Thank you so much for joining us in this interview series. Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I’ve worked in healthcare IT for over 30 years. My first job out of college was doing market research on health systems, then known as Physician-Hospital Organizations. It was a brand-new market because hospitals and providers had just begun working together to take on risk. This was before the widespread use of the Internet, so my job was to summarize healthcare magazines and analyze where the market was heading. That first job is where I fell in love with the healthcare industry which led to my decision to get my master’s in healthcare finance.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lessons or ‘takeaways’ you learned from that?
A few years into my career, a customer sent me 1,000 pages of documents to read and load into my company’s system within a week. Out of aggravation, I dropped the stack of paper on my boss’s desk and asked if he could believe they expected me to upload all of this information. Calmly, he said, “Well you better get started.” He explained the importance of focusing on the end goal, in this case making the customer happy, rather than the task at hand. This lesson has been crucial while working in healthcare IT because I spend much of my time on long-term projects.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful for who helped get you to where you are? Can you share a story?
I’ve had many great mentors during my career, including Steve Krupa, our CEO at HealthEdge.
At one of the first companies I joined, the CEO instilled in me a love of customer obsession. He boiled everything down to how the customer would perceive and benefit from what we were providing. If you look at everything through the customers’ lens, anything else will work itself out.
Is there a particular book, podcast, or film that made a significant impact on you? Can you share a story or explain why it resonated with you so much?
CODA is a movie about a teenager who is the only hearing member of her deaf family. It’s a great feel-good movie where she tries to balance supporting her family business and pursuing her dreams of being a singer. More than anything, this movie speaks to how people will always find a way to engage with each other, which has inspired me recently. Connection is key to our survival, and we will always find ways to seek it.
Are you working on any new, exciting projects now? How do you think that might help people?
HealthEdge is a SaaS platform serving over 130 health plans across 48 states and with more than 81 million covered lives. We’re creating deeper integrations between our solutions, which support health plans through claims processing, payment integrity, care management, and member engagement. Each of these solutions is effective on its own, but when they work together, we see the greatest potential to change member behaviors and improve outcomes.
Thank you for all that. Let’s now turn to the main focus of our discussion about Digital Transformation. Digital transformation can mean many things to many people, from your perspective, how do you define digital transformation in your industry?
For HealthEdge, digital transformation means making the healthcare information members, providers, and employer groups need to make decisions easily accessible through a digital platform. Historically, health plans relied on confusing and infrequent communication with members, and most consumers probably only heard from their health plan when they were sick. We help insurers take a more proactive approach that involves scaling member support and improving outcomes with frequent digital touchpoints.
Which companies can most benefit from a Digital Transformation?
In the payer world, legacy health plans that have spent decades in the industry are learning about the importance of digital transformation from newer, smaller plans. Legacy health plans are moving away from the traditional and fragmented model of member communication and prioritizing digital support. These are huge organizations, so change can take time but is ultimately critical for their long-term success.
Has integrating Digital Transformation been a challenging process for some companies? What are the challenges? How do you help resolve them?
Healthcare is one of the last remaining industries where consumers’ first instinct is to make a phone call rather than go online for support. The industry has some catching up to do but is making real progress. Consumer expectations are at an all-time high, and health plans need the right partners on their digital transformation journeys. That’s why HealthEdge keeps members’ needs and deep integration at the center of its solutions.
Based on your experience and success, what are “Five Ways a Company Can Use Digital Transformation To Take It To The Next Level”?
To reach the next level through digital transformation, health plans need to stop thinking about individual transactions and focus on the overall member journey. Members’ interactions with health plans have traditionally started and ended with one question, such as “How can I find an in-network provider?” or “How can I access my benefits?” Plans need to reach their members proactively through frequent digital engagement and focus on what will keep their members healthy.
Digital transformation is also key to driving new sales at scale. In the 1990s, large health plans held Medicare Advantage seminars at diners to reach seniors. This strategy worked well to win over the folks eating at those diners, but digital engagement, marketing, and shopping have the potential to reach many more potential members.
Additionally, digital transformation can help health plans improve member outcomes. For example, with Wellframe, HealthEdge’s member engagement solution, members can interact with a nurse and get real-time answers to their health questions. Rather than providing a transactional experience, the platform improves health literacy and equips members with the guidance they need to improve their health.
Health plans can safely experiment and implement emerging technologies, such as generative AI, through their digital transformation journey. Payers need the right technology ecosystem to navigate generative AI while handling their members’ highly regulated protected health information. At this stage of generative AI, health plans should identify use cases that boost efficiency without sacrificing safety or privacy. For instance, HealthEdge uses generative AI to save nurses’ time by summarizing members’ health information.
Finally, health plans need to think digital-first to reach the next level. Everyone at the organization should take a digital approach to their roles — from building a new feature or service to marketing it to consumers.
Thank you so much for sharing these important insights. We wish you continued success and good health!