Maximize Operational Efficiency to Overcome Regulatory Change

Healthcare is evolving at a rapid pace, and teams are constantly pushed to achieve new standards set by state and federal agencies with limited resources. Regulatory changes, fragmented data and tedious manual processes complicate workloads for teams and make it difficult to focus on their important work of guiding members along their healthcare journeys. By reducing burnout, improving employee engagement and improving staff satisfaction, businesses can improve revenue by up to 50%.

Resolve these roadblocks and enable teams to focus on developing innovative strategies for improving member engagement, experiences and health outcomes to achieve plan goals.

Impact of Staffing Challenges

Stronger employee engagement supports stronger member engagement. When equipped with the right tools, insights and strategies, teams can conduct creative member engagement campaigns to address member challenges while meeting new regulatory requirements. Gallup reports that highly engaged teams drive a 23% increase in profitability by addressing consumer needs, increased productivity and more streamlined operations.

Unfortunately, teams are limited in how they can engage members due to operational challenges. Meaningful member engagement requires data-driven, coordinated outreach that continuously move members along their health journeys, but teams face daily barriers in delivering these experiences due to:

• Stricter budgets: As the Centers for Medicare & Medicaid Services (CMS) increases scrutiny around risk adjustment reimbursement and Star Ratings performance, health plan budgets are expected to tighten, if not decrease. Teams are unlikely to receive new staff to offset current workloads and achieve higher performance targets with limited resources.
• Point solution fatigue: Dividing surveys, analytics, outreach and chronic condition management across point solutions leaves teams struggling to manage multiple programs at once. Manually aligning these different solutions places a large amount of pressure on staff that can contribute to employee dissatisfaction and burnout.
• Disparate data: Breaking down data silos is a time-consuming, tedious process that puts significant strain on staff. As researched by the Harvard Business Review, team members who are forced to collaborate across departments and vendors to collect data sets experience higher rates of burnout. Finding ways to automate data consolidation reduces burdens on staff and streamlines analytics.
• Complicated spreadsheets: Fragmented data and incompatible point solutions make it difficult to access a complete view of member journeys. Time that should be spent on coordinated engagement strategies is instead used to stitch together reports across multiple platforms, software and dashboards.
• Complex regulations: Increased regulatory scrutiny towards risk adjustment, health equity, prescription drug prices and CAHPS require the full attention of teams to overcome, but few have capacity to fully understand and address these changes.

All of these factors contribute to member engagement strategies that have a limited impact on plan performance, member experiences and health outcomes. Without the right data to support campaigns or the right dashboards to coordinate outreach, teams struggle to create personalized member experiences and address performance goals. As a result, members often receive duplicative, generalized outreach from multiple departments that contributes to poor health outcomes, negative plan perceptions and higher costs.

At the end of the day, better member engagement requires informed, supported and motivated teams. It also requires the right partner, technology and expertise. Clearing these challenges enables teams to focus their unique skills and knowledge on innovative engagement strategies.

Keep Teams at the Top of Their Skillsets

The healthcare industry requires every staff member to specialize in a specific area while also staying up to date on new regulations, best practices and innovative solutions. Helping teams perform to the best of their abilities starts by looking at ways health plans can streamline daily operations.

“Health plans have hired some of the best and brightest in the industry, but teams cannot overcome challenges with fragmentation and evolving regulations unless they are equipped with the right data-driven technology tools and processes,” says Kent Holdcroft. “Working from a centralized platform allows teams to coordinate personalized engagement strategies to address multiple performance targets without getting preoccupied by tedious, manual tasks.”

The more automated, organized and integrated plan operations are, the fewer roadblocks teams will encounter in their workdays. This frees up time to focus on solving bigger performance pain points, such as controlling medical loss ratios (MLR), advancing health equity, improving Star Ratings and increasing risk adjustment revenue. These types of challenges require critical thinking and problem solving, which re-engage employees in their roles and reduce turnover.

Key areas plans should focus on are:

• Consolidated data: Unifying member data into a single platform enables teams to capture a complete view of member records without the need for manual silo busting processes. Keeping all data in one location informs smarter analytics, more coordinated outreach strategies and faster responses to plan challenges, like open care gaps or negative CAHPS experiences.
• Coordinated outreach: Each team has a different priority when engaging members, which can lead to a lot of overlap and costly messaging. Getting a complete view of all member touchpoints allows teams to reduce unnecessary outreach and focus on the next big task.
• Scalable personalization: Personalization demands a significant amount of time and attention to manually develop but scaling it across larger and complex populations is possible with the right integrations. By first aligning member data and outreach into a single platform, teams can quickly segment populations by similar data points to quickly develop personalized member journeys.
• Industry expertise: Teams are equipped with unique skills and knowledge, but no one is an expert on every aspect of healthcare. Partnering with the right regulatory experts, thought leaders, behavioral scientists and content strategists can help teams quickly gain access to a wealth of knowledge and get up to speed on new regulations.

Through Healthmine’s Quality Relationship Management^TM (QRM®) integrated platform, teams gain access to all of these features and capabilities. QRM aligns data, outreach and plan goals to empower teams to conduct meaningful member engagement at scale. Designed to fit health plans’ evolving priorities, teams can customize their QRM experience to address immediate needs while optimizing budgets and reducing reliance on point solutions.

Your teams deserve the best member engagement tools on the mark. Equip them with QRM and accelerate plan performance with fewer operational burdens. Contact us for a demo.