1st Edition
Voices of Innovation - Payers Opportunities for Creating Solutions to Improve Member Experience and Health
As the health delivery landscape in the United States evolves in a post-COVID-19 era, both incumbents and new entrants are reimagining models of care. Technology and medical advancements are transforming the way care is delivered and experienced, and changes in regulations and incentives across the industry are redefining how the healthcare system works and interacts. As a result, care delivery is undergoing several transformations: from sick care to preventative whole-person care, from intermittent to continuous care, from facility-based settings to omnichannel offerings through virtual care and video or telephonic technologies, and from standardized to personalized solutions. In addition to healthcare providers, payers are also redefining their role in care delivery through provider ownership, technology, and provider enablement to deliver higher-value care to members. While the payer community has been slow to innovate, they now have an opportunity and an incentive to play an active role in reimagining the future of care delivery. In the past year alone, significant disruptors have entered the provider space threatening the existence of payers, specifically self-funded programs such as Amazon and Walmart. This has served as a giant wake-up call that healthcare has shifted.
Now, more than ever, there is an emphasis on the patient and clinician experience. Perhaps hastened by the pandemic, the race is on for innovations from the payer community to improve patient and provider engagement. Unlike other players, payers have end-to-end visibility into individual care needs and utilization patterns across providers and settings. This perspective can provide informed choices around optimal care models, unlock value through improved health outcomes, and lower the total cost of care for members and customers.
This book is loaded with numerous case studies and interviews with healthcare leaders from the payer community, helping stakeholders understand how to leverage innovation leading them to superior business and clinical outcomes. The book also discusses how and why data is key to innovation activities and how partnerships are key to using data effectively.
Foreword by SACHIN H. JAIN, MD, MBA, CEO of SCAN Group and SCAN Health Plan, Industry Leader
Introduction by Cliff Deveny M.D., President, CEO, Summa Health
Acknowledgements
About the Editors and the Contributors
Series Page
Prologue
Chapter 1: Blend Cultures
· The Nursing Process Strengthens Clinical Optimization by Bonnie Matthews and Nicole Denham
· Cleveland Clinic & Oscar Health Innovate the Payvider Model by Edward W. Marx
· Aligning your Organization’s Belief System by Sakshika Dhingra
· Bridging Healthcare Innovation: Blending Cultures in Payer Models by Anonymous
Chapter 2: Use People with IT
· Disrupting Legacy Processes by John Lee MD
· The Convergence of Data and Relationships is Where the Magic Happens by Brandy Bailey
· Leveraging IT Solutions and Human Resources for Improved Provider Data Management by Anonymous
· Payor Enablement in Accessibility and Delivery of Psychosocial Care to Enable Whole Person Care and Outcomes in Primary Care Provider Clinics by Jay Subramanian
· Closing Gaps in Healthcare is a High-Tech, High-Touch Endeavor by Anna Pannier & Dawn Carter
Chapter 3: Create Roadmaps
· Empathy as a Foundation for Change by Taylor Seymore
· Designing an Integrated Operating Model for VBC Success by Julie Bonello
· Insights in Nanoseconds by Mike Treash
· Navigating Healthcare Innovation for Payer Transformation by Anonymous
Chapter 4: Collaborate and Listen
· Anthem's Approach in Birthing of Avaneer by Anonymous
· Don’t lose the “person” in the “process” by Carol Palackdharry
· The SummaCare Innovation Journey by William Epling
· Revolutionizing Cancer Care by Arvind Sivaramakrishnan
Chapter 5: Communicate and Eliminate Barriers
· A New Model for Member Engagement by Fred Kopplow
· Implementing an Enterprise-Level Patient Engagement Strategy Leads to Better Outcomes by Carrie Kozlowsky
· Kaiser Permanente's Integrated Payer-Provider Model by Anonymous
· Breaking Down Barriers: Payer Healthcare Innovation through Effective Communication by Anonymous
Chapter 6: Stress Simplicity
· The Pursuit of Parsimony by Vishakha Sant
· Cutting Through the Complexity of Payer Systems by Manish Mehta
· Adopt Secure Digital Communication to Simplify Engagement and Operations by Krishna Kurapati and Bobbi Weber
· HCSC's AI-Aided Processing of Prior Authorization Requests by Anonymous
Chapter 7: Recognize and Reward
· Celebrating an End to a Great Payvider by Edward W. Marx
· Strive for creative thinking and innovation shall follow by Sakshika Dhingra
· Incentivizing Payer Healthcare Innovation by Anonymous
Chapter 8: Co-Create Solutions
· Revolutionizing the Member Experience by Tanvir Khan & Tina HsinTing Liu
· Creating the Perfect Atmosphere for Innovation by Sakshika Dhingra
· The Catalyst for Payer Healthcare Innovation by Anonymous
· Summa Health Technology Governance Model for Payer & Provider Optimization by Elbridge Locklear
Biography
Edward Marx serves as Chief Executive Officer of Divurgent. Divurgent is a solutions provider focused on what matters most to our client partners. Divurgent disrupts the typical value equation by using data-infused, flexible, and scalable solutions that demonstrate and quantify value for our partners. Edward is active on Boards, writing books and speaks globally. Edward was Chief Digital Officer for Tech Mahindra Health and Life Sciences, a $6B digital transformation company. As CDO, he oversaw digital strategy and execution for providers, payors, life sciences and bio-tech. Previously, Mr. Marx was the global Chief Information Officer at Cleveland Clinic. His responsibilities included virtual care, digital solutions and information technology. Prior to joining Cleveland Clinic, Edward served as CIO for The Advisory Board/NYC Health & Hospitals, Texas Health Resources and University Hospitals. Concurrent with his healthcare career, he served 15 years in the Army Reserve as a combat medic and combat engineer officer. He is a Fellow of the College of Healthcare Information Management Executives (CHIME) and Healthcare Information and Management Systems Society (HIMSS). He has won numerous awards, including HIMSS/CHIME 2013 CIO of the Year, and has been recognized by CIO and Computer World as one of the “Top 100 Leaders.” Becker’s named Marx as the 2015 “Top Healthcare IT Executive” and the 2016 “17 Most Influential People in Healthcare.” He is the author of 5 books including the 2019 healthcare bestseller “Voices of Innovation” and the 2020 bestseller “Healthcare Digital Transformation; How Consumerism, Technology and Pandemic are Accelerating the Future” both published by Routledge/Taylor & Francis. Ed is currently writing a book for the Mayo Clinic on “Patient Experience”. Edward received his Bachelor of Science in psychology and a Master of Science in design, merchandising, and consumer sciences from Colorado State University.
