The document discusses five imperatives for healthcare providers and payers in response to the COVID-19 pandemic. It summarizes each imperative as follows:
1. Take out costs - Providers and payers must reduce costs due to financial pressures from rising supply costs, decreased utilization of services, and changes in insurance coverage.
2. Deliver care@home - The pandemic accelerated adoption of telehealth and more services can now be delivered virtually. This allows decoupling of care from physical infrastructure.
3. Implement low-touch healthcare - Providers must reduce physical contact to ensure safety while maintaining a personalized experience through contactless processes and virtual care.
4. Accelerate digital transformation - Changes in consumer behavior
Will the Revenue Ever Return? COVID-19 and the Rise of the Insurers; the Case...Health Catalyst
As healthcare providers face the long-term revenue compression of COVID-19, they’re also navigating significant industry changes. Current challenges include horizontal competition from large insurers and digital disrupters, growing telehealth volumes, headwinds from price transparency, and growth in managed care programs, like Medicare Advantage. Without restored or growing volumes, how do health systems return to profitability?
Health systems will need accurate financial data around service line and procedural profitability, which very few have. Allocations, estimates and averages of cost, and large pools of clinical “overhead” are inaccurate, and these methods have no credibility with physicians and administrators.
Join Rob DeMichiei, Strategic Advisor for Health Catalyst and former Executive Vice President and Chief Financial Officer for UPMC, to learn more.
What You’ll Learn:
- How insurers look at their medical expenses, and their plans to reduce utilization and steer volumes away from traditional providers.
- The implications of price transparency; why a rational pricing strategy is critical to success.
- Using existing EHR data to measure and assess 100 percent of your clinical costs.
- How improved costing enables service-line management and allows for improved clinical care delivery and insight into profitability.
- How activity-based costing can help identify physician and clinical variation.
- Implications of inaccurate RVU/RCC costing on contract negotiations, resource management, and productivity reporting.
- Benefits and simplicity of activity-based (consumption) costing.
Top Healthcare and Revenue Cycle Trends to watch for in 2019Manish Jain
2017 required healthcare organizations to respond to several new challenges – political change, growing role of technology, shift to value-based care and the increasing role of information security. While we anticipate that these issues will continue to influence through 2018, we will also see new challenges. The blurring lines between providers and payers, a refocusing on care (and more so on the patient), and a changing policy environment will occupy the center stage for 2018.
State Of Healthcare Q2’21 Report: Investment & Sector Trends To Watch. Contents include Summary, Market Drivers, Investment Trends, Sector Highlights (AI, Health IT, Omics, telehealth, digital therapeutics, mental health, medical devices, digital health, etc). Global healthcare investment rose for the seventh consecutive quarter. European investment nearly doubled. A flood of new entrants pushed early-stage deal share
above 50%. M&A activity persisted. The top healthcare deals in the quarter (by deal size) went to companies working in life sciences. The SPAC frenzy continued within digital health. Eleven healthcare startups joined the unicorn club during
Q2’21 (valued in aggregate at $27B).
Will the Revenue Ever Return? COVID-19 and the Rise of the Insurers; the Case...Health Catalyst
As healthcare providers face the long-term revenue compression of COVID-19, they’re also navigating significant industry changes. Current challenges include horizontal competition from large insurers and digital disrupters, growing telehealth volumes, headwinds from price transparency, and growth in managed care programs, like Medicare Advantage. Without restored or growing volumes, how do health systems return to profitability?
Health systems will need accurate financial data around service line and procedural profitability, which very few have. Allocations, estimates and averages of cost, and large pools of clinical “overhead” are inaccurate, and these methods have no credibility with physicians and administrators.
Join Rob DeMichiei, Strategic Advisor for Health Catalyst and former Executive Vice President and Chief Financial Officer for UPMC, to learn more.
What You’ll Learn:
- How insurers look at their medical expenses, and their plans to reduce utilization and steer volumes away from traditional providers.
- The implications of price transparency; why a rational pricing strategy is critical to success.
- Using existing EHR data to measure and assess 100 percent of your clinical costs.
- How improved costing enables service-line management and allows for improved clinical care delivery and insight into profitability.
- How activity-based costing can help identify physician and clinical variation.
- Implications of inaccurate RVU/RCC costing on contract negotiations, resource management, and productivity reporting.
- Benefits and simplicity of activity-based (consumption) costing.
Top Healthcare and Revenue Cycle Trends to watch for in 2019Manish Jain
2017 required healthcare organizations to respond to several new challenges – political change, growing role of technology, shift to value-based care and the increasing role of information security. While we anticipate that these issues will continue to influence through 2018, we will also see new challenges. The blurring lines between providers and payers, a refocusing on care (and more so on the patient), and a changing policy environment will occupy the center stage for 2018.
State Of Healthcare Q2’21 Report: Investment & Sector Trends To Watch. Contents include Summary, Market Drivers, Investment Trends, Sector Highlights (AI, Health IT, Omics, telehealth, digital therapeutics, mental health, medical devices, digital health, etc). Global healthcare investment rose for the seventh consecutive quarter. European investment nearly doubled. A flood of new entrants pushed early-stage deal share
above 50%. M&A activity persisted. The top healthcare deals in the quarter (by deal size) went to companies working in life sciences. The SPAC frenzy continued within digital health. Eleven healthcare startups joined the unicorn club during
Q2’21 (valued in aggregate at $27B).
The Biggest Healthcare Trends of 2019 and What's to Come in 2020Health Catalyst
In our Healthcare Outlook for 2019 webinar, Stephen Grossbart, PhD, and Bobbi Brown, MBA, shared their predictions for the biggest trends of the year. Which predictions panned out and which didn’t? View this webinar as Stephen takes a look back at 2019 and makes his forecast for 2020.
So, what did happen in 2019? Following the 2018 midterm elections, we predicted a divided Congress would not pass policies to strengthen or weaken the Affordable Care Act (ACA). We were right. Meanwhile, Democratic presidential candidates debated the extent to which they would support Medicare for All. Insurance costs continued to rise, breaking $20,000 annually for families with employer-sponsored coverage, and CMS continued to support payment policies rewarding quality and interoperability as part of their payment policy.
Join Stephen as he looks in the rearview mirror at these important issues and how they impacted the healthcare industry in 2019 and then gazes into the crystal ball to predict the trends that will most impact healthcare in 2020. In this webinar, Stephen discusses the following topics and more:
• The continued focus on price transparency.
• Congress’ efforts to control prescription drug costs.
• Policies that may change the future of ACOs.
• What to expect going into the 2020 election year.
A Smart and Connected Ecosystem for Faster Return to Work for Disability and ...Cognizant
Digital and workers' comp insurers should leverage a wide range of digital health technologies, monitoring devices and wellness analytics to reduce return to work (RTW) times and thereby increase operational efficiency, cut claims costs and offer better outcomes to all stakeholders.
It’s 2020 and healthcare is at a crossroads. Will this be the tipping point in the transformation of care or are we in for yet-another decade of radical change and resistance? Here's six key trends that I think are likely to tip the scales and shape the healthcare business model of the new era.
Health Services Tax Conference May 18-19, 2015, Presentations included: Mega Trends and the Impact on Healthcare, The Healthcare Industry: A View from Washington and The New Health Economy.
More than 60% of providers struggle to derive optimal value from their EHRs and 85% believe consumer self-pay will continue to impact their organizations, according to an annual HFMA/Navigant survey of 108 provider CFOs and revenue cycle executives.
Healthcare Financial Transformation: Five Leading StrategiesHealth Catalyst
Healthcare financial transformation—improving care delivery while lowering costs—has been an ongoing challenge for health systems in the era of value-based care and an even more prominent concern amid COVID-19. While better care and reduced expense to organizations and consumers might seem like opposing goals, by understanding the true cost of services and other drivers of expense, organizations can successfully manage costs while maintaining, and even improving, care delivery. To that end, health systems can use data- and analytics-driven tools and strategies to addresses financial challenges, including uncompensated care, prolonged accounts receivable days, discharged not final billed cases, inefficient resource use, and more.
The healthcare reform law will have far-reaching impacts in areas of
Coverage
Insurance Reform
Insurance Mandates
Health Insurance Exchanges
Get the FACTS here a MUST see POWER POINT
Healthcare providers are ready and planning to assume increased levels of risk through commercial payer and Medicare contracting models and Medicare Advantage, according to a new Navigant analysis based on a survey conducted by HFMA.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
The Work Ahead: Moving Healthcare Organizations into the Digital AgeCognizant
For healthcare payers and providers, the digital revolution offers a powerful prescription for transforming an industry value chain in need of drastic modernization. In this installment of our Work Ahead research series, we look at the way forward to the future of work for healthcare.
The Biggest Healthcare Trends of 2019 and What's to Come in 2020Health Catalyst
In our Healthcare Outlook for 2019 webinar, Stephen Grossbart, PhD, and Bobbi Brown, MBA, shared their predictions for the biggest trends of the year. Which predictions panned out and which didn’t? View this webinar as Stephen takes a look back at 2019 and makes his forecast for 2020.
So, what did happen in 2019? Following the 2018 midterm elections, we predicted a divided Congress would not pass policies to strengthen or weaken the Affordable Care Act (ACA). We were right. Meanwhile, Democratic presidential candidates debated the extent to which they would support Medicare for All. Insurance costs continued to rise, breaking $20,000 annually for families with employer-sponsored coverage, and CMS continued to support payment policies rewarding quality and interoperability as part of their payment policy.
Join Stephen as he looks in the rearview mirror at these important issues and how they impacted the healthcare industry in 2019 and then gazes into the crystal ball to predict the trends that will most impact healthcare in 2020. In this webinar, Stephen discusses the following topics and more:
• The continued focus on price transparency.
• Congress’ efforts to control prescription drug costs.
• Policies that may change the future of ACOs.
• What to expect going into the 2020 election year.
A Smart and Connected Ecosystem for Faster Return to Work for Disability and ...Cognizant
Digital and workers' comp insurers should leverage a wide range of digital health technologies, monitoring devices and wellness analytics to reduce return to work (RTW) times and thereby increase operational efficiency, cut claims costs and offer better outcomes to all stakeholders.
It’s 2020 and healthcare is at a crossroads. Will this be the tipping point in the transformation of care or are we in for yet-another decade of radical change and resistance? Here's six key trends that I think are likely to tip the scales and shape the healthcare business model of the new era.
Health Services Tax Conference May 18-19, 2015, Presentations included: Mega Trends and the Impact on Healthcare, The Healthcare Industry: A View from Washington and The New Health Economy.
More than 60% of providers struggle to derive optimal value from their EHRs and 85% believe consumer self-pay will continue to impact their organizations, according to an annual HFMA/Navigant survey of 108 provider CFOs and revenue cycle executives.
Healthcare Financial Transformation: Five Leading StrategiesHealth Catalyst
Healthcare financial transformation—improving care delivery while lowering costs—has been an ongoing challenge for health systems in the era of value-based care and an even more prominent concern amid COVID-19. While better care and reduced expense to organizations and consumers might seem like opposing goals, by understanding the true cost of services and other drivers of expense, organizations can successfully manage costs while maintaining, and even improving, care delivery. To that end, health systems can use data- and analytics-driven tools and strategies to addresses financial challenges, including uncompensated care, prolonged accounts receivable days, discharged not final billed cases, inefficient resource use, and more.
The healthcare reform law will have far-reaching impacts in areas of
Coverage
Insurance Reform
Insurance Mandates
Health Insurance Exchanges
Get the FACTS here a MUST see POWER POINT
Healthcare providers are ready and planning to assume increased levels of risk through commercial payer and Medicare contracting models and Medicare Advantage, according to a new Navigant analysis based on a survey conducted by HFMA.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
The Work Ahead: Moving Healthcare Organizations into the Digital AgeCognizant
For healthcare payers and providers, the digital revolution offers a powerful prescription for transforming an industry value chain in need of drastic modernization. In this installment of our Work Ahead research series, we look at the way forward to the future of work for healthcare.
Five Macro Trends Driving Healthcare Industry Investment in 2011 and BeyondCognizant
Here are five industry trends that will strongly influence where and how healthcare ecosystem participants will invest business development and technology dollars this year and into 2012.
DIGITAL TRANSFORMATION IN THE NEXT NORMAL: How consumerism, technology and th...Damo Consulting Inc.
What was assumed to be a transformation journey stretching over several years has now shrunk to a matter of months, and the pace of change is accelerating. Paddy Padmanabhan and Ed Marx, the authors of the first book published on healthcare digital transformation since the pandemic hit us, discuss 5 major themes in healthcare’s digital transformation, and what the next normal looks like.
They will present findings from recent research on how mid-tier systems must approach transformation.
1. How COVID-19 accelerated the timelines for transformation
2. Why health systems must go beyond just telehealth
3. Why digital leaders must develop enterprise roadmaps
4. How CIO’s can transform IT to support digital health
5. How technology decisions must deliver enterprise-level impact
Healthcare Revenue Cycle Trends to Watch in 2019Jessica Parker
The revenue cycle process and its management have continuously progressed over the last few years to keep up with the changes occurring in the healthcare industry.
The Work Ahead in Healthcare: Digital Delivers at the Frontlines of CareCognizant
The pandemic has clarified the role and value of digital technologies and approaches for healthcare providers, according to our recent study. Providers are using AI and intelligent machines to personalize care and change how care is delivered.
COVID-19 heightened chronic challenges within the global healthcare industry. It became a catalyst amid fierce competition and tight regulations for health providers and payers to focus on digital health, cybersecurity, patient data transparency, and a variety of customer-centric and operational enhancements. As a result, we found the 2022 trendline pointing to improvements in access and quality of care.
Healthcare challenges such as optimizing the cost of care while simultaneously enabling personalized interventions and consumer-friendly shoppable services are long-standing − but, historically, the industry has been slow to react.
Read our Top Trends 2022 report to examine the lingering ramifications of the pandemic, responses from medical and insurance organizations, and the worldwide impact of ever-changing regulatory standards and mandates.
Healthcare IT Services Insights - January 2016Duff & Phelps
This issue of Healthcare IT Insights details the increased use of predictive analytics in the healthcare industry to reduce costs and improve outcomes for patients and populations. Predictive analytics can address three categories that unnecessarily cost the healthcare delivery system in the U.S. approximately $350 billion annually: overtreatment, care delivery failure and lack of care coordination.
White Paper - Digital strategy and the shift to value based careTerence Maytin
Summary: The U.S. healthcare system is rapidly transitioning from fee-for-service to value- based care as part of massive and ongoing industry-wide transformation. Digital strategy is evolving to meet new challenges, help drive disruptive innovation, and better engage a large, growing audience of connected health consumers.
