The healthcare industry is experiencing change and uncertainty like no other – with acquisitions and mergers becoming commonplace. Companies operating in the healthcare space can’t always turn to industry best practices for answers, due in part to the unique and nuanced nature of their business models compounded with the dizzying wave of regulatory controls.
In particular, those organizations operating in the evolving Medicare landscape will see their profitability tied directly to their ability to comply with changing policies and regulations. Inability to comply can result in fines or a complete loss of accreditation. The FDA, CDC, Medicare, the Department of Health and Human Services all have growing ability to influence how organizations operate, and in some cases, what you can charge for your products and services.
This growing trend is not a newsflash for anyone who works in the industry, but a critical backdrop for discussing how the role of cloud technologies can help organizations “evolve or die” by eliminating aged legacy systems and migrating to more agile processes that will capture better data.
The merger is complete, now what?
Once a merger or acquisition is complete, it’s time to take a look at how to identify which legacy sales operations to migrate away from in order to streamline business operations.
Compliance is the primary consideration. Any deviation from government requirements to receive reimbursements (Medicare, Medicaid, Medi-Cal, etc.) will not only impact your company’s ability to get reimbursed for any given claim, but leave you subject to fines, litigation, and in some cases complete loss of accreditation.
The first step is to identify trusted advisors in the areas of technology, compliance, and business and make sure that key decisions are made collaboratively by qualified representatives of each stakeholder group.
Next, collaboratively lay out short term and long term goals. It’s important to note that bottlenecks to enact change have surprisingly little to do with the lack of capabilities of a legacy IT application, and far more likely to do with users not adapting to that system. Don't think for a second that just giving users a new system (even if they ask for it) will correct their issues. In fact, assume it won’t.
With regard to business functions, it is crucial to document and validate the “as-is” and “to-be” processes. Awareness of how things work, and a consensus on how things should be done in the future, needs to be worked out every time. Make sure whoever is running the consensus building process is capable of facilitating a level discussion, even if it includes strong minded executives with differing opinions. The loudest voice is not always the right one.
Once you have determined the “must have” changes in order to be compliant, do not ignore your organization’s ability to enact that change. Consider IT capabilities and priorities, end user adoption, and yes… political obstacles. Many organizations zoom in on any process that is perceived as being inefficient. That alone is not justification for making a large investment, rather a broader evaluation of the change being proposed including its IT, business, and overall change impacts.
Cloud technology considerations….
When choosing your cloud technology portfolio, first rationalize where you are capable of changing as a business, and where technology can solve your problems.
Maintenance. Always consider maintenance of any technology. No system can sustain itself without administration. The question becomes how many administrators do you need, what do they need to know, and how much code is involved. If your project leadership is not addressing these questions during the technology evaluation process, they are not setting the project up for success.
Reporting. Take a close look at what top executives need to make improvements to the business, and then work down to the business processes which will give you that reporting accurately. Data driven technology initiatives which don't have reporting goals, will probably never deliver anything to help decision makers actually make decisions.
Data Quality. Normalize data across systems by any means feasible, even if it means temporary spreadsheet processes. If processes are not already in place for consolidating information, implementing something manual and short-term will help you learn what it is you really need from a unified system, or if the overall cost of implementing a unified system is justified.
And lastly, remember it is inevitable that you will be asked to explain your selections down the road. It’s important to be able to map the “to be” processes to more granular business requirements, which map to demonstrable capabilities of the cloud technology.
Cloud solutions and technology are central to evolving in any business and healthcare is no exception. Given the rapid change, it’s a great differentiator and accelerator to your organization’s change. With the continued refinement of government laws and policies, cloud solutions can help organizations adopt and change at a more efficient rate to meet the ever growing compliance demands. If you do, you’ll thrive, if not good luck.
Ryan McGinn is a director in the healthcare practice at strategic management and technology consulting firm Acumen Solutions.