Healthcare Payer Digital Transformation: Navigating Change Through Strategic Planning

November 13, 2023

Scott Snell

Digital Health Payers turn to technology to help

If you are reading this blog, you are likely somewhere on your journey to becoming a Digital Payer. In fact, you are likely already a digital payer in some areas and continuously looking to optimize and expand your digital transformation.

Five key Digital Payer characteristics:

1. Improving Member Experience

You are working to improve the end user/member experience through access to information and digital tools, maybe through your member portals, price comparison tools, online PCP selection, etc.

2. Reducing Transaction Costs

You are always looking to reduce transaction costs; increasing your auto adjudication rates, eliminating manual intervention in claims processing, digital authorizations, etc.

3. Improving Quality

You are constantly on the hunt to improve quality; in how you operate the business, ensuring your staff is trained and taking advantage of all the ways they can leverage available technology, managing to key metrics and using data to identify improvement areas.

4. Enhancing Service

You are constantly working on improving your services levels; maybe through digital survey tools that allow you to capture data, analyze feedback, and adjust.

5. Increasing Transparency

You are operating your business with transparency; leveraging platforms and digital tools to provide information, self-service, and online collaboration tools to improve communication and information sharing.

Navigating Change

A key factor to consider, regardless of where you are in your digital payer life cycle (thinking about implementing a change, in the middle of an implementation, or actively running your business on HealthEdge) is that you are transforming your business.

The reality is that if we put our “continuous improvement” hats on we never really reach “the end”. This is why it’s imperative that we talk about how critical planning is to success.

Business Transformation is a Marathon…Not a Sprint

Adopting a “Marathon Mindset” is a critical mindset. When you decide to implement a new enterprise software solution, you are initiating one of the biggest business transformations you might ever be involved in. Typically, a health plan will migrate to a CAPs or Care Management system once in a generation

It’s important to prepare the team for a marathon not a sprint…meaning we have got to start to think “continuous improvement” and this approach will serve you regardless of where you are in your digital transformation.

Six Main pillars of Digital Payer Transformation

There are 6 main pillars of a successful digital transformation:

Define your Success
Plan & Prepare
Design the future state
Execute the plan
Measure key performance metrics
Optimize for continuous improvement

HealthEdge & Digital Transformation

By automating business workflows and seamlessly exchanging data in real-time across the ecosystem, HealthEdge customers experience the business benefits of:

Improved end-user experience
Decreased transaction costs
Increased quality
Increased service levels
Increased business transparency

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.

We will be exploring these in depth through an upcoming healthcare payer digital transformation series: