The forces at play in healthcare are well-recognized and well-understood. Payers need to modernize, but what do you do about it when modernization is such a high risk.
By Michael Brouthers, Chief Innovation Officer, Health Insurers and Payers, CSC
We all know the mega-trends in healthcare: medical advances are delivering new treatments; shifting demographics mean a rise in chronic conditions; and changing patient expectations require a more consumer-oriented approach. Add to that the drive to improve health outcomes and control costs through reimbursement for value approaches, and it’s clear why the pressure is on.
My view is that we’ve reached the end of the road for step-wise efficiency improvement – pretty much everyone has made yesterday’s systems work very well. Being a cost leader is table stakes, and the game now is transformation. That’s a key shift and it needs to be driven by digital innovation. It will take a lot of organizational agility, and it can only happen if the C-suite embraces a Chief Innovation Officer.
The challenge for a Chief Innovation Officer in a payer organization is this: you know there’s a pressing need to modernize your claims system to reflect these new market norms, but replacing a mission-critical system might be the riskiest thing you do in your career. So what’s the right approach? Patch and play? Rip and replace? One thing is for sure, you need to do something.
Here are a few things to think about:
- The winners in the new healthcare ecosystem will be both highly differentiated and highly efficient. This means taking the best systems the market has to offer, then changing them to address needs your consumers didn’t even know they had. This has a lot of implications. Of course it means advancing mobile and multichannel access for members, but it also means participating in the API economy to integrate with the wider healthcare ecosystem and drive coordination. Increasingly, business partners – and even members – will expect to access and interoperate with your systems.
- No matter how good your data analytics are, you almost certainly need to be better at delivering actionable insights for business leaders. That’s not a criticism, it’s a reflection of the incredibly rapid pace of change that’s happening in the world of big data. Payers already have valuable data, but it will be even more valuable – both to drive better care and to reduce per-capita costs – when it’s correlated with other institutionally and personally owned health data.
- This could be the time to shift the business model. Take a look at your Web site and you’ll probably find a range of healthy living resources. Increasing your level of direct digital engagement with members means you can take the lead in driving healthy behavior by directly targeting members with particular needs or risk profiles. That could mean stronger relationships, better health outcomes and lower costs.
If there’s one thing to conclude it’s this: there’s no one standard approach that represents the gold standard any more. Consumer expectations are moving too fast for that.