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Future-proofing the healthcare payer infrastructure

There is a new paradigm for healthcare payer organizations. Prepare for the future with the technology you need to seize new opportunities.

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Julie Clements

Healthcare solution marketing manager

After payers helped their employees make the abrupt shift to work-from-home, and after the dust settled, many found themselves contemplating a comprehensive review of their technology infrastructure. Small cracks in the road to digital transformation had widened and could no longer be ignored.

But COVID-19 was hardly a lone disruptor for payers. Pressures were building for some time from new competitors, regulatory agencies, providers, partners and the new digital-first consumer.

So, now what? What changes are needed to pave a smoother, more resilient highway to the future?

The need to quickly adjust to a larger remote workforce and serve customers in entirely new ways has exposed cracks within content-centric tools and processes.

— Prepare for the Next Business Stress-Test with Content Services, Forrester Consulting, March 2021

Mending the gaps

Payers finding their way in this new era are looking for technology infrastructure changes that can best strengthen their resilience, performance and agility. I see three challenges that commonly surface in payer organizations I’ve talked with where there is great opportunity for change and ROI. They are:

  • Information agility — Payers capture and process mass quantities of information daily. It enters and exits the business on paper, electronically, through email, fax, the mailroom … and all kinds of applications. As the volume and variety of data continues to grow, it becomes increasingly difficult to manage it — much less get ahead, transform, or grow.
  • Process efficiency — All that information becomes part of a uniquely large volume of complex, multi-step processes, from medical claims processing to appeals and grievances, with varied compliance and reporting requirements and SLAs. To stay on top of deadlines, meet compliance requirements and customer expectations requires a powerful solution.
  • Disaster recovery — Like many organizations, payers need resilient, yet flexible, technology underpinnings to help ensure secure, ongoing operations in the face of natural or manmade threats. At the same time, they’re looking to offload in-house management responsibilities of managing applications and the data center to specialists, in order to increase focus on their core business.

Moving toward a future-proof content infrastructure

Technology infrastructure changes that address business goals are paramount. Over the years, we’ve seen the incredible positive impact that content-centric strategies can have on payer organizations in addressing challenges and meeting business goals. Today, they’re accelerating adoption of cloud, intelligent capture, and process automation and looking for low- and no-code solutions to help achieve operational excellence.

Here are a few examples of what payers are doing to transform their content management strategy:

  • Intelligent information capture to scale and grow — Automatically capturing, understanding and classifying information as it enters the payer organization is critical to every process and interaction that follows. Intelligent capture greatly speeds up processes, cuts costs and reduces human error. It lets the organization scale and manage whatever comes in. It helps them stay ahead. AI and RPA can be force multipliers here.
  • Process automation for dramatic efficiency gains — A payer’s multitude of incredibly varied processes can be simplified dramatically with the right solution. That is, one that can handle the complexity. It’s a dramatic cost-cutting, step-reducing, process-expediting game-changer for payers. Reporting too — something that once involved databases, spreadsheets and emails, becomes a one-click exercise.
  • A cloud-based strategy for agility and resilience — A cloud-based content services platform can be that secure, flexible, agile foundation for managing content and processes that payers need. At Hyland, our cloud team manages the infrastructure and the application, and adds tailored compliance support that extends to the application layer. So those worries, the costs, the burden and unpredictability of maintaining your content management solution in-house are gone: they’re in the hands of a team of experts. Your resources are now free to focus on transformation.

Infrastructure changes for tangible ROI

Again, the right cloud-based content services platform with intelligent automation can change the game for the healthcare payer. Our customers have pointed to reductions of more than 50 percent in quarterly reporting, 95 percent improvement in appeals and grievances processes and achievement of 98 percent accuracy and timeline goals. This payer, recipient of a four-star rating for its Medicare plans in 2020 and 2021, entirely transformed its appeals and grievances process with Hyland.

There is a new paradigm for payer organizations. Is your organization prepared with the technology it needs to be nimble, adaptable to change? Ready to pivot and seize new opportunities? If you’d like to know more, I’m happy to chat!

Learn more about Hyland solutions for healthcare payers.