Healthcare Payer Digital Transformation: 3 Critical Key Performance Indicators

December 1, 2023

Amy Kelly

Measuring your Success

Undertaking a healthcare payer digital transformation, such as migrating to a new CAPs or Care Management System is one of the biggest business transformations you might ever be involved in. With change and impact of this magnitude, it’s critical to constantly monitor the success of these changes.

This kind of change is a marathon, not a sprint. It requires ongoing measurement and optimization. Be prepared to measure your progress so you can quantify success and know when to pivot. To do this, organizations must identify what is important to them and set target goals.

Top 3 Measurement Metrics:

1. Legacy Benchmarks

Know your legacy KPIs. Consider initial KPIs to legacy such as transaction turnaround time, auto adjudication rates, authorization turnaround time, claims backlog, etc. Good questions to ask include:

Are your auto adjudication rates better than your legacy rates?
Are you getting better than average auto adjudication rates?
Are you able to measure customer satisfaction and tie it back to specific improvements you’ve made? Such as faster access to information for your customer service teams or a better member portal.
Have your authorization turnaround times improved?

2. Project Metrics During Implementation

Monitor project metrics weekly so that you can adjust proactively based on what your project is trying to achieve. Include KPIs to benchmark project metrics such as on time, on budget, in scope and employee satisfaction. If a project metric is go-live by end of year, that will affect project decisions such as adding additional scope or functionality that is not needed day 1.

3. Ongoing Quarterly Operational Metrics

Keep your metrics front and center. Use them to motivate the teams, adjust, and improve.

Top 3 Measurement Mistakes:

Don’t make these common mistakes:

1. Unable to prove it.

Take the emotion out of evaluating success. Stick to the facts. Don’t rely on ‘trusting your gut’. Determine how the metric will be calculated, how often and by whom.

2. Perception over Reality

Let the data tell the story, measure the project health and guide changes. If you miss the target, determine the reasons why and create an action plan to get you back on track.

3. Getting Complacent

Stay vigilant and adjust as needed. Your business will evolve – keep pace.

Sample Measurement Dashboard

Showcasing your KPIs on a dashboard is a quick and easy way to showcase your progress on your digital transformation journey and rally your team. Share it with the project team and wider organization to bring everyone along on the transformation journey.

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.

Join us for the rest of the Healthcare Payer Digital Transformation series