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New Approaches to Healthcare Member and Provider Care Coordination

Cate McConnell
May 21, 2018

This is a critical time for healthcare provider and member services. The right technology can help health plans push forward and deliver new, innovative solutions that satisfy their providers and members. However, legacy architecture and siloed information still remain a challenge.

Digital disruptions continue to challenge leaders to reimagine and reinvigorate their business models and deploy the necessary technology to support their key initiatives.

How do payers push forward in an era of rising costs, market disruption, and mounting member expectations across the care continuum?

Health IT Challenges

Top of mind for Healthcare CIOs is finding new technologies and ways of delivering better experiences for members and providers. Challenges include:

    • Increasing demands for lower costs, better access to care, transparency, and personalized services and experiences

    • Unsustainable, high cost of care

    • Pressure to operate more efficiently and perform more intelligently

    • Although these challenges are not new, they come with new challenges as digital solutions come into play, and these challenges will persist for many years to come.

What is new, however, is that healthcare payers' options for meeting these challenges has changed. Having the right digital transformation solution implemented or in the near-term roadmap will differentiate savvy healthcare payer organizations from those who get left behind.

New Approaches to Care Coordination

To better serve members and providers across the digital care continuum, healthcare organizations are increasingly turning to an agile platform approach to application development. A platform approach that aggregates all data from across systems and connected health devices into one interface gives payers the right information at the right time, allowing them to process claims correctly for providers the first time and coordinate the most appropriate and personalized care for members. This saves time and money that is currently being spent on manual processes and potential errors.

The Appian Platform for healthcare can break down silos and tap into various data sources, including blockchain, to provide complete, actionable views of relevant data. Get a real-time view of provider information to ensure accurate network directories and avoid the risk of fines for outdated data. Plus, increased visibility and engagement for members by integrating medical data from wearables into portal environments that help them better manage their health.

Appian's leading process automation capabilities, turbocharged by robotic process automation (RPA), intelligently streamlines important steps across the care continuum, such as prior authorization processes, increasing external satisfaction and internal efficiency. Additionally, payers can use these capabilities to streamline provider interactions for more efficient claims processing. Native mobility makes it possible for apps to be deployed on any device at the click of a button, with no extra coding or configuration, so care can be coordinated at any time and in any location.

Championing Transformation in Healthcare

Healthcare organizations across the United States are embracing the powerful platform approach that Appian offers. Take the example of AIM Specialty Health (AIM), a benefits management organization with over 50 million members.

Using the Appian Platform, AIM is consolidating eight systems into one unified interface that increases data visibility into their core operations. Appian's agile, low-code app development and mobile capabilities allowed AIM to rapidly deploy transformational apps and deliver new approaches to care coordination. Hear from Phil Merrell, AIM CIO, in this video.

Visit our healthcare payer resource hub to learn more about how Appian can help your organization navigate the digital care continuum to better serve members and providers.

Cate McConnell

Industry Lead, Healthcare Payers

New Approaches to Care Coordination