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Diversity and inclusion are essential components of HealthEdge’s recruitment and retention efforts. At HealthEdge, we see diversity is a competitive advantage and strive to recruit A-plus talent from a variety of backgrounds, who bring together a mix of skills and experiences that makes us stand out!

“We are constantly striving to do better and to bring different experiences and perspectives together to create something stronger at HealthEdge,” says Katie Conti, Director of Talent Acquisition “Diversity of thought sparks innovation, collaboration, and growth, so we’re always looking to expand the candidate pool that we hire from.”

Diversity and inclusion in the workplace are at the core values driving HealthEdge’s mission. Our HR team provides training, coaching, and mentorship to set the bar high when it comes to making sure HealthEdge employees are happy both in and out of the workplace. In addition to company events in and out of the office, HealthEdge offers and encourages professional development with the help of many free resources.

HealthEdge has been voted best ‘Best and Brightest Places to Work For’ for the two years in a row—a testament to our diversity and inclusion efforts. This year we achieved a National Best and Brightest Gold Standard 101. This gold-star standing says a lot about how the company recognizes, respects, and treats its employees.

“The different perspectives of employees can influence how a company performs. At HealthEdge, we help to foster diverse perspectives, acknowledge religious and cultural differences, and reflect on daily needs and preferences,” Katie noted. “We want HealthEdge employees to feel excited about work. We want people to lean into flexibility, learn the product, and ensure everyone has the necessary tools and resources to be successful at our organization.”

At HealthEdge, we find ourselves in a unique position during these difficult times. We are incredibly fortunate that our employees were able to move remotely overnight and our open positions remain active; in fact we are growing and adding new positions For the second time in less than two months, we welcomed our second full new hire class of five; the first having eight.

While we would all agree it is not ideal, it’ s certainly hopeful that we continue to grow and thrive even under such circumstances. We know this story of ‘business as usual’ makes us incredibly lucky and we are grateful to be resilient in these times.   If you or others have been impacted by job loss during COVID-19, we encourage you to connect and check out our healthedge.com/careers page.

Katie Conti is a senior talent acquisition professional with 20 years of experience with resource management and recruiting. She is currently focused on building a diverse, robust five-star healthcare IT talent pool at HealthEdge. Katie’ passion for building teams and impacting culture with every hire is evident.

With constant change in the healthcare sector, our customers have always relied on us to follow through, help them with opportunities and challenges, and deliver value and results. Building trust with our customers is our number one priority.

The impact of the COVID-19 pandemic is far-reaching. The federal and state officials’ guidance and regulations related to COVID-19 testing and treatment had many health plans adapting while operating in a new work environment. Health plans also needed to quickly enact policies and procedures that transformed payment models, authorization requirements, and state-specific waivers, while also paying providers who were treating patients in unique ways and with new coding requirements.

HealthEdge customers can rapidly implement configuration changes—which was paramount during the global pandemic. We quickly provided guidance on how best to address shifting governmental regulations using the capabilities our customers already had. HealthEdge partnered with our customers to ensure that their operations could continue smoothly amidst all the changes impacting members and providers.

The ability to respond to the myriad of operational and clinical changes caused by the pandemic is allowing our customers to stay focused on and the critical mission of providing vital, quality care for their members.

At HealthEdge, we are fortunate to have the capabilities and resources in our remote work environment to help keep our customers’ businesses running, no matter the circumstances.

In my 25-year career, I have found that strong customer relationships, built on transparency and trust, are crucial to success in healthcare. And this is just one example of how we have proven that our customers can trust us in a time of crisis. In many ways, HealthEdge is at the core of a health plan and how it serves its members. For our HealthEdge customers, we are their partners in success, and here to help overcome challenging times.

Want to know more about HealthEdge, email me or follow HealthEdge on LinkedIn.

This edition of ‘the Edge Report is authored by Chris Conte, Chief Revenue Officer. Chris is an accomplished healthcare sales leader and is responsible for ensuring the successful growth of the company. Chris has over 20 years of Industry and Sales Management experience in progressive and varying leadership roles. He began his career in Federal Law Enforcement.

The international COVID-19 outbreak has introduced unforeseen changes and uncertainty to all parts of our lives. HealthEdge is taking the health of our employees, customers and communities seriously and like many other businesses across the country, we’ve told our staff to work from home exclusively and replace travel with virtual meetings to help reduce the spread of COVID-19. During this time, we’re committed to helping our customers run their business, and we are ready to assist in resolving real-time, business-critical challenges.

HealthEdge’s Commitment to Customers 

The international COVID-19 outbreak has introduced unforeseen changes and uncertainty to all parts of our lives. During this time, HealthEdge wants you to know that we are here for you and committed to helping you continue running your business as you work with your providers and members.  We understand your business may be unusually impacted, for example by the increased need for healthcare services, putting additional strain on your resources. We are ready to assist you. Every day, customers rely on us to help them rapidly resolve real-time, business-critical challenges and COVID-19 does not change our ability to provide those critical capabilities.

