Healthcare Payer Digital Transformation: 3 Keys to Design your Future

November 20, 2023

Amy Bannister

When we think about your digital transformation a key part of it is designing for the future. This is where we examine: what do you want to achieve? Why do you want to achieve it? What will achieving it mean to your members, your staff, and your organization?

You are not investing in this transformation to rebuild your legacy system on a new technology. You are modernizing and improving your business operations, driving increased quality, better service and driving cost out of the transactions. Design based on best practices to meet your goals and objectives. Don’t be handcuffed by lack of feature/functionality of your existing solution – encourage curiosity and question why.

Design for your future: Top 3 Best Practices

1. Organizational Change Management (OCM)

Organizational change management plans are a critical success factor. Invest in this area and focus on communication plans, processes, staffing, and desk level procedures. Ensure the people, process, and technology components are identified and accounted for in the design plan.

Define and deploy strategies for successful user adoption. If the end users are not on board, health plans are unable to realize the full ROI of their investment.

2. Ecosystem Design

Finalize and design your ecosystem in its entirety. Design for goals and objectives and identify workstream leaders that are excited about the future changes. Embrace best practice designs. Remember – the “Just because we’ve always done it this way” mentality won’t deliver a transformation. Instead, ask yourself, “why did we do it this way?” Give yourself the time and space to reflect on why things were done in a certain way and how they can be enhanced.

3. Centered on Goals and Objectives

Design decisions in support of desired outcomes. Reinforce the goals and objectives frequently. Address the fears that people will be replaced with technology. They are being freed from manual processes so that they can use their expertise to focus on things that have a bigger impact.

Design for your digital transformation future: Top 3 Mistakes

Be sure to avoid the following missteps:

1. The “Surprise” Factor

The list of people, processes, and technology changes is extensive. Develop an OCM plan to mitigate risk. Don’t underestimate the data clean up that will be required.

2. Disruption

Changing ecosystem partners will impact data, integrations, timelines, and budgets. Avoid changing key vendors while the project is in flight. This can cause disruption and rework to data requirements.

3. Rebuilding Legacy Workflows

Legacy workflows are not delivering on your future state goal and objectives. Don’t let the notion of ‘perfect’ get in the way of ‘good enough/better’ than today.

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.