Want to Enhance Your Health Plan Technology Systems? Start with an Optimization Assessment
Optimizing healthcare technology solutions is no longer just a nice-to-have—it’s a strategic move that can drive significant improvements in efficiency and cost saving. From reducing operational costs to improving member and provider experiences, well-executed technology optimization can deliver measurable benefits across your organization.
But how do you unlock the full potential of your digital solutions? Where do you even start?
The first—and most crucial—step is an optimization assessment. Designed to evaluate your current system setup and workflows, an optimization assessment identifies opportunities for improvement in your workflows and technology use, helping ensure your business maximizes the value of its technology solutions.
This blog will address common questions about optimization assessments and provide guidance for health plans considering technology optimization initiatives.
What Is an Optimization Assessment?
An optimization assessment is a detailed evaluation of your digital solutions, such as Core Administrative Processing Systems (CAPS) and Care Management. With the help of expert teams, an optimization assessment identifies potential pain points and recommends best practices to maximize your technology investment.
Key outcomes include enhanced system performance, more streamlined workflows, and empowered end users who understand how to best leverage the tools available to them.
But how exactly does this benefit your organization?
How Can My Health Plan Benefit from an Optimization Assessment?
Optimization assessments aren’t just about fixing what’s broken—they focus on empowering health plans to better leverage the solutions they already have to achieve their strategic goals. Here are three ways these assessments can create value for health plans like yours:
1. Increase Operational Productivity
By conducting a deep analysis of your current workflows and system setups, optimization assessments help identify inefficiencies that may be slowing your team down. Perhaps processing times are lagging, or manual workarounds have crept into daily operations. Through customized recommendations, experts can help your team work more efficiently, reduce manual input, and improve overall productivity.
2. Leverage New Functionality and Updates
Technology evolves rapidly—especially in the ever-shifting healthcare industry. With each new product release, features and capabilities are updated to keep your organization on the cutting edge. An optimization assessment ensures that your organization continues to get the most value out of its HealthEdge solution as it grows and evolves.
3. Empower End Users with Training
Your system is only as effective as the individuals who use it every day. A key component of optimization assessments involves engaging directly with end users, addressing process gaps, answering their workflow questions, and providing targeted training. The result? A more confident, knowledgeable workforce that can leverage your technology more effectively.
What Types of Optimization Assessments Does HealthEdge® Offer?
HealthEdge offers two key types of optimization assessments tailored to address your specific organizational needs. Whether you require laser-focused insights on a particular challenge or a broad system evaluation, there’s an assessment type designed for you.
Targeted Assessments
Targeted assessments are designed to investigate and solve specific issues within your systems, such as:
- Addressing low auto-adjudication rates
- Streamlining care coordination
- Improving the end-user experience
The findings and recommendations you’ll receive focus entirely on resolving the identified issue, outlining actionable steps that can be implemented quickly for measurable improvements.
Comprehensive Assessments
Comprehensive assessments take a holistic approach by evaluating your entire HealthEdge solution, including configurations, workflows, and user processes.
Many customers choose to conduct a comprehensive assessment three to six months after implementing a new HealthEdge solution. Why? It provides an opportunity for payers to make usage adjustments, refine workflows, and focus on additional training as part of the broader optimization process. Optimization assessments can also serve as a vital step in preparation for new strategic initiatives, like expanding into different markets or serving new member populations.
3 Steps of the GuidingCare® Optimization Assessment
When it comes to GuidingCare, the care management solution from HealthEdge, optimization assessments follow a structured three-step process for maximum impact.
Leadership Alignment Meeting: We start by meeting with your leadership team to align on key goals, identify specific areas of improvement, and establish expectations for the assessment.
End-User Group Sessions: Next, we engage directly with your end-user groups—such as care management, utilization management, medical directors, and others. These sessions involve day-to-day process observations and workflow evaluations, identifying opportunities for optimization and training.
Recommendations and Follow-Up: A detailed report outlines the findings discovered during the assessment, with actionable next steps to address gaps and enable improvements. Then we coordinate a leadership session to review the insights and assist your organization to formulate an action plan and ensure alignment moving forward.
5 Steps of the HealthRules® Payer Optimization Assessment
For HealthRules Payer, optimization assessments use a five-step methodology designed to uncover inefficiencies and improve outcomes more broadly across the organization.
Preparatory Meeting: We work with your health plan’s leadership to define the business problem and set expectations with project sponsors and stakeholders.
Project Startup: Using information from the initial meeting, we determine the scope of the assessment and align stakeholders on deliverables through a structured work plan.
Workflow Assessment: At this stage, we interview subject matter experts, collect and review system and workflow data, and evaluate configurations and resource inputs impacting performance.
Operational Analysis: Our team conducts a SWOT analysis to identify gaps, pain points, and configuration improvement opportunities.
Health Plan Recommendations: The final report provides key findings and recommended action items. We review the benefits and impact of suggested improvements and outline clear next steps.
How Can Your Health Plan Get the Most Value Out of an Optimization Assessment?
To get the most out of your optimization assessment, preparation and transparency are key.
For GuidingCare Assessments
- Opt for On-Site Assessments: Whenever possible, conduct assessments on-site. This allows for direct observations of user workflows and tools for a richer understanding of challenges and potential improvements. For remote assessments, your health plan may have to make additional preparations.
- Pre-Visit Preparation: Collaborate with HealthEdge to collect necessary data, align department representatives, and coordinate schedules beforehand to ensure a smooth process.
For HealthRules Payer Assessments
- Define Clear Outcomes: Our team will work with your leadership to define the scope of the engagement, assess and evaluate your current systems and workflows, diagnose any problems or issues, and deliver a report of key findings and recommendations.
- Focus on Transparency: Provide full and accurate data on pain points, KPIs, and areas for ROI estimates to better enable HealthEdge to effectively diagnose issues and deliver impactful recommendations.
Move from Optimization to Transformation
An optimization assessment isn’t just about improving the technical side of your system—it’s an opportunity to align your technology and processes with your broader business goals. By streamlining workflows, empowering end users, and keeping your organization ahead of technology trends, optimization assessments unlock both immediate and long-term benefits.
Still on the fence? HealthEdge’s proven track record includes transforming inefficient workflows, enabling features that reduce operational costs, and boosting overall system performance for health plans just like yours. By leveraging an optimization assessment tailored to your needs, you’ll not only maximize your existing technology investment but also set the stage for sustainable growth.
To learn more or schedule your assessment, contact your HealthEdge customer success executive today. The sooner you begin, the sooner your health plan will reap the benefits of streamlined operations and improved outcomes.
