Health Plans - The Modern-Day Tortoises

The age-old fable of a tortoise and a hare gave us a strong message that slow and steady wins the race. However, in today’s digital world, where businesses race to acquire customers, does it still stand true?

Who’s the Hare and the Tortoise?

With digital disrupting businesses, industries can be identified as hares and tortoises in the digital race. Industries such as Media, Retail and Banking can be identified as the hares of the digital race*. These industries leveraged digital at an early stage and altered their service delivery models, offering services to customers beyond the limitations of time and place. The tortoises, however, are the process-oriented industries such as Healthcare, Energy, Logistics, and others, which are just beginning to adopt digital technology.

In the era of enhanced member experience, patient-centricity and increased provider network, Healthcare Payers cannot bank on this adage. To thrive in the digital race, Health Plans need to jump over the hurdles:

• Health Plans in Silo– With multiple departments such as Configuration, Operations, and Credentialing working on disparate systems, it results in duplication of work and lower productivity. Lack of an integrated system across departments leads to broken processes, low transparency and unintentional delays.
• Members in Distress– The tech-savvy members are used to anytime-anywhere services. However, Health Plans still favoring manual handoffs and physical documents leave members confused, offering low accountability and ‘less-than-expected’ member experience.
• Providers in Turmoil– Provider contracting remains a document-heavy process with multiple administrative overheads such as access, printing, and validation. Also, multiple levels of negotiations lead to multiple draft versions and various state policies further, add to the complexity.

And, if all these were not enough, compliance remains as one of the biggest challenges with myriad rules and regulations coming into play.

Make Way for the Modern-Day Tortoise

In the older version of the story, the tortoise with his steady efforts, and because of the hare’s negligence won the race. However, in the modern-day version, the tortoise analyses his capabilities, strategizes for the race and ensures his victory by using a hoverboard.

Just like the modern-day tortoise, Health Plans also need to analyze their business needs and leverage technology that empowers with the right mix of automation and human intervention. Digitized processes backed with agile workflows and content management capabilities are critical for a modern Health Plan to cater its members’ needs. A Business Process Management (BPM) platform with its agile workflows, extensive integration and exception handling capabilities can facilitate Health Plans to transform and enhance their service delivery model.

Here’s how BPM can ensure victory for Health Plans:

• Streamlined Appeals and Grievances – Don’t let your appeals and grievances process hurt your star-ratings anymore. Make your members smile with real-time updates, timely and effective resolution of cases. Capture complaints from multiple channels and fast-track resolution through auto-routing and auto-prioritization of cases.
• Simplified Provider Contracting – Provider contracting is no more a back-end operational activity, but a business lever. Gain the competitive advantage and speed by streamlining the end-to-end contracting process from contract creation to termination.
• Mobile Enrollments – Enhance members’ enrollment experience by eliminating errors and irregularities in your enrollment process. Empower your field executives to capture information on-the-go, auto-validate data, and drive contextual member interactions.
• Faster Claims Processing – Leverage BPM’s extensive integration capabilities to integrate with core systems and optimize claims processing. Consolidate critical information, enable faster and accurate claim settlements, leading to greater customer satisfaction and adherence to regulatory mandates.

Well, it’s time for Health Plans to take the winning leap with BPM and ensure victory in the Digital race.

*https://www.bcgperspectives.com/content/articles/transformation-large-scale-change-technology-business-transformation-how-jump-start-digital-transformation/