Hi everyone, and thank you for tuning in to the
Becker's Healthcare podcast series. I'm Ryan Mohammed, a writer
for Becker's Healthcare. Today I am pleased to be
joined by Angie Adams, director of Professional Services
Healthcare provider at Care Works. Angie, thank you so much for joining
us today. How are you? I'm doing well. How are you, Mariah? I am so good. I'm so excited
to have you on today. Um, and with that we can jump right into the
first topic in our conversation today. Uh, to begin, would you mind giving us some background
on how long you've been with the company and what your position entails? Sure. Um, and I'm excited to be here,
so it's great talking with you today. I am the director of Profess Professional
Services here at Carrier Works'. Been here for three to four years now. I'm actually responsible for making sure
that when we provide services to our customers, that we have
the right skillset, um, to do the work that is being requested, as well as just providing some industry
expertise and knowledge to our team members, informing our product line and supporting
our sales team to make sure that our customers needs are being met when
it comes to professional services engagements. Wonderful. Thank you
for that introduction. And since it sounds like you have a lot
of knowledge on healthcare providers, um, can you tell us any industry
trends you're seeing currently? Yeah, you know, I I started my career, um, 17 or 18 years with a healthcare payer
in the provider network space. And so I, I've been monitoring those, um,
activities and trends over those years. And I think most recently, you know, covid kind of changed our world
when it comes to healthcare, especially for providers. One of the big trends we're seeing now
is providers opting out and having just a paucity of providers
available to support members combined with advancing
technology that is rapidly evolving and trying to
marry those two so that providers actually can spend the
time that they have with members seeking care, um, along with the pressures of inflation
and increased cost and increased administrative burden on both providers
and payers. It's, it's really a, a complex, um, time right now, in particular with healthcare providers
opting out and a lot of healthcare providers retiring in future years. One of the trends that really needs to
be addressed is how do we make sure that there's equity with members? How can members and patients get medical
treatment that they truly really need? Um, and that's one of the biggest
challenges that I see today along and, and some of the things that they're
addressing doing to address some of those things are health equity, um, uh, programs as well as interoperability
to try to help bridge that gap between payers and providers
as well as between providers themselves. Absolutely. I completely
agree. And for you, why is it so essential for payers
to be more agile in their work? Uh, is there any technologies you know
of that can assist in that work? There absolutely is. There's,
there's a lot of tools today that, especially with that evolution are,
are critically important. Some, some of the things that, um, we're
seeing today is, is that low-code, no-code type of application
that allows payers, um, to build software and build
applications that can support, um, automation and, uh, processes and improving efficiencies
so that they can work better with providers. You know, it used to be
that it, it might take, you know, a year or 18 months or even longer
to build a program that will support operational, um, tasks and functions with low-code
and no-code platforms. It's, um, much easier and, and
software can be built in, applications can be built to
support workflows much faster, um, than it used to be. It's not
uncommon to have, you know, a new product or software built
in just a couple of months. Um, and, and then allowing those types
of things to be improved upon, um, in a, in a more agile fashion so that you can
evolve very quickly as processes change, as the industry landscape changes. There's also other things
like machine learning, um, to help improve some of the manual tasks
and processes that are inevitable in every process and, and operational
tasks. Those are some of the, the key technologies that we're seeing
a lot more as well as a lot of health plans and payers are starting to move to
the cloud, which just, you know, five, 10 years ago was really
not something that, um, healthcare payers were interested
in because, you know, they, they're, they've been around for a long
time and, and the security was, is definitely not as good as it is now. Yeah, absolutely. Thank
you for that insight, and I think you would agree that for
everyone's best interest member and provider relations need to maintain a
level of understanding and teamwork. Um, how do operational process
improvement improvements make a substantial impact on this relationship? You know, that is such a a loaded
question because the, the key, the key aspect to healthcare is
really the providers being able to see patients. You know,
just 10, 15 years ago, they used to spend, you know, nine to 10% of their time
on administrative functions,
which means, you know, working with healthcare payers to
get approvals and things like that. Over the last, you know, 10 years, that has increased to a
significant portion of their day, um, 30% and some even reporting as much
as 50% of their time is spent on administrative tasks. That's not just
interacting with payers, that's also, you know, charting and things
in their E H R systems. But the, the more that healthcare payers
and providers can work efficiently and effectively from everything
to onboarding and enrolling the providers in the process,
credentialing them, um, their authorizations and,
and claim submission, the easier that can be done
and made for providers, the more time they will have to spend
with patients and providing the care that that patients need, which will
be critically important. Um, as we're seeing a reduction in the
availability of providers being able to build processes and procedures
that allow them to spend more time is in everyone's best interest. Absolutely. And for me, I've repeatedly heard professionals
discuss network provider contacts. Uh, for you, Angie, how and why do payers now
more than ever really, uh, need to manage network
provider contacts proactively? It, it's, it's exactly what, you know, we were just talking about is the, the more that they can engage
with one another to make sure that they understand how to
interact with one another effectively and efficiently, the quicker they can adapt to the
changing healthcare landscape. I mean, even medicine is changing. There are
things that were not very common, you know, five, 10 years
ago like telemedicine, that was not something that
was leveraged heavily and, and often many healthcare
payers did not have that type of service in their contract.
There are services, um, that have not even been available
with c M s coding and Medicare. Those types of things change and, and those contacts and contracts
have to keep up with that. Um, as new services are made available, providers need to know what to
expect and not be limited by, am I going to get paid for
providing the care? Um, and, and the contracts with payers
have to keep up with that, um, both administratively and financially. Yes. Thank you so much for
sharing that information. Um, and before I let you go, what you happen to have any closing
thoughts for our listeners or any tips healthcare providers can use to combat
any of these challenges we discussed today? You know, I think the, the most important thing
is for payers and providers to keep talking because
ultimately healthcare is about treating people and providing
them the services that they need there. There's often a
a bit of a, you know, contentious relationship between payers
and providers because sometimes their objective are at odds with one another. Compassion and trying to understand the, the position that each is in and
coming up with solutions that meet the needs of both groups, um, because it is a complex
problem and there's a lot of complex things that occur
in healthcare today. And being able to make sure that
patients get the care that they need is ultimately very important. And
that's the goal of healthcare. Payers and providers can
partner together on this and, and we're seeing some of those
payer provider partnerships
and interoperability, um, among payers and providers
will really set the stage for that. But they have to continue
talking and working together to make sure that patients actually
get the care that they need. And that's in the best interest of
the providers as well as the payers. Payers really wanna make sure that their
members get the care that they need. Um, but it requires that we talk and
work together and, and remember, um, and think about the position that each
other is in and the challenges that they have to come up with the best and most
creative solutions to those problems. Absolutely. Thank you so much, Angie, for your time and a great
discussion today. It's Tru, we've been an honor to speak with you. Thank you so much. It's, uh, been
a wonderful experience and um, thank you for the opportunity. Yes, of course. And I also like to thank Harry works
as well for sponsoring this episode. You can tune into more podcasts
from Becker's Healthcare
by visiting our podcast page.