Change management in healthcare takes a human touch

Navigating change is critical for any organization, but in the healthcare industry, where the lives of patients are on the line, the stakes are sky high. 

Consider prior authorization (PA). It’s a process that requires physicians to get approval for the delivery of a prescribed drug, test, or procedure to qualify for payment under a health plan. More than 9 in 10 physicians report that the administrative red tape of PA hinders their caregiving efforts, according to the American Medical Association. Some 34% say PA errors have led to a serious adverse event, such as hospitalization, long-term disability, or even death for a patient in their care. 

Prior authorization is our core mission at Express Scripts, a pharmacy benefit management company owned by Cigna. We work to ensure patients receive medications and medical care as safely, smoothly, and inexpensively as possible. Advances in technology, such as cloud data storage, computer vision, and RPA automation, are helping us to do that better every day – but effectively putting those digital tools to use requires human empathy.

Change management is all about supporting people. When change is necessary to scale up and streamline operations, and ultimately deliver better customer outcomes, all stakeholders must be participants in it. Instead of feeling like anxious passengers shuttled to an unknown destination, they must feel like front-seat drivers on the journey.

At Express Scripts, we have two such major transitions underway. The first is the migration of our company’s operations and data – as well as data provided by our stakeholders, such as insurers, physicians, and government agencies overseeing Medicare and Medicaid – to the cloud. The second is the move from our legacy prior authorization platform, Coverage360, to more advanced technology and a comprehensive enterprise-quality utilization management platform called OnePA.

The lessons we’ve been learning as we shepherd people through these changes may be invaluable not only to other healthcare companies, but to any organization seeking to move from outdated, entrenched modes of operation to new digital ones.

It’s obvious why healthcare companies are increasingly embracing the migration of data and application processes to the public cloud. McKinsey estimates that cloud migration by the industry could unlock up to $140 billion in additional profits by 2030.

But obstacles have slowed the transition. Some stakeholders are hesitant due to security concerns – understandably so, given rising cybersecurity risks and stringent regulations around patients’ data privacy.

But another roadblock is more entrenched, namely a reliance on paper prescriptions and medical charts shared among them via fax machines. At least 70% of healthcare providers still exchange medical data by fax, according to a 2021 federal study. How can you migrate data to the cloud when it’s hand-scrawled on a fuzzy fax?

For Express Scripts, the solution is building trust. We build trust by explaining our heightened encryption standards and access control, which severely limits who gets to see and manipulate data. We detail our advanced monitoring systems inside out and outside in, using neural networks to not only detect but prevent potential incidents.

And we work hard to communicate the benefits of cloud in reducing operational expenses, increasing efficiency and scalability, and helping the environment by easing our reliance on energy-hungry, carbon-emitting data centers. 

But we also factor patience and empathy into our approach. For some stakeholders, cloud is just not the answer at this point, so we reserve the non-cloud infrastructure for members who are not ready to agree to move their data into the cloud. And we accept that, in time, trust will grow. For now, the more we can reduce our dependence on physical infrastructure and move to cloud is a win for us.

When Express Scripts first built our product, it was called Coverage360, and it covered only one type of prior authorization. Now we’re pivoting to OnePA, an enterprise-level platform that will manage any type of prior authorization whether it is for drugs, testing, or procedures in the near future. It will create a seamless customer experience that delivers not only better member experiences, but better patient outcomes.

It’s a massive shift that’s in progress but bringing it to fruition will take some time. Today, many of our stakeholders have already made the move, and we’re growing OnePA organically by onboarding new members to it. 

Communication is the key to managing this major change. We’re opening a dialogue with stakeholders not just about how to use the new tool, but what benefits it will bring. 

RPA automation will create digital workflows that reduce redundant, repetitious tasks – allowing people to focus on higher value activities. Machine learning and optical character recognition will “read” faxes and translate them into digital data, rather than requiring staffers to spend hours deciphering handwriting. 

More than that, we share with them the real-world impact on patients, who won’t need to call three different doctors to get their medication, testing, or procedure authorization needs met – delaying diagnosis, treatment, and care.

Lastly, we have learned to allow people to move at their own cadence. Rather than telling them, “You must shift to OnePA by this date,” we ask them, “What can we do to help manage this transition to make the experience better for you? Tell us your concerns.”
 
And that can make all the difference. 

With any major change like adoption of new technology, platforms, or workflows, you’re bound to encounter resistance. It’s human nature. People might hate the legacy tools that they’re using, but they’re so acclimated to them that changing to something new creates a bucket of anxiety in them. Clear communication, patience, and inviting stakeholders into the process can ease that anxiety. 

Just as it’s a natural human response to resist change, human beings also will open their minds and alter their behavior when you’ve won their trust – by making them participants in change, rather than imposing it on them.