Provider

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative were clear and they may have had very little to do with the actual quality of the product. 

Healthcare payers focus a significant amount of time and money on improving their member and provider experience, as they should. However, what many payers overlook is that by taking steps to improve employee experiences, you in turn improve both member & providers experience. Think about the last time you had to make a return to a store or call someone about a mistake on a bill. When you spoke to a customer service agent did it impact your response and overall experience? If the customer service agent is understanding, sympathetic and empowered to resolve the issue quickly it makes for a positive experience for you. If they are rude, take forever to rectify the situation or imply that the problem is somehow your fault, how do you respond? How do you describe the experience to others? Doesn’t it impact your willingness to do business with them in the future? Studies have shown that understanding and improving the employee experience is critical for companies operating in a highly competitive global economy because attracting and retaining skilled employees is imperative to what drives a strong customer experience.

How would you describe everyday life for your Appeals & Grievances team? Are they stressed out trying to process appeals in a time frame that maintains corporate and CMS compliance? Do they dread receiving a letter that states an audit is right around the corner? Do they have to scramble around putting in long hours and missing lunches to ensure Universes are created and the data is correct? If this sounds familiar there are ways to improve the employee experience, build departmental collaboration, easily create Universes with the click of a mouse – all while making employees feel confident in their contributions and productivity. Enter digital transformation.

Technology solutions are designed to streamline the Appeals & Grievances process, improving compliance, increasing productivity and boosting member, provider & EMPLOYEE experiences. How does digital transformation change the employee experience? It’s simple:

  • Instead of managing data in excel spreadsheets or on paper, cases are electronic, and data can be leveraged across the enterprise. Technology can then ensure CMS compliance deadlines and regulatory requirements.
  • Providing advanced notifications to employees when deadlines are approaching so that action can take place and a timely decision can be made. No more running around and scrambling last minute to get answers.
  • Reduce stress and long hours needed to complete cases, workloads can be managed up front and distributed accordingly.
  • The nightmares that ensue with the word…Universe are no more! Universe reports can be created with the click of a mouse – simplifying the process and saving time.

Improving member experience should always be at the forefront of any healthcare payer strategy. Happy members are what keeps your business thriving, but so are happy employees. Focusing on innovation and improving your internal processes kills two birds with one stone and improves the experience for everyone. What are you waiting for?

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You Can’t Manage What You Can’t See – Thoughts from the Optimizing Appeals & Grievances Conference

Much of the discussion last week at the Optimizing Appeals & Grievances and Improving ODAG & CDAG Outcomes Conference centered around accountability and company culture.  There was also a great deal of attention given towards the ability to pull Universes on demand.  These topics along with better ways to manage your day to day workloads are common challenges we hear from […]

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Building a Strong Network: It Takes an Empowered Team

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting that the factors behind why your experience was positive or […]

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The Secret to Improving Member Experience? Hint: It’s Probably Not What You Think.

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative […]

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Digital Transformation in Manufacturing: Getting You Ready For Race Day

A couple years ago when I started thinking about running my first half marathon I knew it was going to be a real project and a real commitment. See, running doesn’t come easily or naturally to me and I don’t hesitate to say I’m usually bringing up the rear in most of my races. Although I’ve been an athlete my […]

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May 22, 2018

The Secret to Improving Member Experience? Hint: It’s Probably Not What You Think.

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative […]
March 27, 2018

Bad Data Is No Different Than No Data.

Imagine if each time you entered an address into your GPS you only had a 50% shot that you would arrive at your correct location. You would be pretty upset if you weren’t in the 50% that made it to their destination. That is precisely what CMS has uncovered during round two of the online provider directory review. The average […]