Patient Engagement: The Next Wave of Change in Healthcare ITCascadia Capital
Patient Engagement is one of the fastest growing sub verticals in Healthcare. Is it really going to solve some of the big issues plaguing the Healthcare system? We think so.
An Effective Financial Response to COVID-19: Three Ways to Leverage DataHealth Catalyst
With COVID-19 presenting unprecedented challenges, health systems are struggling to financially survive. With little data about the novel coronavirus, traditional financial approaches that rely on historical information are not sufficient. However, organizations can get back on the road to financial recovery and well-being by practicing three key strategies centered around data:
Prioritize access to real-time data.
Understand data at a deeper level.
Realize margin and cost by service line.
Leveraging data allows financial healthcare leaders to effectively manage the COVID-19 challenges and prepare their health systems for future obstacles.
Similar to From Chaos to Catalyst: Five Imperatives for Healthcare (20)
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From Chaos to Catalyst: Five Imperatives for Healthcare
1. August 2020
Digital Business
From Chaos to Catalyst:
Five Imperatives for
Healthcare
COVID-19 could be the catalyst for lasting change throughout
the industry—if providers and payers make the right moves to
respond to ongoing waves of the virus, reset operating models and
reimagine their future roles in a world reshaped by the pandemic.
2. Executive Summary
2 / From Chaos to Catalyst: Five Imperatives for Healthcare
Digital Business
While no one knows what the long-term impact of the
COVID-19 pandemic will be on society and business, we
can make educated forecasts based on initial indicators. In
healthcare,the virus has forced providers and payers to adopt
new ways of working, from wider adoption of telehealth consults
to breaking down state barriers for care. Simultaneously, a
historic drop in healthcare service consumption is creating
serious new financial stresses on many institutions. Providers
could lose over $200 billion in just the first half of 2020.1
Meanwhile, consumers seem to be adapting to new tools that
support virtual and in-home care delivery. Taken together,
these forces are creating unparalleled opportunities for the
U.S. healthcare industry to reimagine its current operating
model to reduce systemic inefficiencies and catch up with other
industries regarding digital transformation.2
3. From Chaos to Catalyst: Five Imperatives for Healthcare / 3
Digital Business
At the same time, providers and payers must deal with the unfolding crisis in the short term.
That will mean contending with the pandemic well into 2021 and determining the usage,
efficacy and potential side effects of forthcoming vaccines. The industry can address its
immediate needs while simultaneously investing in the capabilities required to emerge from
this pandemic with new, more efficient models of care and better engagement with patients
and members. The key is selecting the right areas in which to invest now to manage the
current and future “new normal.” We recommend that payers and providers address the
following five imperatives, adapting these to their business vision, local market conditions
and financial strength.
A checklist for COVID-19 catalyzed change includes:
❙ Take out costs.
❙ Deliver care@home.
❙ Implement low-touch healthcare.
❙ Accelerate digital transformation.
❙ Improve collaboration.
4. 4 / From Chaos to Catalyst: Five Imperatives for Healthcare
Digital Business
Imperative 1: Take out costs
The healthcare industry faces pressure to reduce costs from multiple
directions. The perennial challenge is reducing the cost of care
while improving the quality of outcomes and patient and member
experiences. The COVID-19 pandemic creates additional financial stress.
Prices have risen for personal protective equipment and other critical
supplies.3
As these costs increase, care utilization rates dropped by 38%
through April 2020 compared to the previous year.4
Consumers who
lose health insurance through their employers or have high deductible
plans and uncertain income often forgo healthcare, further suppressing
care utilization.5
In addition, the pattern of insurance coverage may
change from employer-covered to a large increase in the Medicaid-
covered population.6
Some providers may need short-term cash-flow
improvement to address immediate financial pressures.
❙ The financial effects of the steep drop in elective procedures have been widely calculated and reported.
The American Hospital Association estimates U.S. healthcare systems will lose $323 billion in 2020
from COVID-19’s impact.7
Further, despite a 20% increase in Medicare payments, health systems could
lose between $1,200 to $8,000 per COVID-19 case.8
Finally, the estimated costs of treating COVID-19
commercial, Medicare Advantage and Medicaid managed care patients over the next 12 to 18 months
range between $180 billion to $546 billion, wiping out shared shavings for the current reporting year and
creating major losses for accountable care organizations.9
It is no surprise that more than 70% of CFOs are
making changes to long-term investment plans.10
❙ During the most recent J.P. Morgan Annual Healthcare Conference, about one-half of the health systems’
executives talked about how their operating margins are lower than those of their industry peers,
indicating less efficiency. COVID-19 is forcing healthcare executives to tackle that immediately in the face
of declining revenues.
❙ High and fluctuating unemployment means providers’ payer mixes are changing rapidly and likely to result
in fewer commercial insurance patients and more Medicaid and uncompensated care.
