Growth and Business Performance Outcomes

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The best prescription for growing pains

Increasingly, health plans are feeling the squeeze of mounting expectations. They are expected to deliver enhanced care at a more affordable cost and drive value-based care while unfailingly meeting margin and profit goals. As a result, even nonprofit health plans face mandates to meet business performance targets.

Currently, the push toward Medicare Advantage and Managed Medicaid are key growth drivers, but these markets can expand only so far. Astute health plans recognize the wisdom of broadening their growth strategies by leveraging technologies such as artificial intelligence (AI) and targeted automated engagement, digital-first primary care, and telehealth primary care. However, plans may encounter disruptions when making forays into these new business avenues because they require the expense of updating legacy systems.

Additionally, as health plans make the shift from a pay-for-service model to outcome-based pricing, plans intent on growth may find that changing regulatory requirements, which remain a moving target, can have system-wide impacts.

Shifting IT leadership is still another factor. Large insurers are bringing in new leaders, wooing them from other industries for their “hot” new technology skills. Thus, older veterans feel the stress associated with forced reinvention as these unwelcome interlopers threaten to push them aside. It is reminiscent of the brave, new world presented by Six Sigma years ago when younger upstarts upended the more traditional way of managing. Still, today automation, analytics and AI are the new kids on the block. Older leaders can’t readily analyze actionable data without mastery of the requisite skills, so we see personal and organizational disruption. Personal disruption is about skills, and organizational disruption is about technology and strategy.

A bitter pill: new technology requires the latest skills

It’s easy to see that older leaders might be nervous about job security. NTT DATA can help alleviate this anxiety by guiding them in adopting new, very current technology toolsets. They need demonstrable expertise with automation, AI, and analytics to operate at a lower cost than they are paying today. By adroitly shifting their best people and thus introducing efficiencies of scale, as well as importing the right skills, health plans can remain competitive in an increasingly crowded marketplace.

There are three areas on which more traditionally skilled health plan leaders facing displacement must focus:

  1. Adopting new tools across the enterprise and making them part of associates’ everyday life
  2. Shifting resources away from legacy platforms to systems of engagement and new technology
  3. Shifting the way they spend their time from keeping the lights on to those capabilities that enable growth

NTT DATA can help leaders shift resources by applying a build/operate/transfer model that enables them to adopt automation, analytics and AI with fewer people in less time and at a lower cost. Additionally, we can also help reskill plan veterans, so they can set up the new technology themselves and/or run it long-term.

Maintaining plan viability requires pinpointing the existing technologies that still work. This enables health plans to continue to use them without continuing to invest in them. Think of it as home improvement: the best approach to modernization may not be to remodel the kitchen if it is still adequate for current needs. Instead, adding a family room that can accommodate additional activities may be the most financially feasible approach. Similarly, NTT DATA can assess which technologies would be best to add, so incoming leaders can swiftly leverage the latest features and benefits they bring. Because we are also an operator, we’re well versed in making the latest technology run. Our many previous engagements have enabled us to establish best practices we know will work.

Health plans often acknowledge that they are eager to adopt automation, analytics and AI, but they don’t necessarily know where to start. To save time, NTT DATA helps them shift resources and time concurrently, rather than sequentially, while proposing effective strategies that include appropriate business models and clinical partnerships. Often, we can begin introducing automation in as little as three months.

Strong medicine that works quickly

Helping plans define and implement their strategy and shift how management spends its time empowers them to quell internal resistance by effectively managing the organizational change element. Managing change is always a factor with technology adoption, but what’s different about this particular change is the speed at which it is happening. We’re jumping to a different curve, similar to transitioning from paper to PC to Web to mobile.

The technology and capabilities are simply tools; the most important factor is the shift in mindset that enables acceptance of a move away from traditional technology to adopting new tools. Making the physical shift and the shift in perspective — from a human- to machine-directed approach — is happening at warp speed.

Plans that cannot make this shift fast will be saddled with — and sidelined by — their legacy platforms. Plans that are conversant with automation, analytics and AI will be positioned for success in the future.

NTT DATA also has the domain expertise in healthcare to operate functions peculiar to health plans and assist them with the technology toolsets. Our experts provide the tools for them to do their own analytics, and our plug-ins can easily position plans to respond to their evolving needs in the future. Our open-component architecture solution integrates a curated set of partners and solutions with administrative and data lake/platforms that will collectively enable futuristic AI capabilities. Thus, health plans can improve patient outcomes with a solution that is outcome-based, modular and configurable.

NTT DATA’s fully integrated Digital Business Process as a Service model is driven by data analytics, AI and best-in-class, industrialized business processes. Health insurance executives are thus empowered to:

  • Increase operational efficiency
  • Drastically reduce administrative costs
  • Maximize return
  • Reduce penalties
  • Increase rating scores
  • Proactively reduce fraud
  • Identify leakage
  • Improve member engagement

We recognize that the shift is neither easy nor straightforward, but we are prepared with the tools, technologies and expertise to help.

NTT DATA and ISG explore insights to help health plans move to a member-centric model, adapt to new technologies, acquire new skills, enhance outcomes and lower costs — all while improving services and fostering resilience. Read the new research.

Post Date: 7/20/2021

Andy Arens Headshot Andy Arends Vice President, Health Plan Industry Solutions

About the author

As the leader of NTT DATA’s Health Plan Solutions team, whose charter is to develop leading-edge solutions for health insurers, Andy’s focus is enabling NTT DATA’s clients to be ready for the next generation of healthcare delivery and financing. The team’s current focus includes consumerism, analytics, artificial intelligence, automation, and value-based care. This global, multi-disciplinary team includes experienced consultants, clinicians, regulatory experts, technologists, and delivery SMEs. Prior to the acquisition of Dell Services by NTT DATA, Andy led Dell’s Health Plan Innovation & Consulting team and Health Insurance Exchange offering, including successful efforts to work with the Massachusetts Connector.

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