Appian Talks

What could you accomplish with better process automation? In the Oil and Gas Sector, the demand for continuous improvement, along with safety and reliability, is driving leaders to identify how they can operate more efficiently. Hear how a combination of performance coaching and automation technology is the key to success, including compelling use cases and fast start approaches.
Participants:
Rick Heyland, COO, RLG International
Glenn Healy, VP of Strategic Accounts, Appian
Moderator: Ryan Byrnes

Scott Polansky, Appian’s Industry Practice Lead for the Healthcare Payer Industry discusses digital transformation topics and trends impacting healthcare payers. Topics include customer behaviors, adapting an agile approach, the importance of a unified member view and accurate provider directories, as well as the current state of uncertainty amidst healthcare reform. Abby Jacobs serves as contributing host.
TRANSCRIPT:
Abby: Hello and welcome to the Appian Industry Outlook Podcast, where we take time to speak with Subject Matter Experts on digital transformation topics impacting their industries. I’m your host Abby Jacobs, a member of Appian’s digital marketing team and a self-proclaimed digital disruption evangelist.
Today, I’m joined by Scott Polansky, Appian’s Industry Practice Lead for the Healthcare Payer industry.
Thanks for joining us today, Scott!
Scott: Thanks for having me. It’s a pleasure to be here.
Abby: Before we get started could you tell us a bit about your background and your role at Appian.
Scott: I’m Appian’s Healthcare Payer Industry Practice Lead, where I help support the sales efforts around the country. Prior to Appian, I have 30 years of experience working for primarily Healthcare Insurers as well as doing some consulting business in a broad range of operational and strategic roles.
Abby: That’s quite an extensive background. I’m sure you’ve witnessed many changes in the healthcare industry over the years and how payers are changing the way they do business. What would you say are the biggest topics currently influencing customers behaviors for healthcare payers?
Scott: I think top of mind for customers is looking at greater flexibility and simplicity in product, benefit and network design. Consumers out there struggle with affordability. We called it the Affordable Care Act but it was really anything but in many instances.There’s also a tremendous lack of transparency around cost and quality, so those are the primary drivers. From the payer standpoint, they’re trying to figure out how they can better engage with their members to be able to drive better outcomes and quality of care.
Abby: From your experience, how are healthcare payers adapting to today’s digital economy?
Scott: It’s a spectrum out there. What we see is that those who are innovative and successful are adapting an agile approach to developing software and technology. They recognize that legacy systems do not provide the flexibility or speed to market so they are adopting new platforms to develop customized apps and integrate data from multiple disparate systems. Innovative payers are moving away from point solutions and towards enterprise platforms that enable the rapid development of customized solutions.
Abby: It goes without saying that adopting a customer-centric approach is essential for any organization in order to compete and deliver in today’s landscape. We’re witnessing a huge shift in what exactly that means and who exactly is a consumer across all industries. For healthcare payers, who are the consumers or stakeholders they need to keep happy and how are they able to do so in an agile way to meet growing expectations?
Scott: Payers have multiple stakeholders and they are trying to figure out how to simplify processes to create a better customer experience. It starts with the members who either come directly as individuals (retail) or through an employer. Often times a broker or consultant is involved and the plans need to meet their needs. Providers (facilities, physicians, medical professionals) are another critical stakeholder and the growth of value-based care will only intensify the need for cooperation and collaboration between providers and payers. Finally, the payer’s employees are critical stakeholders whose needs cannot be overlooked.
Abby: Now you spoke a lot about providers and recently we’ve been hearing more about how having a unified view of members and providers is critical, and the importance of maintaining accurate provider directories. What are the biggest risks and opportunities for healthcare payers around this topic?
Scott: I’m glad you asked that. As I travel around the country talking to our prospects and clients and speaking with industry professionals at conferences, that’s one of the number one topics out there and the risks are many. For provider directories, the risks are both financial and operational. The financial risks include potential fines from CMS and State regulators for not maintaining accurate directories; as well as more indirect costs due to membership losses (or lack of growth) because members are dissatisfied with their experiences. Additionally, providers might be less willing to contract with a payer if they’re not being represented accurately to members.
Operationally, there are huge inefficiencies and wasted resources because payers have not developed efficient processes to manage provider data. The ch...

Digital transformation is not one-size-fits-all. There are no technology vendors selling a Digital-Transformation-as-a-Service solution. So, how can financial institutions implement a successful digital transformation strategy that delivers on strategy, increases operational efficiencies, reduces operating risks, and fosters higher levels of interaction and integration? This type of success requires an organizational culture that fosters a focus on customer centricity and a dedication to breaking down the silos that traditionally exist between business and IT. Without that cultural shift, digital transformation efforts can flounder.
Listen in as Appian invites Julien Courbe, Financial Services Advisory Leader at PricewaterhouseCoopers (PwC), and Michael Heffner, Vice President at Appian, covering Global Banking, Capital Markets, and Insurance, for an opportunity to discuss the challenges and responses they are seeing as financial institutions move forward on the digital transformation journey.

According to recent research from Strategy Meets Action (SMA), an independent strategic advisory firm for insurers and technology solution providers, approximately 57% of insurers have some type of digital transformation initiative in progress, yet there is still a lack of clarity about what encompasses a shift to digital and what the best practices are for a company when planning and executing these initiatives.
Appian invited Deb Smallwood, the founder of SMA, and Kate Gingras, Vice President & Global Insurance Lead at Appian, to speak on episode of the AppianTalks podcast series to discuss digital platforms and how they help insurers.
Listen to the conversation as we touch on the need for digital everywhere in insurance companies - and how an iterative, agile technology approach will enable insurers to solve business challenges faster.

We’re going through a radical restructuring of humanity. And it’s not just business and commerce and finance and technology. It’s actually a re-wiring of who we are as humans. Soon, not only will everyone on the planet be connected digitally, but they can be raised out of poverty through digital inclusion which is a low-cost way of reaching everybody—who was unreachable before—through the network and through the digital platform. So says Fintech commentator and best-selling author Chris Skinner in our latest Digital Masters podcast.