5. Consumers who lose health
insurance through their
employers or have high
deductible plans and uncertain
income often forgo healthcare,
further suppressing care
utilization.
From Chaos to Catalyst: Five Imperatives for Healthcare / 5
Digital Business
6. 6 / From Chaos to Catalyst: Five Imperatives for Healthcare
Digital Business
✔ Benchmark operations, including revenue cycle, patient contact centers, and the
supply chain against industry peers to identify cost-savings opportunities.
✔ Consolidate and standardize clinical and non-clinical applications in the IT
portfolio to reduce IT operating costs. Create strategies for retiring and/or
modernizing legacy applications.
✔ Reduce IT operating costs by moving to cloud. Cloud-based platforms put many
leading-edge technologies within reach with minimal infrastructure investment
and volume-based operating costs.
✔ Evaluate outsourcing non-core operations such as revenue cycle, supply chain
operations and others and moving to outcome-based or volume-based pricing
models to optimize operating costs consistent with volumes.
✔ Accelerate the implementation of business process automation and self-
service initiatives. Develop member- and provider-facing high-value automation
use cases, such as taking advantage of interoperability to automate prior-
authorizations based on business rules and new members’ past claims histories.
✔ Increase productivity by automating processes using artificial intelligence (AI)
and machine learning (ML), and ensure optimal performance from best-in-class
modular applications by making data from core administrative systems available
via an orchestration platform.
✔ Assess portfolio applications for scalability and support quality. Some software
solutions implemented ad hoc to address immediate COVID-19 work-from-home
needs and other demands may not be able to scale to enterprise quality.
✔ Streamline IT operating models. Automate IT and improve its productivity with
DevOps and service management. Move away from traditional project-based
software development models to more iterative, member-centric, product-based
models, and reevaluate which IT investments will deliver the greatest returns.
✔ Move to cloud to shift infrastructure investment from a capital expense to an
operating expense model.
Actions
for
providers
Actions
for
payers
7. From Chaos to Catalyst: Five Imperatives for Healthcare / 7
Digital Business
Imperative 2: Deliver Care@Home
COVID-19 has forced the high-scale adoption of telehealth. Care@home
is the next evolution of virtual care in which healthcare providers offer a
wider range of services virtually. Implementing this imperative will give
greater freedom to providers to serve their patients, optimize total cost of
care and improve member and patient engagement.
❙ COVID-19 has demonstrated telehealth is a viable channel for care delivery. Consumers are becoming more
comfortable using virtual consults and practicing in-home care.11
❙ Many chronic conditions can be monitored in remote care settings, and some outpatient procedures and
follow ups can be virtualized. For example, dialysis sessions may now be done at home.
❙ In fact, McKinsey & Company estimates that about 20% of ambulatory care can be virtually delivered,
creating a value pool that is worth approximately $250 billion in 2020 alone.12
❙ Leveraging telehealth capabilities as part of a care-at-home strategy enables health systems to decouple
care delivery from the constraints of their physical infrastructure. That also allows healthcare settings to be
optimized for patients requiring in-person care.
✔ Evaluate existing telehealth capabilities and performance; determine what
additional services could be delivered in home via virtual channels.
✔ Ensure the telehealth workflow is integrated into clinical workflows and electronic
health record (EHR) systems to capture documentation needed for reimbursement
and care management.
✔ Extend virtual care to patients with chronic conditions such as congestive heart
failure and COPD.
✔ Create a differentiated care-at-home experience for pregnancy and patients with
gestational diabetes and hypertension.
✔ Work with network providers and health systems to create a set of policies and
benefits to incentivize adoption of care-at-home.
✔ Streamline referral and prior-authorization processes to make access to in-home
care smoother.
✔ Work with health systems to generate insight from additional data created, and
leverage the insights to create more tailored health management programs for
specific populations.
Actions
for
providers
Actions
for
payers
8. 8 / From Chaos to Catalyst: Five Imperatives for Healthcare
Digital Business
Imperative 3: Implement low-touch healthcare
The continued risk of COVID-19 infection is forcing providers to
reduce physical contact during care delivery and related administrative
processes. A critical challenge is delivering a personalized, human
experience while practicing social distancing and contactless processes.
❙ Caregivers, employees and patients must be safeguarded while COVID-19 remains a threat.
❙ Providers must convince patients that medical office buildings,clinics and surgery centers are safe to visit.Similarly,
payers must ensure that members have access to care,especially those managing chronic diseases or cancer.
❙ The pandemic presents a new opportunity for the industry to achieve its longtime goal of paperless
physician practices.
✔ Expand virtual care.Delivering virtual care anywhere is increasingly possible through
the rise of sophisticated in-home monitoring tools,smartphones equipped with high
resolution cameras and even diagnostic devices such as portable ultrasound units.13
Data from these inputs,plus AI agents,could power direct-to-consumer care,coaching
and services.Such services would help healthcare organizations build closer patient
relationships with daily and weekly health coaching and care management interactions.
