How Health Plans Capture New Business in a Competitive Landscape

Successful health plans are focused on expanding membership, increasing revenues, and controlling administrative costs. However, administration costs attributable to outdated technology and manual processes result in one of the highest sunken costs in healthcare.

Health plan operations, especially at smaller plans with limited resources, are pulled in a million directions. They are continually searching for ways to innovate and improve operational efficiency while reducing costs. However, as administrative expenses increase, tighter budgets become, and less money is available to reinvest in crucial differentiators and forward-thinking initiatives. Outdated technology and siloed systems can adversely impact operational efficiency, create significant processing challenges, drain productivity, and ultimately impact the bottom line.

For example, Michigan-based McLaren Health Plan’s outdated 30-year-old technology was resulting in a zero percent claims auto-adjudication rate. McLaren’s legacy solution was clunky, hard to configure, not user-friendly, and not scalable.

As Mike Comick described in a blog post, “At some point in time, the amount of road remaining for ‘investment modernization’ of existing organizational structure, use of data/business intelligence, and legacy technology is depleted. Ultimately the risk of minimal maintenance, or worse, doing nothing, is by far greater than ‘taking the big transformational jump.’”

McLaren agreed, as its Vice President of Business Information and Operations, Sara Mavredes, said, “We wouldn’t be in business if we didn’t make a change.”

McLaren decided that it needed to implement new technology that would allow the business to work more efficiently and intelligently, and that would provide it with the margin to implement new strategic initiatives like customer service, care coordination, new lines of business, and other innovations.

McLaren implemented next-generation technology and gained flexibility, transparency, and performance, critical for its success.

Continue reading this case study to learn how HealthRules Payor® enabled McLaren to respond to industry changes, reduce costs, increase efficiency, gain an edge over the competition, and more.

About the Author

Janet Barros

Janet Barros, Senior Manager, Business Development, HealthEdge
Janet Barros is a seasoned healthcare business development executive with extensive sales and client management experience. Janet works closely with senior executives to identify their business objectives and provide the solutions and strategies that enable them to achieve their goals. She has an extensive background in digital health, payer, provider, and solution sectors. Prior to joining HealthEdge in 2018, Janet led successful revenue-generating initiatives at Influence Health, Premier Medical, and, most recently, Aptus Health.