Employee Focus

We take the health of the community and our employees seriously and are following the advice of medical experts and local authorities regarding steps we can take to help reduce the spread of the virus, such as social distancing. We have told our staff to work from home exclusively, and this policy will continue to be evaluated. We’ve also directed our employees to replace travel with virtual meetings during this time.

Agility and collaboration have been the focus at HealthEdge in our culture and how we approach our day to day support commitments.  Our staff are all deployed with equipment and toolsets that enable them to work effectively remotely.  Employees are trained in the use of video conferencing tools for virtual meetings to ensure our collaborative work focus for our customers continues.  Our internal support teams continue to support our customers 24x7x365, managing and monitoring any critical events that may occur.

We believe it’s our duty to play a role in reducing the spread of COVID-19, and precautions like these are in the best interest of our employees, their families, and the communities in which they live.

Crisis Management

The senior management team at HealthEdge is meeting daily to assess all aspects of the crisis and ensure that our resources are deployed to help you continue managing your business.  Please address any concerns to your Account Executive as we work through this unprecedented situation.

Changing CMS regulations, benefits and challenges of narrowing provider networks, tapping front-line staff to share the pulse on Medicare Advantage membership, and innovative consumer-focused benefit plan design top the list of key insights shared at the recent Health Plan Alliance Medicare Advantage Product and Implementation Fly-In. As an HPA business partner and silver sponsor of this event, HealthEdge, along with several member plans, shared insights and best practices drawn from the successful implementation and support of health plans leveraging the HealthRules solution suite for MA lines of business.

While a wide range of topics were discussed during the two-day event, below are the most compelling takeaways we’re actively talking about with health plans:

CMS loosening allowable provider marketing regulations. Plans can now co-brand materials with their provider networks and this is making inroads.  Tapping these new regulations contributed to one plan’s Medicare Advantage business growing by 37 percent last year. Providers can now conduct sales activities, distribute materials, answer questions on plans – including cost sharing and benefit information – and can refer patients to other sources of information, including marketing representatives. Additionally, marketing materials may be distributed and displayed in all areas of the health care setting. In the Fall, Medicare Advantage enrollment windows will compete with a plethora of political messaging in this election year. This will be particularly true if a publicly floated Medicare For All option gains momentum and lands on a political party’s platform.  As a result, loosened marketing rules will mean health plans will work harder and experience a longer duration by which to ensure they are capturing the attention span of people from Labor Day to Election Day, which directly competes with their open enrollment window.

Pros and cons of narrowing or expanding provider networks continues to be debated.  Some data indicates provider networks are indeed narrowing; however, only anecdotal data surrounds this hypothesis. While the average consumer may not fully understand the intricacies of a provider network, health plans with a Medicare Advantage line of business wrestle with the perception that a narrower network may mean longer wait times, less access, and less consumer choice. Some health plans believe a narrower provider network may create cost savings through tighter coding controls, improve quality improvements, and reduce system leakage by pushing providers to use designated facilities. The data suggests most five-star Medicare Advantage plans have narrower provider networks.

Medicare Advantage health plans continue to conceptualize and operationalize innovate, supplement plan design. Involving a cross-functional approach to plan design, health plans are looking to all for input into member pain points. Coders offer insight into how one benefit may seem to be a “sell” only to share it could offset another code, thus being a detriment. Operations and configurations staff are critical in benefit design. Call center representatives and the data points they collect are instrumental. Some plans utilize a member consumer advisory board but struggle with a lack of governance. Others are using a member and provider council with membership strategically selected across demographics and satisfaction levels. Listen to HealthEdge’s webinar, SDoH: A Payer’s Strategic Advantage on-demand to learn about some existing operationalize programs.

Local and regional plans are building relationships with community-based agencies so they can link members to services. Social service coordinating agencies are there to create linkages and yet many health plans are not fully capitalizing on these to create a more positive customer experience. One health plan is considering the Disney Fast-Pass® experience by giving expedited appointments to in-network providers. Health plans are reaching deep into the community to leverage these relationships. Training and education of the customer service call center representatives empowers them to solve problems directly, which correlates to satisfaction levels – the greater the ability to do this, the happier the beneficiary.

Looking for additional Medicare Advantage resources? Check out our 2019 Voice of the Market Survey: Health Plans are Riding the Wave of Medicare Advantage Plans, a survey of over 200 health plan executives working in the Medicare or Medicare Advantage and found insurers are focused on growing those lines of business faster than traditional Medicare.

At the recent Medicare Advantage Leadership Innovations conference in Phoenix, AZ, individuals from health plans, health systems, provider organizations, community-based organizations (CBOs) and providers of technology platforms and services gathered to share information, insight and ideas on a wide variety of factors that impact the success of Medicare Advantage lines of business.

