The Managed Care industry will face unprecedented challenges in the coming years.
Managed Care Organizations and State/Federal Health officials are confronted with the increased need to drive measurable improvements in clinical outcomes, improve member engagement, compliance and experience, and reduce unnecessary and duplicative costs.
These complex challenges are not easy to overcome. Longstanding vendors offering legacy solutions seem attractive, but oftentimes these traditional solutions fail as they do not adequately address the increased complexities of modern health care challenges. Additionally, many of the latest healthcare solutions are tech-based, with industry data showing a first-year failure rate of approximately 90%.
MCOs have started to recognize the siloed nature of their operating infrastructure. Further, they have come to realize that future success requires an adjustment to their structure and process. Understanding challenges from an organizational perspective demands solutions that address the organic and interdependent nature of plan operations.
A practical example of this is the role of Provider Relations staff and their indirect impact on member experience. The provider-member interaction is one of the most influential factors in a member’s experience. To the extent the Provider Relations staff drives:
improved provider experience and practice success
real-time quality performance metrics
effective communication regarding pertinent plan policy and procedure changes—involving billing and cash flow
Each of these will undoubtedly ensure a better member experience with a more engaged, informed, and valued provider.
This evolving set of challenges requires a different “type” of vendor solution: a vendor that brings both a depth of technical expertise and understanding of organizational dependencies/interdependencies.
The Managed Care Resource Alliance (MCRA) recognizes and acknowledges the attributes of our individual members and identifies collaborative opportunities for members to work together, offering comprehensive, enterprise-wide solutions. We solicit members who embrace a collaborative and creative approach to solution development for the Managed Care industry. MCRA supports and endorses Managed Care vendors who drive unique, comprehensive, and informed solutions to complex problems.
As we move into 2024 and throughout the coming years, MCRA will continue to offer industry relevant education and challenge traditional views of the industry, ensuring not just simple solutions but solutions that are relevant, built around measurable results and that demonstrate a deep understanding of the organizations ecosystem.