“Move fast and break things” has never been healthcare’s motto. Pandemic pressure forced innovators, enterprises and investors to transform and reshape discovery, care delivery and whole-system approaches to improving one’s well-being faster than ever to meet consumer and business needs during a pivotal moment in time.

As the pace of disruption accelerated, payers and providers alike adapted with short-term “band-aids” on business functions to deliver care at a distance with telemedicine, remote monitoring and various omni-channel approaches including no-contact delivery, video conferencing and texting. As we all begin to return to “business as usual” and healthcare operations begin to normalize, these quick fixes should be evaluated and integrated into an organization’s long-term strategy.

The industry has proven it can quickly adapt, and by building on the transformation of 2020, organizations should look to further optimize operations with business models that leverage technology and proven, consumer-centric methodologies to achieve operational efficiencies, reduce costs, improve time to market and repurpose resources towards more value-added activities.

Transformation Here and Now

Recent shifts in the industry underlined the benefits of diversified business functions and the cons of operating in a silo. To scale telemedicine at a swift pace, the areas of consumer experience, revenue cycle management and IT could not act independently from each other. To meet new cost, regulations and mandates, organizations must operate more efficiently, especially as the industry moves from fee-for-service to value-based care.

As organizations expand outreach and offerings across the entire continuum of care, the appetite for strategic capabilities is growing through mergers and acquisitions (M&A). The first quarter of 2021 closed with $6.7B in digital health funding, the most-funded quarter in history. With larger deal sizes and a faster pace, optimizing for strategic capabilities and scale through M&A are proving to be a competitive differentiator in patient satisfaction and member experience, all of which drive revenue margins.

Growing M&A strategy remains centered around adding capabilities and reaching more consumers. However, changes catalyzed by emerging technologies and M&A needs to be supported operationally with comprehensive change management and adaptive organizational structure for true cost efficiency.

To make this ideal a reality, transformations need to center around the care journey and be purposeful in considering the end consumers within healthcare. Without a proper understanding of the consumer journey, business functions remain siloed, priorities remain divided, stakeholders lack the right information at the right time and change management is a fruitless effort.

The Call to Optimize Operations

Even before the pandemic, a major call to action for healthcare organizations has been the demand for a seamless, frictionless consumer journey both in-person and virtually. However, the short-term fixes quickly put in place in 2020 are not sustainable, forcing organizations to begin looking holistically at their organizational model.

Successfully transforming a longstanding business model is best accomplished through consumer journey mapping, because effective and impactful change to drive revenue cannot take place without holistically understanding the consumer. By mapping the end-to-end journey from the perspective of the end consumer (payer, member, provider or patient), internal structures can be optimized at a foundational level to optimize the consumer experience across the enterprise. This is no longer seen as a differentiator within healthcare; these are now table stakes from the mindset of the healthcare consumer.

Every touchpoint is analyzed to identify opportunities for improvement within the front, middle and back offices of an organization, which need to be seamlessly integrated to improve the end-to-end consumer experience. Analyzing the sum of the parts through a comprehensive, systematic exercise such as journey mapping is especially important to mitigate risk and discover potential opportunities, especially for transformation to garner internal support from within.

For instance, a claims operation was once hindered by delayed processing and high call volume. Working through a journey map with emids, the organization evaluated strategic and operational inputs including the current state, growth rate, digital priorities, existing applications and future state. The outcome included process automation, a growing member base and a reduction in per claim processing cost and average handling time.

Healthcare, as we think of it today, needs to be redefined to serve a new landscape with new consumer expectations. Traditional business models will be challenged to survive, with little choice but to change. As stakeholders move forward with transformation, organizations need to prepare for the business model of tomorrow with meaningful, proactive steps today – not just quick “band-aid” fixes.

When it comes to comprehensive and sustainable business transformation, our approach includes a proven 10-point transformation framework to drive organizational growth, improve profitability and operational efficiency. The framework assists healthcare organizations across key areas including consumer experience, operating model assessment, build vs. buy assessments, system selection, implementation and integration services, data and analytics, operational readiness and change management. The preeminent step of this framework is a Transformation Management Office (TMO) to manage the execution of simultaneous enterprise-wide initiatives, to mitigate risks and to promote team performance of these focus areas.

Transformation Beyond the C-Suite

Transformation can happen in many ways, both in the immediate and long term. However, studies have shown that unsuccessful organizational transformations far outnumber successful ones. Meaning for transformations to succeed, organizations need a proven strategy, employee buy-in, transparent communication, and sometimes, a strategic partner. In other words, truly successful transformation cannot just occur at the c-suite level – it must be embodied throughout the enterprise

This is where a TMO steps in.

A TMO is a single point of consolidation that ensures transformation happens seamlessly without negatively impacting the consumer or the current state of the organization. As an extension of the organization, this office can accurately assess the current state, people, processes and technology to gauge the readiness for transformation towards a future state. Serving as the brains of optimizing operations, a TMO can set forth a transformation strategy, communicate and move change along the continuum, from CEO to staff.

Looking Ahead

To keep up with consumer expectations and meet the increasingly complex healthcare landscape, today’s organizations need to deliver maximum value every step of the way. Optimizing operations to remove the band-aids and create holistic change will increase the probability of a successful, lasting transformation that better serves the healthcare industry and patients.

Kathleen Entwistle is a Senior Manager with emids and has over a decade of healthcare IT experience. Her leadership skills and passion for helping organizations deliver better care to their consumers have played key roles in driving value-based partnerships. Kathleen’s experience includes laboratory informatics and management, application managed services, interoperability, consumer engagement and journey mapping and complex project and program management. She has a collaborative, forward-thinking style that yields revenue-generating solutions and successful client partnerships. Be sure to connect with Kathleen on LinkedIn. 

Josh Kaffee is a seasoned result-driven leader as Senior Vice President of the Consulting Practice at emids. With over 20+ years of experience, his expertise lends itself well to managing complex, high-risk technology initiatives from ideation to realization. As a dynamic self-starter, he builds and guides diverse teams, with the unique ability to influence key audiences including internal stakeholders, business users, C-suite executives and strategic client and partners. Josh’s result-oriented mindset and bottom-line oriented style leads to client success. Be sure to connect with Josh on LinkedIn. 

Tarah Keech is a Senior Manager with emids with 16 years of healthcare IT experience.  She has an in-depth understanding of cross-functional change management, innovation strategy, go-to-market delivery and end-user adoption. Her executive team management style, local and national advisory experience and change management methodologies within healthcare and finance have supported successful client relationships and communications. Be sure to connect with Tarah on LinkedIn. 

Jayesh Sanyashiv brings over 19 years of experience in business strategy and operations across multiple industries globally to his role as Vice President, Consulting Practice at emids. Jayesh has been actively engaged with top Fortune 100 organizations in the US healthcare industry developing and executing strategy to reduce administrative and medical costs, improve member and provider experience, instill a business outcome focused culture and build innovation capabilities. He plays a key leadership role in growing emids portfolio of strategic innovative solutions addressing business challenges related to access, quality and cost of healthcare as well as driving value based partnerships. Be sure to connect with Jayesh on LinkedIn.