The healthcare landscape is evolving rapidly, driven by the convergence of advanced technologies, shifting policies, and a growing emphasis on patient-centered care. Yet, despite these advancements, the industry faces significant challenges in delivering a seamless experience for both patients and providers. In a recent podcast discussion, healthcare experts delved into the core issues confronting the industry today and explored how innovative solutions and strategic partnerships are paving the way for a more proactive approach to healthcare.
The complex challenges facing healthcare today
Healthcare is at a critical juncture, with numerous forces shaping its future. Some of the key challenges include navigating Medicare Advantage and CMS (Centers for Medicare & Medicaid Services) rates, improving the quality of care through provider partnerships, and empowering patients to take an active role in managing their health. The underlying question is: How can we leverage technology to support these complex transactions and ensure they lead to better health outcomes?
For many healthcare organizations, the challenge is not just about having the right technology but also about getting people – patients, providers, and payers – to effectively use it.
“The industry has moved past the era of if you build it, they will come. Now, the focus is on adoption, and the journey often begins with choosing the right partners to embark on this mission.”
The struggle with technology adoption
Despite the abundance of advanced healthcare technologies, the experience for both patients and providers has often been less than satisfactory. The challenge lies in transforming the vast amounts of data generated by these technologies into meaningful, actionable insights for users.
Historically, healthcare systems have provided basic information, such as claims and visit counts, which offer limited insights for proactive health management. The goal now is to create a more unified and cohesive experience that supports patients throughout their healthcare journey. This involves integrating various point solutions, protocols, and security measures into a single, cohesive platform that not only simplifies the user experience but also ensures that patients receive timely and relevant information and support.
From reactive to proactive care
A significant shift in healthcare is moving from a reactive to a proactive approach. Instead of waiting for conditions to worsen before taking action, healthcare providers aim to intervene early, using data-driven insights to guide patients through their healthcare journey. This proactive care model is especially important for managing chronic conditions and preventing them from escalating into more serious health issues.
However, the success of this approach relies heavily on patient engagement. While patients often place more trust in their providers than in their health plans, healthcare organizations can enhance this relationship by providing comprehensive data that supports informed decision-making. By offering patients a clear roadmap of their healthcare needs and enabling them to take proactive steps, healthcare providers can significantly improve overall health outcomes.
The role of strategic partnerships
With a myriad of technologies available, healthcare organizations face the challenge of choosing the right partners to support their long-term goals. Deep due diligence is essential in selecting partners who can not only meet current needs but also scale with the organization's evolving requirements.
For instance, Highmark’s selection of Pega as its health data backbone was driven by the platform's ability to support both current and future needs. Pega's robust infrastructure allows for the efficient use of clinical data, which is critical in delivering timely and accurate care recommendations.
Strategic partnerships extend beyond just technology vendors. These partnerships are essential in creating a scalable, secure, and stable environment that can grow with the increasing demands of the healthcare industry.
The importance of clinical data
In today’s healthcare landscape, clinical data is invaluable. Accurate, accessible, and timely clinical data is crucial for effective patient care. Highmark’s previous system for utilization management and clinical management was hampered by technical debt, leading to inefficiencies and high costs. By transitioning to a more advanced platform like Pega, Highmark was able to overcome these challenges, ensuring that clinical data could be effectively managed and utilized.
The move to Pega was not just about addressing current inefficiencies but also about preparing for future growth. As the volume of clinical data continues to grow, so too does the need for systems that can manage this data at scale. The right partners are those who can evolve with these demands, ensuring that healthcare organizations can continue to deliver high-quality care as the landscape changes.
Real-world success stories
enGen’s journey with Pega offers a compelling case study of how the right technology, combined with a deep understanding of user needs, can drive significant improvements in healthcare delivery. Highmark, the parent company of enGen, a wholly owned healthtech subsidiary, faced significant challenges in healthcare delivery due to outdated technology and inefficient workflows. To address these issues, enGen implemented Predictal, a utilization and clinical management tool built on the Pega Platform™.
Before Predictal, Highmark struggled with outdated technology that was difficult to maintain and inefficient workflows that frustrated clinicians. enGen took a user-centered approach, involving end users in the development process to create a system that not only met current needs but also allowed for continuous improvement. The implementation of Predictal has led to substantial gains in productivity, showcasing the success of enGen's innovative approach to healthcare technology.
In this podcast, Mick Malec highlights some of their results. This success underscores the importance of choosing the right technology partners and taking a collaborative approach to system design and implementation.
- Training and onboarding times have been reduced by 50%
- Overall productivity is up 20%
- Turnaround time is up 300%
The future of healthcare
As healthcare continues to evolve, the focus will increasingly be on creating integrated, patient-centered systems that leverage the full potential of technology. Strategic partnerships and a commitment to continuous improvement will be key to navigating this complex landscape.
Through enGen and Highmark’s whole-person care efforts, this aims to create a more proactive, data-driven approach to healthcare. By choosing the right partners, embracing innovation, and focusing on the needs of patients and providers, the healthcare industry can overcome its current challenges and deliver better outcomes for all.
The journey is far from over, but the path forward is clear: Healthcare must move toward a model that is not only technologically advanced but also deeply human-centered. We can create a healthcare system that truly works for everyone by prioritizing the needs of patients and providers and using technology in a thoughtful and strategic way.