Larger organizations could offer virtual ICU monitoring and remote-care and disease-
management services for rebranding to smaller and/or rural providers.
✔ Redesign office processes to increase patient comfort levels and protect against
virus transmission. Typical areas of focus should include:
4 Scheduling and check in. Enable patients to schedule appointments and then
check in for those via portals or their devices.
4 Notifying patients. Most physician offices do not have enough space for social
distancing and or resources for frequent cleaning of chairs and surrounding
area. One way to address this is to allow patients to wait in their cars and be
notified via their smartphone when they may enter the office.
4 Prescreening. In addition to collecting patient information and consent, healthcare
providers should check body temperatures and ask screening questions to ensure
proper protocols are followed to stop the accidental spread of the virus.
4 Check out. Enable digital delivery of visit summaries and orders and digital
scheduling of follow-up appointments.
4 Payments. Enable touchless payments, including Apple Pay, Google Pay, and
others, at the point of care or before or after the visit to avoid physical handling
of paper and surfaces.
4 Redesign the physical layout of waiting areas to maintain appropriate social
distancing, especially for elderly and other high-risk patients.
Actions
for
providers
9. From Chaos to Catalyst: Five Imperatives for Healthcare / 9
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10. 10 / Creating Competitive Advantage from the Inside Out
Digital Operations
Imperative 4: Accelerate digital transformation
Shifts in consumer behavior, combined with regulatory easing and
powerful new technologies and their accelerated global adoption, create
a perfect environment for change.
❙ COVID-19 has forced all businesses to adopt at least some virtualization. As a result, technologies and
behaviors that were slow to catch on, particularly telehealth, appeared poised to become mainstays.14
Forrester Research estimates that video visit volume will reach 1 billion transactions in 2020, up from a
projected 38 million transactions before the pandemic. Furthermore, McKinsey & Company estimates that
approximately $250 billion — roughly 20% of all estimated Medicare, Medicaid and commercial outpatient,
office and home health spend for 2020 — could be virtualized.15
❙ Post COVID-19, significant changes will be required in core business processes, including:
> More efficient provisioning and localized delivery of care for members and patients.
> Greater interaction and data sharing with partners.
> Ability to sustain consistent member and patient experiences even as care sites grow more distributed.
> Ensure employee, patient and member safety through contact tracing, touchless experiences and
public-health surveillance.
> Provide greater self-service options to reduce costs while improving convenience.
❙ These new processes must interact seamlessly with EHR and claims engines; older systems may not be
flexible enough to support new services and data flows.
❙ Vendors are also upgrading their software to facilitate digital transformation. Healthcare organizations with
legacy systems and processes will find it difficult to get full value from these new capabilities.
❙ New regulations, including interoperability and price transparency, will break down industry silos and make
data flow more fluidly among healthcare organizations.
✔ Create a broad care ecosystem around existing EHR investments that will enable
care anytime, anywhere. This may mean creating a scalable and agile architecture
around prioritized use cases such as public health surveillance or remote health
monitoring and ensuring that an organization’s EHR vendor can support the same.
✔ Implement a digital front-door strategy that delivers a consistent set of experiences
for patients regardless of their entry point into the healthcare provider’s system. A
robust workflow behind a digital door should integrate patients into the healthcare
system and all its offerings at the first interaction. With good integration, patients will
Actions
for
providers
11. From Chaos to Catalyst: Five Imperatives for Healthcare / 11
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be recognized throughout the system and their health data will be readily available
to all providers. These frictionless experiences will help improve patient loyalty by
increasing their satisfaction.
✔ Modernize how employees work from home with automation that enables a
paperless office, no-fax processes, etc.
✔ Modernize data infrastructure to:
4 Get a coherent view of operations, identify areas to take out costs and lay
the foundation for growth and optimization opportunities such as effective
syndromic surveillance.
4 Pool clinical data and administrative data from payers to disease surveillance
systems for faster response to outbreaks.
4 Leverage AI and ML to drive better clinical and operational outcomes.
✔ Provide a simplified experience to members to facilitate finding and financing care.
Help members select the best value by comparing prices that providers publish
under price transparency rules.
✔ Modernize and retire any remaining large legacy mainframe systems. If that is not
practical, componentize and modernize parts of those systems in a manner that
aligns with the business priorities.
✔ Transform the IT operating model to align better with the organization’s business
objectives and by moving to a product-oriented consumer-focused mindset.
✔ Create strategic partnerships with established vendors with experience and scale
as well as niche product vendors to take advantage of the best capabilities of each.
✔ Build new strategies around increased and improved data flows, including greater
availability of longitudinal data, and use AI and analytics to:
4 Identify members and populations likely to be at greater risk for complications
from COVID-19, then use that information to monitor for and predict
outbreaks and adjust resources accordingly.
4 Discover, during enrollment processes, which members would benefit from
care management.
4 Integrate social determinants of health initiatives into population health
management strategies for better and sustainable outcome improvements.
