Achieving Operational Efficiency and Effectiveness with Digital Transformation Technology
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This document discusses how digital transformation can help achieve operational efficiency and effectiveness in healthcare payers. It describes how legacy systems, manual processes, and rising costs are driving the need for digital transformation. New approaches like workflow automation, integrating clinical and financial data on new software platforms, and low-code application development can help drive cost savings and efficiencies. However, two-thirds of digital transformations fail due to barriers like outdated culture and skills in IT organizations. The document advocates using a low-code platform approach to accelerate digital transformation across various functions like provider data management, utilization review, and claims modernization.
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Achieving Operational Efficiency and Effectiveness with Digital Transformation Technology
- 1. Achieving Operational Efficiency and Effectiveness with Digital Transformation Technology Scott Polansky | Practice Lead, Healthcare Payers AHIP Institute | June 8, 2017
- 2. About Appian 2 • Appian provides a leading low-code software development platform that enables organizations to rapidly develop powerful and unique applications. The applications created on our platform help companies drive digital transformation (DT) and competitive differentiation • Headquartered in Reston, VA • 18 year history
- 3. To succeed, every company must become a software company. “Software is eating the world.” 3
- 4. What’s Driving DT for Healthcare? 4 • Reliance on legacy systems requiring significant customization • Prevalence of manual processes • Member expectations for mobile capabilities • Growth of IoT • Rapid pace of regulatory change
- 5. What’s Driving DT for Healthcare? 5 • Unsustainable cost increases • Administrative complexity • Need to gain a competitive edge • Division between IT and business owners
- 6. Historical Drivers of Cost Reduction and Operating Efficiency • Provider owned payers • Plan mergers and consolidation • Contracting strategies and reimbursement models • Pricing and underwriting strategies • Traditional Business Process Redesign 6
- 7. New Approaches to Achieve Cost Savings and Operating Efficiencies • Enhanced workflow automation • Technologies to integrate clinical and financial information • New software platforms – PaaS, SaaS • Low-code application development • Cloud computing • AI and Robotic Process Automation = DIGITAL TRANSFORMATION 7
- 8. Existing systems consume 80% of IT resources Insufficient agility Silos Scarce developer resources 8
- 9. Two-thirds of digital transformation projects end in failure. Harvard Business Review, July 2016. 9
- 10. IT Organizations Face Significant Barriers - They are on their own journey of transformation 10 COMMON IT ORGANIZATION BARRIERS TO LEADING DIGITAL TRANSFORMATION People We do not have enough people with the right skills Culture We do not have a risk taking, innovation culture Legacy Systems We have legacy systems to support that consumer our efforts Incentive Systems Our current evaluation system does not measure us on innovation 32% 25% 27% Source: IDC IT Executive Survey, Jan, 2016, n=103 Partnerships Our LOB peers do not perceive us as adding value in DX Leadership Our IT leadership does not have the right vision 8% 5% 2%
- 11. Digital Transformation is not Single Threaded Case Management Business Process Management Low-Code Digital Transformation Platform
- 12. Accelerating Digital Transformation Governance, Risk & Compliance Master complex compliance requirements and manage global risk. Customer Journey Deliver superior customer engagement in sales, marketing, and support. Business Operations Drive operational efficiency, maximize employee productivity, and optimize business decisions. 12
- 13. Functionality Requirements Monitor Complex event processing for real- time tracking, analysis, and response Report Comprehensive visibility into business operations Optimize Self-optimizing processes eliminate bottlenecks and inefficiencies Audit Complete audit trails instantly available for all system activities 13
- 15. 15 Challenge Improve ability to manage provider information and accommodate continued growth – Provider data stored in multiple systems – Disconnected standalone contract management system – Arduous credentialing process – Challenging manual on-site auditing process – Poor visibility into provider/member relationships Appian’s Solution Creation of new core systems using Appian’s platform – A single UI to on-board, access and update Provider data – Automated scheduling, task and reporting – A more professional and streamlined process to reduce time to credential new Providers Leverage existing investments, unite disconnected processes & data and deliver Provider Data Management with Appian Case Study: Provider Data Management One of USA’s largest organizations of government-sponsored managed care plans with 6 million beneficiaries
- 16. PwC | BPM Services | page 16
- 17. PwC | BPM Services | page 17
- 18. 18 Challenge Minimize dollars paid out in error due to false approvals, even though they felt they were roughly 98.5% accurate. ➢ Care coordinators took down notes in notepad review on spreadsheets to interpret the rules ➢ Rules in the spreadsheets may not be up to date and differ by geography and plan ➢ Months needed to set up customized accounts Appian’s Solution Reduce handling times and increase quality of decisions using Appian’s platform ➢ Authorization rules automated ➢ Escalations were automatically created and routed ➢ Follow up activities were created for case managers to review cases Case Study: Utilization Management Large multi-state insurer serving 10M+ members Savings of ~$1M/mo 30% increase in productivity and 5% increase in quality
- 19. • Care Management • Encounter Reporting • FW&A • Appeals & Grievances • Claims Modernization • Product Lifecyle Management • Member and Account On-boarding • Legacy Systems & Technical Debt Other Potential Applications 19
- 20. Faster More Agile More Innovative (We make it easy for you to build and run enterprise-grade software.) Appian is the platform for digital transformation. 20
- 21. The Digital Transformation Platform.™ The Digital Transformation Platform.™