The Ongoing Search to Reduce Costs, Increase Quality

Those working in health plan operations are always in the fury of the moment. They are focused on what is the next emergency. How many people is that going to take? When are they going to deliver? No matter their title, the real job is firefighter and janitor; because they are relied on to put out the fires, mop up the mess, and do whatever it takes to make their customers happy.

Health plan operations, especially at smaller plans with limited resources, are pulled in a million directions while also continually searching for ways to reduce costs per member per month (PMPM) to administer their business. Health plans tend to use report-based managing in a very reactive manner, but they could immensely improve their business operations and cost savings if they took a proactive approach.

From the technology side, health plans see hands on a keyboard as a key factor that increases PMPM. Health plan managers will agree that keystrokes cost money. And every time a health plan puts a new person into the system, it costs money. It costs money from a human resources perspective and a data quality perspective; because the most significant chance of introducing error into a system is through the people using the system.

So, from a systems viewpoint, health plans want to lessen the chance of human error. That is why automation is so important.  Automation that empowers the business user to reduce PMPM and increase quality is critical.

When it comes to automation, and increasing quality, one way health plans can do this is through automated-based testing; you never want to test in production when it’s too late to find out if something is wrong. Business user automation through imports, exports, and auto-reprocessing provide a low-cost/ high-quality solution to this problem. When health plans are looking to lower PMPM, they need to make informed decisions. The flexibility to model production transactions in a test environment will allow health plans to uncover what changes could save costs or generate revenue for the health plan.

To successfully reduce PMPM, health plans need a flexible system that does not require a sophisticated IT function for configuration, testing, and accessing real-time data. One that empowers the business user through automation to drive decreasing costs and increasing quality.

About the Author

Dustin Rojas

Dustin Rojas, Senior Director of Sales Engineering and Strategy, HealthEdge
Dustin Rojas is a senior healthcare technology professional with deep expertise and extensive experience in many aspects of Healthplan Operations, and the Payer Software industry.  Dustin primarily focuses on collaborating with the Sales team and the overall organization to lend his collective experience to the achieve the overall strategic goal of "Crossing the Chasm.”  As Senior Director of Sales Engineering and Strategy for HealthEdge, he regularly works with Prospects and Senior Leadership to assist in current sales pursuits, in addition to collaborating and consulting on emerging services opportunities.  Prior to joining HealthEdge in 2019, Dustin spent 22 years in a variety of roles in the healthcare payer space with organizations that include Great-West Healthcare (Cigna West), and Cognizant/TriZetto.

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