For better or worse, the insurance industry is confronting the digital challenges other industries dealt with years ago. Claim executives are dealing with issues that challenge 20 years of standard business practice; which makes this an incredibly exciting time to be involved with claim organizations.
The issues driving this move cover virtually every aspect of the business practice. A growing scarcity of quality human resources. Increasingly sophisticated competitors using specialized technologies to peel away small but profitable slices of the market. A business clientele demanding better outcomes and data, increased productivity and more customer-centric service strategies.
Complicating the issues for today's claim organization is an aging technology infrastructure in which much of the data required to meet current demands is drawn from a patchwork of different software applications. The problem with drawing data from the patchwork is there are many inconsistencies in workflows, data nomenclature and tracking methodologies. Subsequently, you can capture loads of data, but the quality of your information is suspect. Unfortunately, this problem continues even in many of the "updated" versions of the established software products.
As a side note, the above difficulty with data quality may be partly responsible for Marsh’s finding in the 2019 Excellence in Risk Management survey finding only 29% of companies reported using data in their planning processes. Really?
Making the pathway even more complex is the explosion of diverse new technologies clamoring for attention. They all promise great things. However, most of the solutions seem to be square pegs, while your organization offers only round holes. Leaving executives feeling like the thirsty castaway on the ocean; lots of water but nothing to drink. This leads many executives to fall back on their old strategies. Very understandable. Unfortunately, those strategies, based on three to five-year plans, are ill-equipped to respond to our evolving market.
Three years is more than a lifetime in the digital age. A McKinsey survey of executives dealing with the innovation challenges, reported the executives considered the greatest threat to be the resistance to take immediate action. Those executives stressed that continued success requires an acceleration in the response to the digital wave. In this new market dynamic, time is your most precious commodity. However, time cannot be banked. If it is not engaged, it is wasted; as is the competitive advantage you built over the past 20 years.
Danielle Lisenbey, Global President of Crawford & Company stated in a LinkedIN post: “…we must recognize that the technology dam has burst. The revolution we have heard about for so long at panels is here.”
Facts be what they may, significant levels innovation are not happening in many organizations. There is still resistance to change the way things are done around the claim office. Several stakeholders maintain special interests they seek to protect, regardless of the cost. It is unfortunate that what often poses as innovation efforts is a reaction to potential disruptions; where the inevitable outcome is the quiet death of opportunities. Subsequently, many claim leaders charged with innovation leadership feel the fate Julius Cesar suffered at the hands of his colleagues may be heading their way.
What is driving innovation today?
Claim leaders are witnessing pieces of their markets slipping away as margins thin and necessary outcomes are harder to secure. Execs are realizing if they hope to remain in the game in the next decade, they need to be taking positive action today. Forward looking leadership understand that to be competitive in the emerging economy, they need to shift gears. Such leaders realize that 90% of success in the digital ecosystem is about taking that first forward step, followed by another.
Rather than waiting for the traditional planning cycle to grind ever so thoroughly through its process, aggressive executives are accepting the need to have a minimum viable product (MVP) out the door within a three to four months and evolve it as they progress. In fact, constant product evolution is today's standard operating mode. Reporting of key performance metrics (KPM) can no longer wait for 30 days; they need to be dash-boarded in a near real-time basis so trends can be spotted early, corrective measures taken, and outcomes monitored before a whole month passes. Too much can happen in a month.
For over a decade, Effective Health Systems has worked with innovative leaders in some of the largest, as well as the smallest, payers in the country. We started with a few simple workflow automation apps and have evolved into a data management and automation platform. Today, BaseLine offers a knowledge platform that integrates and normalizes data from disparate software products. This includes data from claims, medical management, UR, vendor management, bill review, PBMs, and various third-party applications.
We are able to launch clients within 90 to 120 days with an MVP and fine-tune their systems in near real-time. Once connected to the BaseLine Platform, a client's existing systems can continue to work, which lessens development time and expense. However, with the MVP launch, their data becomes fluid, transparent and accessible. That means, our client's operational move to digital are relatively swift.
Once the data issues are resolved, BaseLine helps clients implement highly functional applications designed to automate specific workflow functions within a claim organization. These apps are designed to complement existing systems, as they pick up the slack by processing routine tasks and decisions according to specific business rules clients establish. The apps are highly configurable to accommodate the multiple workflows, resources and requirements of each client. Thus, BaseLine offers the claim organization the means to cost-effectively digitize its existing operations and infrastructure, integrate emerging technologies, automate workflows and augment the intelligence of its human capital.
In a nutshell, BaseLine frees your workforce from the hundreds of routine tasks and decisions that consume large tracks of their day and handicaps their ability to engage the thinking skills required to effectively manage a claim.
The efficiency benefits delivered by BaseLine are matched by its ability to aid management teams craft a more perfect organization. BaseLine delivers an enhanced understanding of the workings of your organization. It creates a transparency into transactions that heretofore were opaque to management. BaseLine allows insights into how your resources are being managed, as well as providing tools to quickly enact corrective actions and monitor outcomes.
The financial impact BaseLine delivers reaches far beyond the basic operational efficiencies offered by typical automation technologies. For example, which medical providers are creating your highest frictional costs? Where are you failing to capture your anticipated ancillary savings? Where, specifically, are non-compliant behaviors occurring? How do you objectively measure the performance velocity of your business partners? Where are your cost containment investments paying off; where are they not? BaseLine not only gives you access to this kind of knowledge; it delivers the ability to continuously monitor and fine tune your processes.
BaseLine is about keeping your organization current and competitive in this evolving marketplace. It allows you to transact claim operations more rapidly with greater effectiveness and less expense. It delivers the benefit of your data to support critical claim transactions while instituting processes that deliver 100% compliance with your rules. Bottom-line, BaseLine allows you to identify and push forward your high performers while paring away the waste within your organization.
Yes, going digital is a challenge. But with BaseLine, it can happen smoothly, thoroughly and with minimal expense and time.
Originally Published in LinkedIN 2019-09-25