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Advancing Care Management Through Digital Transformation

Stuart Myer, Chief Information Officer, VillageCare, a community-based, not-for-profit organization in New York, recently joined HealthEdge leaders Christine Davis, Vice President, Product Marketing and Len Rosignoli, Vice President, Customer Success in a live webinar to share how his health plan is advancing care management through digital transformation. The webinar was hosted by the Association for Community Affiliated Plans (ACAP).

In the discussion, Myer shared real-world scenarios that his organization experienced along its digital transformation journey and explained how every stakeholder in his organization is benefiting today. In case you missed the webinar, here is a snapshot of what the team covered.

1. Industry dynamics and challenges are driving health plan executives to realize that now is the time for digital transformation.

Workforce shortages, regulatory changes, evolving business models, and shifting consumer expectations are pushing health plan executives to seek new ways of reducing costs, improving efficiencies, and investing in innovation. Davis shared highlights from the company’s Annual Health Plan Market Survey that showed the majority of leaders are focused on aligning business and IT teams, as well as investing in innovation and moving to modern technology.

2. Digital payers are leading the way in transforming the industry.

“HealthEdge defines digital payers as those bringing business and IT areas together to create a modern, digital organization that constantly improves health and financial outcomes,” explained Davis. A digital payer can be identified by five key attributes:

  1. Leveraging digital tools to improve end-user and member centricity.
  2. Achieving higher levels of quality to deliver better outcomes for members and communities.
  3. Increasing business transparency, breaking down siloes and improving exchange of information.
  4. Advancing customer service by empowering teams with next-generation solutions.
  5. Constantly reducing transaction costs through automation and connectivity.

3. VillageCare leaders implemented a digital transformation strategy that enabled a more data-driven approach to every aspect of their business, which is driving better care for their community and more efficient operations.

“Using a digital foundation has allowed us to become a data-driven organization that operates more efficiently. We are in it for better outcomes for the community we serve. A more efficient workforce delivers better care,” explained Myer.

Using the GuidingCare® platform from HealthEdge, VillageCare was able to support their top business and clinical objectives in many ways, including:

  • Improving clinical and business operations through integrated work processes
  • Creating a data-driven organizational culture
  • Advancing clinical partnerships through data integration
  • Sharing data with members and clinical partners using industry standards
  • Using best-in-class applications that integrate to create a seamless systems environment

4. Becoming a digital payer transformed experiences for five key groups across VillageCare and the healthcare ecosystem in which they operate:

  • Members: VillageCare consolidated data and streamlined process to better enable a member-centric approach. They migrated disconnected touchpoints (such as finding providers and eligibility, benefits, and cost information), to easy-to-use, self-service tools within GuidingCare. With a frictionless member experience, they increased member engagement and satisfaction, while ultimately improving health outcomes.
  • Providers: The organization transformed their relationship with providers by delivering instant access to real-time patient benefits, claims data, authorizations, and more in GuidingCare’s easy-to-use digital collaboration tool.

“One way we were able to improve the experience for providers was the GuidingCare Utilization Management application that is tightly integrated with the claims processing system,” Myer explained “This process was a big pain point for our staff. Many health plans have staff managing these processes in separate environments, manually entering information into both systems. We solved this problem, and as a result were able to launch an authorization portal. So rather than having providers fax or make phone calls to request authorizations, they can now request them electronically. We also use a claims portal where they can check the claims outstanding.”

  • Member Services: VillageCare streamlined the disconnected workflows that were a result of multiple software systems and improved access to information to transform the experience for their member services teams. With better tools and more accurate, real-time data, member services teams have been able to improve service quality, reduce costs, and improve the member experience.
  • Care Managers: VillageCare also eliminated functional siloes and put accurate, up-to-date data in the hands of care managers to streamline workflows and improve outcomes.

“We aim for integrated, care management processes. Systems should support the work processes, which was not always the case. But through our digital transformation and using GuidingCare, we have much more structed work processes. This frees up our care managers to focus on care management, while also forcing compliance and regulatory adherence through the system. In addition, we now have proper segmentation of membership so that we can develop real-time alerts, improve population health, and direct efforts where needed as opposed to being the same across the whole organization,” explained Myer.

  • Information Technology: VillageCare has consistently focused on aligning business and IT teams to successfully use technology to address priority needs and challenges across the organization. By transforming the IT foundation, they delivered on their goal of becoming a data-driven organization. Now, the organization uses business intelligence to improve operations and deliver better care for members. In addition, through implementing solutions that use interoperability standards such as Fast Healthcare Interoperability Resources (FHIR), they have advanced integrations that allow for more streamlined processes and seamless workflows.

“The transformation has truly changed the way our teams operate, improving the experience for members, providers, member services, care management, and IT. All of these components are part of our digital transformation strategy. It is important to touch each of them and ensure that they talk to each other,” stated Myer.

VillageCare is addressing top challenges facing many health plan leaders today through their digital transformation journey,. They are delivering benefits for key stakeholders across the healthcare delivery systems by improving connectivity, enabling access to accurate data, and streamlining workflows.

Ultimately, the digital transformation is enabling VillageCare to deliver better health outcomes for the community they serve.

Learn more by watching the webinar here.