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Transformational ECM I: Health Payers

January 25, 2011

In the last post, I kicked off a series on organizational transformation by getting on my soap box about how ECM should be seen less in terms of technology, process, compliance, or risk management, and instead as a powerful force for transformational change at organizations.

With that done, I want to turn to the first post in the series and take a look at an industry vertical that’s been getting a lot of attention lately—health payers.

With the advent of health care reform, payers across the board (from smaller, single-state Blues to for-profit national giants) are under tremendous pressure to reimagine their operating models to keep pace with the dynamic, emerging shape of health care legislation coming out of Washington.

I’ve been doing a lot of work recently with health payers, and over the last 18 months in particular, I’ve seen ECM come into its own as an important tool available to payers to overcome the challenges they face between now and 2014.

Likely effects of health care reform

If you ask folks involved in health care what they think of health care reform (HCR), you’ll get a lot of different answers. But one thing everyone would agree on is that no one has any idea what the final shape of HCR will look like—the legislation, despite being thousands of pages long, moves in generalities that require further elaboration to be implemented.

That having been said, I think we can take an educated guess at some big bucket effects likely to come about due to the current trajectory of HCR.

  • Communications required with members and providers will rise, both in terms of kind and frequency
  • Intensifying scrutiny of payer/provider activities, leading to increased federal litigation
    • There’s been recent high-profile litigation activities in MI, PA, MA, and the DOJ has specifically mentioned the payer/provider relationship as an area of interest going forward
    • The current administration has singled out Blues as “anti-competitive” on numerous occasions
  • Heightened pressure to modernize systems and applications
    • There’s already been a spate of regulation impacting payer technology (e.g., ICD 10, Mental Health Parity)
    • The current administration places high value on the use of technology to improve how they do business (e.g., appointing a Federal Government CIO, using crowdsourcing to surface and rank problems for the administration to tackle, etc.)

All three of these likely effects not only have big price tags associated with them, but could well be impossible for some smaller payers to react to while remaining financially viable.

Broad ECM solution areas

And while there different ways a payer might choose to address these challenges, ECM supports some critical solution areas that can contribute signally to overcoming them.

  • Customer Communication Management (CCM) – by improving the way payers create and deliver communications to members and providers
    • Automation of the authoring process
    • Multi-channel delivery of content (“write once, publish many”)
    • Print suppression
  • Records Management – by addressing over-retention to reduce the amount of likely discoverable content
    • Less content needs to be put through the discovery pipeline in the first place
    • Faster and easier to pull back initial data set required by a litigation event
    • Fewer “smoking guns” lurking out there
  • Storage Management – by reducing the volume of content stored on systems and applications to enable more agile IT delivery
    • Less budget spent on storing content that has passed it’s legal and operational usefulness – can be applied to new development that increases organizational capacity to respond to HCR
    • Easier to implement, update, or sunset systems and applications

Real world examples

And this isn’t all theory: I’ve personally been involved with payers over the last year and a half who have addressed these three ECM solution areas with real-world initiatives:

  • Enabling web self-service and mobile delivery, suppressing paper communications
  • Moving off of shared drives and onto document management systems
  • Deploying reusable SharePoint templates (with compliance requirements baked in) to meet common business needs across the organization
  • Reducing the number of letter templates in use, streamlining/automating the correspondence authoring process
  • Centralizing the management of off-site paper storage to reduce the amount of documents sent to storage facilities to cut monthly storage costs and reduce the legal risk associated with maintaining warehouses full of likely discoverable paper records that are past their retention periods

Have the payers adopting these initiatives solved the challenges of HCR once and for all? Of course not. But they have realized important incremental gains as a result: cost savings to contribute to administrative cost reduction commitments, net gains to productivity that can be applied to higher-value activities directly related to responding to HCR mandates, and improved system performance that delivers increased technology capabilities without new investments.

They’ve also significantly improved their litigation risk profile by addressing over-retention: they’ve reduced the amount of content they keep that has passed its legal and operational relevance, which lowers discovery cost and risk in addition to making day-to-day operations less costly (IT storage, line worker efficiency, system performance).

The final word

So there you have it–a snapshot into how payers are using ECM to respond to the demands of HCR. In the next post, we’ll turn to another industry vertical that’s an exciting, if unexpected, ECM practice area: mining. With the recent run up in commodity prices, mining companies have been not only generating tremendous profits, but investing those profits in improving their operations. And like health payers, ECM is an important part of these improvements.

But in the meantime, jump in and share your experiences and thoughts on health payers and ECM–I’d love to hear from folks out there!

One Comment leave one →
  1. February 15, 2011 9:20 am

    Hi Joe,

    Another way to look at this is to create audit trails that allow users to rollback and find that piece of content they needed… rather than start from scratch every time and/or make another copy and share this.

    For example, creating a publishing strategy can be very useful as with the rise in document collaboration tools, it will make doc owners rethink how and where they share information assets…. and factor best practices for sharing information into the equation.


    Ivan Walsh

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