How Medical Supply Companies Can Take Charge with Digital
Many businesses today worry about being “Ubered” or “Amazoned” – that is, seeing their markets invaded by digital native upstarts that overturn traditional business models and value propositions. The healthcare industry’s complex supply chains and regulatory burdens seem to create a high wall that will discourage such disruption. Yet the reality is artificial intelligence (AI), machine learning, data analytics and intelligent automation, broadly known as digital technologies, are already disrupting healthcare by powering three key developments: consumerism; data management; and analytics.
Some leading medical supply chain companies already are embracing the demands and opportunities created by these forces to build closer relationships with their customers, to grow and defend market share, and to drive down costs and accelerate their revenue cycles. Here is just a sampling of ways in which medical suppliers can use digitally powered tools and strategies to address market trends to their advantage.
Medical supply companies traditionally have focused their efforts on successful order fulfillment. That’s changing. Industry leaders realize their customers now expect a great experience, not just a shipment. Further, these leaders recognize they are competing with companies such as Amazon and Apple that continually raise consumer expectations about what constitutes a great experience. And healthcare consumers matter: they are paying for increasingly larger shares of their healthcare through high deductible plans and/or assuming larger percentages of health premiums. They expect price transparency and real-time, intelligent, personalized service. It’s imperative medical suppliers begin to integrate digital technologies into their processes to deliver experiences that meet those expectations.
Digital technologies today are mature enough to enable medical supply companies to consider customer-centric tactics and strategies like these:
– Personalized supply catalogs. It is possible today to dynamically create custom catalogs for patients based on their insurance benefits and help them make more-informed supply choices in line with their coverage, co-pays and deductibles. Ultimately, medical suppliers could help patients monitor their eligibility and benefits in real time, calculating and collecting a patient’s financial responsibility up front to streamline receivables while also providing a higher level of customer service.
– Partner with providers for pricing transparency, accessibility and revenue cycle efficiencies. Exchanging data digitally with providers will help streamline delivery of supplies to consumers and improve revenue cycles. Many payers insist on pre-authorizations and prescriptions being on file before approving shipments.
The too-common phone-call-and-fax routines required to ensure all the right parties have the right paperwork at the right times are frustrating for patients and slow supplier reimbursements. Digital technologies such as application programming interfaces (APIs) and electronic data interchange (EDI) can enable providers and supply companies to share pre-authorization and prescription data and even trigger “next best actions” automatically via robotic process automation. These smart digital data flows eliminate error-prone manual processes, speeding claims submission and ensuring patients have prompt access to the supplies they need.
– Digital customer interactions. Digital options for engaging with customers are exploding. Healthcare consumers expect to have an identical and continuous experience with their service providers across all the devices they use to connect, making omnichannel support a given. Chat windows and augmented reality (AR) features also are rapidly becoming standard. Conversational AI agents can answer questions and help customers place orders; AR instructions can help customers understand which products to select and how to use them. Self-service options can help customers set up and manage payments.
2. Data Management
Successful data management is a critical enabler for responding to the consumer-centric shift that is driving the industry. Data can reveal insights needed to deliver better customer service and spark innovation. Medical suppliers must establish a data management infrastructure that can store vast amounts of medical information in a flexible way.
The necessary data goes beyond basic claims and order information to prescriptions and other medical documentation requests, including to whom supplies and documents were sent, the supply period, document status and more, to enable sophisticated analysis on provider trends. Going further, software bots and sensors make it easy and relatively inexpensive to gather even more data by instrumenting operations and IT processes as well as physical equipment used in warehouses, fulfillment and shipping.
Analytics can reveal important patterns in and across large data sets such as order data, provider response data, and claims data. Analyzing this data can help reveal trends, such as a steady increase in payer claim rejections not only related to a specific payer or provider, as well as the ability to drill down to specific data elements that are missing or incorrectly documented, resulting in denials. Then suppliers can take the specific corrective steps needed to ensure clean claims submissions and fast first pass reimbursement—wins for the payers, providers, suppliers and consumers.
Analytics coupled with machine learning and AI also can help anticipate patient queries so these can be addressed even before the questions are asked, thus reducing customer service costs. Medical suppliers may also use analytics to determine population health needs as well as predict effective care management strategies for groups of customers. The tools could even determine the most cost-effective shipping methods and routes, helping ensure supplies arrive when and where needed.
Getting Digital Done
The above are just a few ways in which medical suppliers can deploy digital to become more efficient while also developing better customer experiences. Whatever tools and tactics medical suppliers choose, modern tools require a modern IT infrastructure. Older systems—whether five or 25 years old—lack the flexibility required to interact with other systems to deliver real-time, intelligent interactions such as dynamically populating a supply catalog tailored to a specific patient’s benefits plan and medical condition. Cloud-based infrastructure services can enable companies to quickly and affordably simplify and modernize infrastructure so they can take advantage of next generation digital capabilities.
Organizations must also decide to what level of customer experience they aspire. Some features will be table stakes—merely the prerequisites for competing at all. Some will be competitive differentiators, and others truly market-leading service levels and capabilities. (Refer to chart here if we are allowed to use it.) Take the example of delivering greater price transparency:
– Table stakes: Executing and monitoring payer contracts; identifying patient-specific coverage and benefits; and maintaining a current fee schedule and visibility into performance.
– Differentiating capabilities: Proactively identifying contracts due for renewal; analyzing fee schedule performance over time; running batch eligibility verifications; coordinating benefits for multiple payers; estimating a patient’s coverage in real time.
– Market leading: Real-time integration with payers to provide patients with more accurate fee schedules.
Developing such capabilities is a process – though digital tools and development methodologies like DevOps and Agile enable fast prototyping and testing of new capabilities. Some of the early lessons emerging from leading companies embarking on this journey include:
– Thoroughly understand current and future state requirements. These must be specific and complete for each function affected by change. “Ability to send order information to the clearinghouse to generate a claim” is a high-level requirement. The necessary details to gather are the frequency at which the data should be sent (batch vs. real time); the specific data required; security requirements for data transition; the clearinghouse requirements for data receipt or transition (flat file vs. API); and data format. These specific requirements can have a significant impact on the solution architecture, development effort and ultimately the overall program cost.
– Evaluate current products on the market for how well they meet specific needs and how they will work with existing infrastructure. Sales pitches are persuasive so it is critical to ask key questions to understand how much implementation effort will be spent on configuration vs. customization of tools.
– Continuously work toward adoption of new processes and technology. Agile development, done well, is one critical success factor. It’s also important to incorporate a strong change management program. For many suppliers, customer-centricity will be a major transition and old processes will be redesigned. Ensuring success is more than a matter of training: agents must understand why processes and screens are changing and how the changes benefit them and patients, such as by eliminating frustrating telephone tag and billing follow up calls
By taking charge of digital, medical suppliers can create better, simpler experiences for patients and build stronger relationships with them while also improving internal processes and results, from greater employee satisfaction to faster revenue recognition. Those should provide the strength necessary to compete successfully as healthcare becomes more digitized and consumer-focused.
Vanessa Pawlak is the Global Health Compliance Services Leader for Cognizant Consulting. As an Associate Vice President at Cognizant, Pawlak has over 14 years of consulting experience with highly regulated government programs and has previously held the industry title of SVP, Chief Compliance & Privacy Officer.