, manually make updates, and manage the software on their own.

Cloud-based solutions, however, have the ability to remotely deliver updates to payment policies as they occur, arming health plans with the most up-to-date information needed to process claims accurately and efficiently. With a single instance of a solution that includes all the business rules on top of it, the entire health plan will have the updated information, no matter where they are calling it from across the whole ecosystem.

A recent study of 245 IT executives at leading health insurance companies revealed that larger health plans are interested in consolidating core systems to improve overall operations and cloud migration/technologies. The majority of respondents at larger health plans (61 percent) indicated that they plan to evaluate their core administrative processing system within the next two years.

In collaborating with health plans of diverse sizes and geographic spans, we find they all share similar challenges: improving member and provider satisfaction, cultivating brand loyalty, standing up new lines of business, staying on top of competitive pressures, improving operational efficiency, driving innovation, and maintaining regulatory compliance – all areas of opportunity given modern technology.

Where we find that plans differ considerably is in the approach, scope and dependencies involved in finding solutions to these challenges. The largest, nationally-focused health plans typically evaluate solutions from both local and global perspectives, looking at issues from the big picture within their organization alongside individual project requirements. While the immediate challenge being addressed may be highly specific to the needs of a geographic region or a line of business, they must take into account broader considerations such as corporate-wide IT initiatives, project prioritizations, resource allocation, existing technical debt as well as assets that could be capitalized on, the potential for solution application across other regions or lines of business, and more.

Whether on a broad national scale or in regionally-based health plans, data integration is also a significant opportunity when modernizing—for both internal- and external-facing purposes. From an internal perspective, key decision-makers require the ability to analyze comprehensive, up-to-date, well-structured data from across the enterprise in a single place to make business-critical decisions for the entire organization. From an external perspective, centralized access to real-time, accurate, enterprise-wide data is essential to creating a cohesive and meaningful customer experience across a health plan’s spectrum of products.

Due to their size, diverse regions and lines of business, and often a history of growth through acquisition, many larger plans have accrued numerous systems over time. These may include applications running on aging technology and/or requiring multiple surrounding point solutions to run effectively, creating all sorts of additional integration challenges. Maintaining this type of complicated ecosystem dramatically impacts the IT costs and resources required to keep all the components current and updated. The integration between these systems and solutions is crucial for delivering on innovation strategies and the overall success of the business. Today’s technology can solve these considerations – with the added bonus of agile implementations that require less time and disruption, which is to be expected compared to systems implemented 10-15 years ago.

In alignment with these findings and observations, we’ve found that while the pain associated with many of the challenges outlined can be more acute the larger the plan, all health plans need a highly interoperable, real-time technology platform that can handle multiple lines of business (LOBs), with the flexibility to react quickly to shifting market dynamics and the reusability to configure and streamline a diverse set of benefit plans and provider contracts. They also need the assurance that their leading-edge platform delivers scalability and versatility to extend across the business, using “Lego” like software that allows for reuse along with regional/LOB configurability. This provides the agility necessary to orchestrate technology implementations across regions and LOBs based on an organization’s unique drivers and dependencies.

Health plans need a technology partner with next-generation solutions that understands, appreciates, and can help to address the big picture.