Actions
for
payers
12. 12 / From Chaos to Catalyst: Five Imperatives for Healthcare
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Imperative 5: Improve collaboration
Payers and providers have an opportunity to work together to engage
members and patients to control costs.They can create a model of joint
operations to maximize operating efficiency, reduce waste and duplicated
effort, maximize information delivery speed and improve patient care.
❙ COVID-19 has forced a dramatic shift in how members and patients consume healthcare services.
❙ Health systems that are dependent on elective procedures are struggling as patients and/or local
authorities postpone these.
❙ Payers’ medical costs are less than expected, but they eventually will feel the impact of COVID-19-related
expenses.16
One estimate puts the cost of COVID-19-related testing, treatment and care in 2020 at $34
billion to $251 billion for commercial payers alone.17
The ultimate financial impact will depend on the
financial assistance that all healthcare organizations receive from federal or state agencies.
❙ Providers with capitation contracts with payers have been affected less compared to providers with
greater share of fee-for-service payments.
❙ Proliferation of digital in healthcare along with high deductibles in many employer-sponsored plans may
result in rethinking traditional healthcare benefits, especially new types of benefits coverages that can be
designed based on digital channels exclusively with no deductibles.
❙ Furloughs and layoffs are pushing a larger share of the population to Medicaid plans, which are
fundamentally less profitable for both payers and providers.
❙ In addition, a sizable number of previously healthy patients may end up having persistent health problems
due to COVID-19.18
❙ High COVID-19 fatality rates among people 65 and older are likely to disrupt actuarial models.19
Health
insurers may need to revisit assumptions about the size and needs of populations that they serve.
❙ Incentives must be aligned between regulatory bodies, payers and providers to support new care-delivery
models, such as services delivered virtually or via care@home, with appropriate reimbursements.
13. From Chaos to Catalyst: Five Imperatives for Healthcare / 13
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✔ Create a financial recovery roadmap by each payer contract to sustain operations
for the new normal.
✔ Embrace digital transformation and start dialogues with payers to prove that this
new model of care will reduce total medical costs.
✔ Show leadership in discussing broad technology adoption. Many payers are
hesitant to implement new technologies such as automation because they
are concerned about provider adoption. Many of the new technologies have
tremendous promise to streamline operations, making this an appropriate time to
launch these initiatives.
✔ Leverage interoperability to create true clinical-data-sharing agreements for clinical
insights and decision-making.
✔ Traditional inefficiencies in traditional payer-provider models such as prior-
authorizations can be eliminated almost completely by automating with newer
technologies. Health systems can take the lead in adopting these technologies by
collaborating with their payers.
✔ Tap into furloughed healthcare worker pools in collaboration with payers to find
quality candidates to take care of patients at their homes. Use excess nursing
home staffing to provide greater engagement with patients and have a seamless
transition from human to digital channels.
✔ Reach out to major contracted health systems and understand the financial impact
and resulting imperatives that COVID-19 has created for them.
✔ Help providers migrate to a greater share of capitation-based contracts.
✔ Create mechanisms to jointly invest in practices or create value-based programs
leveraging new care-delivery models that can incentivize the provider community
to invest in more continuous engagement with patients.
✔ Work with providers to jointly evaluate high-risk patients and educate them about
the risks of postponing elective surgeries, screenings and outpatient procedures,
and plan to safely conduct those based on preparedness of the health system.
Actions
for
providers
Actions
for
payers
14. Endnotes
1 “New AHA report finds financial impact of COVID-19 on hospitals & health systems to be over $200 billion through June,”
American Hospital Association press release, May 5, 2020, https://www.aha.org/press-releases/2020-05-05-new-aha-report-
finds-financial-impact-covid-19-hospitals-health-systems.
2 Peter Borden,“Novel Coronavirus Will Spark A Whole New World Of Healthcare,” Digitally Cognizant blog, April 29, 2020,
https://digitally.cognizant.com/novel-coronavirus-spark-new-world-of-healthcare-codex5596/.
3 Emilie Koum Besson,“COVID-19 (coronavirus): Panic buying and its impact on global health supply chains,” World Bank blogs,
April 28, 2020, https://blogs.worldbank.org/health/covid-19-coronavirus-panic-buying-and-its-impact-global-health-supply-
chains.
4 Cynthia Cox, Rabah Kamal, and Daniel McDermott,“How have healthcare utilization and spending changed so far during
the coronavirus pandemic?” The Peterson Center on Healthcare and KFF (Kaiser Family Foundation), May 29, 2020, https://
www.healthsystemtracker.org/chart-collection/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-
coronavirus-pandemic/#item-start.
5 Hidden Costs, Values Lost: Uninsurance in America, Institute of Medicine (US) Committee on the Consequences of
Uninsurance, Washington (DC), National Academies Press (US), 2003, https://www.ncbi.nlm.nih.gov/books/NBK221653/.
