Winning the Race to Deliver Seamless Healthcare Experiences

The following is a guest article by William Shea, VP of Cognizant Consulting Healthcare Practice, & Trish Birch, SVP, Healthcare Consulting & Strategy Leader at Cognizant.

Many healthcare organizations have set their sights on delivering holistic customer journeys that seamlessly blend physical and digital experiences. Care, payment, follow-up, referrals. and ancillary services soon will blend into a single, frictionless process that makes traditional boundaries between payers and providers transparent to consumers. This vision stands in stark contrast to the disjointed, fragmented, and inefficient processes that characterize today’s healthcare industry. 

Healthcare’s traditional technology infrastructures are not optimized to enable new value propositions based on the forces shaping the seamless healthcare consumer experience. These forces include interoperable data sets across payer and provider settings, price transparency for medical services, “on-demand” and “healthcare anywhere” care delivery models and real time transaction processing, to mention just a few. Instead, payer and provider core platforms have been optimized to drive value in an industry ecosystem created in an era of proprietary data silos, walled-off adversarial market segments and closed architectures. These outmoded systems now require extensive custom code and manual workarounds to interact with external systems and devices.  

Recognizing this, some large healthcare industry players are jockeying for position, investing in new core systems and platforms that can support frictionless end-to-end consumer experiences. Making the best strategy and investment decisions to succeed in a price transparent, interoperable health industry requires healthcare executives to separate the hype from substance in these offerings. Working through these key questions will help you cut through the market noise: 

  • Will you be locked in? Some healthcare C-suites are initially enamored by the idea of buying a single, integrated end-to-end solution from one vendor. However, this can be a rigid and expensive choice. The monolithic approach puts a healthcare company at the mercy of one vendor’s ability to deliver all required capabilities and makes it more difficult to assemble best-of-breed solutions on open platforms. 

  • How fast can you innovate? Organizations locked into a single vendor’s solution will only be as responsive to market and regulatory changes as their vendor is. Those powered by open core technology can vet and integrate new apps, devices and solutions as fast as the marketplace develops them. 

  • How comfortable are you with a competitor powering your business? The large national health insurance carriers that have diversified into launching platform and technology operations still maintain their core insurance businesses.  It’s important to ensure that vendors separate their new platform and technology services from the core businesses on which they may compete against their customers, e.g., health insurance and care delivery. 

Evaluating open core technology 

Many healthcare organizations want to modernize while still getting value from their existing technology investments, data stores and experience and knowledge. That flexibility is possible with core technology that has an intelligence layer that can absorb, integrate, orchestrate and act upon data from sources across the ecosystem. Using core environments with open, standards-based APIs, business logic and workflows, organizations can assemble best-of-breed applications and tools to create experiences specific to their member and population health needs. 

Other key qualities to look for in core technology include: 

  • Real-time change capabilities fed by insights and recommendations from inside and outside of the system. Both internal audiences and members/patients should have access to the insights for making decisions, from comparing prices to checking quality ratings of providers for a specific procedure.

  • Support for next-generation payment models including outcomes-based benefit and contract designs, bundled services, reference pricing, provider incentives and real-time adjudication and payment. As data barriers fall, systems increasingly will need to fully integrate claims and medical data with specialty, pharmacy, and non-medical health services. 

  • Event-driven insights and automation to publish data generated from EMR, claims and other processes in real time so it’s available throughout an organization’s application ecosystem. Using AI, organizations can then make key processes predictive and automated, such as an ML-based review of rejected claims that then approves those meeting a specific threshold.

Healthcare organizations’ core technology strategies will influence how effectively the industry shifts to value-based models that promise improved outcomes and frictionless experiences at lower costs. The interoperability regulations enable industry players to converge their data sets and use analytics to identify care gaps and social determinants of health. But friction points and outright obstacles among payers and providers with obsolete core systems are slowing realization of these benefits. 

Organizations that embrace open core technologies will be well positioned to tap the power of the emerging health ecosystem and its fluid data flows to deliver the end-to-end health experience consumers want. Those that lock in with one vendor may perpetuate traditional industry barriers, which ultimately will hurt their ability to compete.

About Trish Birch

Trish Birch is Cognizant’s Healthcare Consulting and Strategy Leader, responsible for working with the extended Healthcare Leadership Team to develop and execute a multi-year strategy aimed at growing Cognizant’s leading position in the Healthcare industry. In addition, Trish leads Cognizant’s Healthcare consulting practice serving providers, payers, and other companies across the healthcare industry. Trish has more than three decades of experience in strategy and management consulting.

About Bill Shea

William “Bill” Shea is a Vice-President within Cognizant Consulting’s Healthcare Practice. He has over 20 years of experience in management consulting, practice development and project management in the health industry across the payer, purchaser and provider markets. Bill has significant experience in health plan strategy and operations in the areas of digital transformation, integrated health management and product development.

   

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