In sessions throughout the conference, it was clear one of the primary elements to success is addressing social needs that support timely, scalable, and cost-effective delivery of Social Determinants of Health (SDoH) programming, including accessibility, affordability, willingness to exchange information and infrastructure support to sustain meaningful change.

As an Educational Underwriter for the conference, HealthEdge moderated the panel, “Social Determinants of Health — Focus on Implementation & ROI,” which featured an esteemed group of executives sharing insights and supporting metrics on how their organizations address patients’ social needs to improve health outcomes and reduce costs. Here are our key takeaways from the discussion.

Implementation and ROI of Addressing Social Needs in Medicare Advantage

Catherine Macpherson of Mom’s Meals shared several benefits her organization has seen after addressing food insecurity and condition-related nutrition – particularly when combined with home-delivery of meals, including:

• 50-70% decrease in admissions associated with proper nutrition after a hospitalization – a 7%-50% decrease depending on population
• Shorter length of stay on readmissions – 25-50% reduction with 37% faster discharge and 30-Day Readmissions reduced 25-50% depending on population
• Better control of conditions – particularly COPD, renal and diabetes.
• The more conditions a person has, the greater the benefit from addressing sdoh needs
• Lower monthly average healthcare costs 30-40%

As was shared by every other panelist – and also in other sessions at the conference – Catherine emphasized that the benefits and ROI of investing in social determinants as a means to improve health outcomes and lower overall costs is in the early stages with much study and analysis to be done.

Patrick Finnerty of DentaQuest shared with the audience, “You can’t have good overall health without good oral health,” and emphasized that people who’ve receive good preventive oral services have much lower overall healthcare costs – particularly with conditions like diabetes, cardiovascular disease and stroke – among others.

Patrick went on to highlight how many social determinants of health impact oral health – particularly the intersection of Age and Income. Further, he shared that regardless of plan type, emergency room visits for dental issues typically result in administering an antibiotic and painkillers but nothing else, leaving the underlying cause untreated. And prescriptions for painkillers can add to the opioid crisis.

Amanda Hazer shared how Oscar Health engages its members via a digital app to solicit information and collect data on member needs in a structured fashion. Oscar Health has a 45% engagement rate in collecting information on its member needs via its digital app, with food and nutrition (25%) most frequently cited as concerns. To help address these concerns, Oscar Health uses the following approaches:

• Enhancing in-house data with data from partners and other 3rd parties
• Coordinating referrals, data exchange and closing the loop through partners/CBO’s
• Equipping caregivers and “people in the field” with the right information and tools.

The value of all stakeholders to see the full spectrum of services the individual has received and is currently receiving cannot be understated.

Now, understanding who’s best positioned and able to address member needs, who has the resources, and the true ROI of addressing social factors impacting health outcomes and costs was a big theme in the insights shared by Kevin Moore of United Healthcare.

Kevin focused on how the movement to address social determinants of health by health plans and providers is increasingly touted as synonymous with lowering costs and improving health outcomes. And that data collected over recent years has raised indications of the need for more research on clinical outcomes, establishing metrics to measure those outcomes, and the importance for health plans and provider organizations to support CBO’s and other 3rd parties through supportive infrastructure and information exchange. Experience with investing in housing for people with chronic illness, severe mental illness and Substance Use Disorders – particularly opiates can result in a huge decrease in claims expense of 45% to 55%. Yet providers and payers need to account for investments in rent and wrap-around services being made. Since Medicaid may not reimburse these expenses, a more realistic ROI – at least in this single housing example – may result in a more realistic 10-22% savings in the total cost of care.

Social Determinants of Health Examples and Common Themes

The panelists in this and other sessions at the Medicare Advantage Leadership Innovations Conference shared great insights and best practices for Medicare Advantage stakeholders to address Social Determinants of Health and other critical initiatives and priorities.

As more and more Medicare Advantage plans embark on SDoH strategies, we’ve distilled the following three key takeaways to keep in mind when rolling out these programs at your organization:

• Focus on Targeted Populations: It’s no longer practical or cost-effective to think all individuals and their healthcare and social needs can be addressed via a single program. And Medicare’s ‘uniformity of benefit design’ regulations recently offered by Medicare are demanding increasing flexibility in targeting specific conditions and populations.
• Supportive Infrastructure and Information Exchange is Key to Positive ROI: Beyond the practical demands of establishing a closed-loop referral and reporting ecosystem, CBO’s and other important 3rd party service providers can struggle to accommodate demand for sdoh-related services. Infrastructures and data exchange processes may become unsustainable operationally. Supporting CBO to CBO referrals is key.
• Get Upstream to Address Social Determinants of Health: There can be long and complex causal pathways linking these SDoH factors with health; often with multiple intervening factors. All stakeholders must understand address specific populations and different geographies of individuals may require different services.

To learn more about Social Determinants of Health examples, listen to HealthEdge’s webinar, SDoH: A Payer’s Strategic Advantage on-demand.

Contact us to learn more about how HealthEdge can help your organization address this rapidly evolving opportunity in a value–based care environment.