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4 Risk Management Strategies to Become a Successful Digital Payer

No matter how much your health plan prepares for a new technology integration, unexpected changes often arise. Healthcare market dynamics are always shifting, and health plans must adapt with them. Developing risk mitigation strategies can save your health plan from falling behind in digital adoption and help you pivot to address changes faster.

It is critically important to leverage risk management best practices at the beginning of the process and throughout implementation to avoid and address potential risks. Based on my experiences with customer implementation, I’ve compiled a list of the most common risks health plans face—including successful risk management strategies we’ve applied.

1. Risk: Misaligned Expectations

Lack of engagement from key business & technology stakeholders may result in misaligned expectations.

Mitigation: Establish a formal Program Governance entity for the implementation to facilitate organizational and vendor communication.

Key executive stakeholders should be involved throughout the implementation and onboarding process—including provider representation. Engaging internal leaders helps to expedite decision-making and stay on schedule. If stakeholders are not part of the Program Governance group, your health plan runs the risk of losing organizational alignment.

Health plans can measure involvement and gauge buy-in by ensuring stakeholders are attending and participating in key strategic and educational meetings. How can your plan gain buy-in? Share the value the new solution will bring, and how it helps meet key performance indicators (KPIs). Establishing KPIs up front also helps your team understand how to best leverage the solution to meet their goals.

2. Risk: Delayed deliverables

Lack of scope management processes may result in scope-creep, delayed deliverable completion, missed business milestones, and increased costs to the overall program.

Mitigation: Implement a formal change control process, including a Change Control Board, to review and evaluate all proposed changes to assess their impact on the program timeline, budget, and business objectives.

Every step of the process should be directly tied to achieving key business goals. When a request arises, ask, “Is this a necessary capability, or is it a request based on a legacy concern?” Your plan can also provide a channel to help expedite and escalate critical changes requiring Program Governance reviews and approvals as needed. Implementing a new solution is complex—to keep the process manageable, start by solving the most widely applicable issues and fine tuning for new markets later.

3. Risk: Digital interoperability

Integration issues within the Enterprise ecosystem (such as system compatibility & readiness, solution selection, data quality & exchange, or missing capabilities) will impact end-to-end system verification and operational readiness.

Mitigation: Define integration requirements early in the planning phase and follow test-driven development practices with iterative delivery for early, ongoing cross-solution validation.

During program start-up, identify vendors and solutions that will work with and support the use of the enterprise ecosystem. Even with an integrated solution suite, your health plan will need to utilize third-party technology. Third-party testing and integration after implementation can cause delays and reduce functional efficiency. Reduce this risk by fully testing data exchange and other key digital interactions before go-live.

4. Risk: Undefined objectives

Lack of operational objectives without defined measurement will lead to competing or disconnected business stakeholders within the organization, leading to a failed implementation.

Mitigation: Define KPIs for your organization and the new solution at the beginning of the process so your organization knows what to aim for.

Once you’ve defined organizational objectives, regularly monitor your progress toward these new metrics. This makes it easier to identify when you’re getting off-track and adjust quickly to support your business objectives. As you implement the new ecosystem, continue to monitor KPIs for opportunities to optimize usage and performance to get the most value.

Risk management is a necessary part of implementation and is a dynamic process—risks change throughout the implementation and go-live process. To stay proactive, health plans must develop and maintain risk management strategies to stay on schedule and on budget.

Whether your health plan is replacing an existing CAPS solution or launching a new enterprise product to support an emerging market opportunity, implementation challenges will arise. By applying Risk Management best practices, like assessing potential enterprise blockers from the start and having documented mitigation plans, the chances of a successful implementation are in your favor.