It’s not Your Grandmother’s Health System, Anymore

Just one short year ago, many in the HC global community were fixated on the massive changes about to take place in the US healthcare system. With the opening of Health Insurance exchanges and other provisions of PPACA, there would be a nearly simultaneous disruption to business models for access to, delivery, and financing of healthcare. In that disruption, there was safety in the numbers – all players had a common “enemy” in managing change. Payers, providers, and consumers may not have understood the changes clearly but everyone was looking at the same changes. Success was a solid strategy to respond to the same information. It was kind of like playing cards with all the cards face-up on the table. While the technology taught us a lesson that the best strategy does indeed require the best execution plan to be successful, there were relatively few “black swans”.

This year, however, the swans are all “black.” Traditional roles are under attack from a new direction. Innovators and self-directed consumers are challenging the roles and authority of payers and providers to make decisions about healthcare. The data being utilized is coming from all directions as new players seek to create a differentiated “consumer experience” that they believe will lead to higher “customer satisfaction” meaning customer loyalty, market share and business viability. Whether it’s or the new iPhone 6, the self-directed consumer segment is taking mind share from the discussion, enabling disruptive innovation from outside traditional roles, and forcing players to a new definition of “modern healthcare.” Making the transition to “modern healthcare” requires traditional participants, e.g., payers and providers, to modernize their people, processes, and technology at the speed of retail change.

Modernization and retail transformation are fraught with risk. A quick review of stats posted on a variety of sites monitoring business success suggests more than half of retail businesses do not survive for five years. In this climate, what is a successful healthcare retail modernization strategy? Retail modernization joins an increasing list of competing objectives that previously was daunting: controlling costs, improving quality of care, optimizing the member experience, and addressing all the number of new payment models and delivery models - not to mention the critical need to stay in compliance with the lightning-fast regulatory changes. Organizations can’t casually experiment; instead they need to deliver demonstrable results while also making foundational changes to their strategies and their operations. Performance-driven modernization within the guardrails of compliance is no mean feat.

For those healthcare organizations that can manage the transformation, the opportunities are profound. Some are making great progress in evolving and launching a transformational journey to position them for success. We are excited to see some organizations thinking creatively and embracing new technologies and new processes to modernize their way of doing business. These innovative ideas, methodologies, and successes will be the focus of Pega’s Fourth Annual Collaborative Healthcare Summit, being held October 27 – 28 in Cambridge, Mass. Pega customers, partners, analysts, and industry thought leaders will discuss the latest concepts and thinking for improving the customer experience, driving advancements in outcomes, and improving operational efficiency. Come discover new ways to build business value through technology and business process improvement and help lead performance-driven modernization in your organization.

Learn more about the 2014 Pega Collaborative Healthcare Summit >