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August 09, 2019
EMPOWERING YOUR PAYER OPERATIONS WORKFORCE
By: Nick Lochner

Put the era of human+ to work for your health plan.

When Accenture recently surveyed 150 payers, it became clear that the pressure is on to have the back office of a health plan power the front office. Operating an intelligent back office can help increase productivity, revenue and quality for a health plan and the use of technology to enable intelligent operations will help transform business operations performance. However, it is the workforce that continues to operate efficiently and effectively in this environment that will truly determine if value is created.

It’s not easy. Among the payers we surveyed, 39% say lack of relevant data analytics, artificial intelligence (AI) and machine learning skills is a high barrier that prevents the organization from achieving its business goals. In addition, 30% say talent retention and recruitment is a challenge. As payer organizations wrestle with the challenges automation will bring to the development of the future operations workforce, there are some approaches that can help health plans to operate differently to manage the new human + machine workforce.

Manage the human + machine balance

Step 1 is anticipating and understanding what the workforce needs, today and tomorrow. Which skills are lacking? Right now, payers feel they don’t have the right skills mix to lead intelligent operations. Those surveyed cite lack of AI and machine learning skills as a No. 2 barrier, lack of relevant IT skills as the No. 3 barrier and lack of talent that understand digital business models as the No. 4 barrier.

What skill gaps will arise in the future? What tasks and activities have you never needed before but will need to compete in the future? Assessing workforce skill and needs is no longer a matter of assessing current job roles. The future is about anticipating and assessing future tasks and determining the skill and attributes required to accomplish those tasks.

Certain tasks might be automated, others will be carried out by new cross-functional teams that are focused on achieving a particular business outcome.

Step 2 then focuses on how to fill the workforce needs for tomorrow from step 1. One way to think about how to fill those needs is to consider the different strategies to fill the skill requirements—will you train your people (BUILD their skills), hire new people (BUY the skills), leverage external/agile workforces (BORROW), or will the skill be accomplished by automation/AI (BOT)?

For instance, if a health plan were to look at the task of claims processing, it might identify that a bot could process simple claims. The bot would flag more complex claims that require human review. The task of logging claims information could be carried out by AI, whereas claims that require troubleshooting or human decisions would be carried out by skilled humans. Who will create the AI logic? What skills will be required to interpret whether AI algorithms are accurate? Who will play the role of interpreting the metrics the AI solution generates? These roles haven’t existed in the past but will in the future.

Thinking about the workforce in this way is very new. and it is more than just the skills or tasks that will be new. The mindset and culture of the organization must evolve, along with the structures that underpin the workforce. First and foremost, the more agile the organization is, the better able it will be to adjust to new skill requirements.

The sharing of resources will become more valuable, for example, looking at teaming models that are smaller. Cross-functional “squads,” “tribes” and “pods” can accomplish tasks in an agile manner, moving fluidly to where help is needed. Teams may comprise a blend of in-house workers and external talent sourced from ecosystem partners or hired on demand as contractors.

As you would expect, these workforce changes will require human resource departments to adjust. The skills of HR professionals will need to expand. Strategic workforce planning, the decision on the best strategy to build, buy, borrow or bot will become a continuous activity, with decisions to be made that have not necessarily been made before.

Applying automation to the back office

Automation in the future is not about a one for one swap with an employee. It is projected that approximately half of process and analysis-related roles (51%) will be augmentable and 40% automatable. So, while parts of jobs will be automated, other parts will not.

Automation will create additional capacity. Decisions will need to be made about how you apply the freed-up capacity of your workforce. How will your employee engagement and culture be impacted? Where will the work get done? Where can you apply this freed-up capacity to drive value across the enterprise? For example, as automation reduces the backlog of work, humans can change their repertoire of tasks. More experienced resources might be upskilled to take on more complex tasks and work on assisted automation—for instance, using AI to process claims and allowing the human to make final decisions on that claim. Employees with transferable skills, such as medical coding, may be useful in other parts of the organization.

Work will become more on-demand or bite-sized. By offering ongoing training, employees can develop a blend of skills. It will be important to develop a culture of learning—enabled by technology. It can equip employees to make continual improvements that support the business as its needs change.

Let the leaders lead

Health plan leaders have choices to make as they approach the new opportunity of intelligent operations. As they make strategic automation/AI investment decisions, it is essential to keep in mind the impact to employees, the community, market and brand.

Leaders can be transparent to employees about decisions regarding human and machine collaboration—not just from a financial standpoint. The change is a positive one and communicating the value of automation to the organization and employee will be an important factor in how people will react. Augmenting roles, providing new opportunities to learn and expand impact, being more market relevant are all messages that emphasize value to the worker. Providing opportunities for employees to reskill or upskill to stay relevant in the intelligent back office is a win-win for the organization and employee.

Fostering an innovation mindset will be important for leaders to emulate and promoting the opportunities that technology innovation affords is important. The number one barrier identified by 39% of payers is a lack of digital/transformation leadership.

More power with people

Technology will fundamentally change the back office for payers. However, to truly unleash the power of digital in payer operations, leaders must optimize the mix of human and machine, adopt technology where it can free up humans to add value and infuse an innovation mindset.

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