6 Gia Gould,“Early Evidence Suggests Increased Medicaid Enrollment Due to COVID-19,” The National Academy for State
Health Policy,June 1, 2020, https://www.nashp.org/early-evidence-suggests-increased-medicaid-enrollment-due-to-covid-19/.
7 “AHA report: Hospital financial losses from COVID-19 expected to top $323 billion in 2020,”June 30, 2020, https://www.aha.
org/news/headline/2020-06-30-aha-report-hospital-financial-losses-covid-19-expected-top-323-billion.
8 Robert King,“Analysis: Large majority of hospitals could lose $2,800 for treating each COVID-19 patient,” Fierce Healthcare,
March 24, 2020, https://www.fiercehealthcare.com/hospitals-health-systems/analysis-large-majority-hospitals-could-lose-2-
800-for-treating-each-covid.
9 Michael Cohen and Julie Peper,“COVID-19 Cost Scenario Modeling: Treatment: Estimating the Cost of COVID-19 Treatment
for U.S. Private Insurer Providers,” America’s Health Insurance Plans, Wakely Consulting Group, LLC,June 3, 2020, https://
www.ahip.org/wp-content/uploads/AHIP-COVID-19-Modeling-Update_Wakely-2020.06.pdf.
10 “Gartner Survey Shows 51% of CFOs Are Preparing for Up to 30% Decline in Revenue This Year Due to COVID-19,” Gartner
press release, April 16, 2020, https://www.gartner.com/en/newsroom/press-releases/2020-04-16-gartner-survey-shows-51-
percent-of-cfos-are-preparing-for-up-to-30-percent-in-revenue-this-year-due-to-covid19.
11 Rimma Kats,“The US Population Is Becoming More Comfortable with Using Telehealth Services,” April 24, 2020,” eMarketer,
https://www.emarketer.com/content/the-us-population-is-becoming-more-comfortable-with-using-telehealth-services.
12 Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost,“Telehealth: A quarter-trillion-dollar post-COVID-19 reality?”
McKinsey & Company, May 29, 2020, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/
telehealth-a-quarter-trillion-dollar-post-covid-19-reality.
13 “COVID-19: Healthcare Can Step Up Digital to Meet Demand,” Cognizant Perspectives, April 13, 2020, https://www.cognizant.
com/perspectives/covid-19-healthcare-can-step-up-digital-to-meet-demand.
14 “Consumer Attitudes Changing on Accessing Care Remotely,” American Hospital Association, https://www.aha.org/aha-
center-health-innovation-market-scan/2020-06-02-consumer-attitudes-changing-accessing-care.
15 Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost,“Telehealth: A quarter-trillion-dollar post-COVID-19 reality?”
McKinsey & Company, May 29, 2020, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/
telehealth-a-quarter-trillion-dollar-post-covid-19-reality.
16 Matt Sheehan,“COVID-19 impact on US health insurers milder than expected: AM Best,” Reinsurance News,June 5, 2020,
https://www.reinsurancene.ws/covid-19-impact-on-us-health-insurers-milder-than-expected-am-best/.
17 “The Potential National Health Cost Impacts to Consumers, Employers and Insurers Due to the Coronavirus (COVID-19),”
Covered California, Policy/Actuarial Brief, March 22, 2020, https://hbex.coveredca.com/data-research/library/COVID-19-
NationalCost-Impacts03-21-20.pdf.
18 “Looking forward: Understanding the long-term effects of COVID-19,” The National Heart, Lung, and Blood Institute (NHLBI),
June 03, 2020, https://www.nhlbi.nih.gov/news/2020/looking-forward-understanding-long-term-effects-covid-19.
19 Matthew Edwards,“COVID-19 (coronavirus): An actuary’s perspective,” Willis Towers Watson, March 9, 2020, https://www.
willistowerswatson.com/en-US/Insights/2020/03/COVID-19-coronavirus-an-actuarys-perspective.
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Sashi Padarthy
Assistant Vice President, Healthcare Practice, Cognizant Consulting
Sashi Padarthy leads Cognizant’s Digital Strategy and Transformation service line. For
more than 20 years, Sashi has helped healthcare organizations in the areas of digital
strategy, digital transformation, innovation, technology-enabled strategy, new product
development, value-based care and operational improvement. He is a Sloan Fellow
from the London Business School. Sashi can be reached at Sashi.Padarthy@cognizant.
com | www.linkedin.com/in/sashipadarthy/.
Niloy Chakrabarty
Principal, Healthcare Practice, Cognizant Consulting
Niloy leads consulting services for government clients. He has more than 16 years
of experience in the healthcare industry and worked across payers, providers,
PBMs, retail pharmacies and ACOs. He is responsible for leading large-scale digital
transformation projects and has experiences in solving complex healthcare problems
through emerging technologies, automation, AI and machine learning. He has an MBA
from the Indian Institute of Management, Calcutta, and he can be reached at Niloy.
Chakrabarty@cognizant.com | https://www.linkedin.com/in/niloych/.
About the authors
About the authors