HfS Network
Barbra McGann
Chief Research Officer 
Learn more about Barbra McGann
Putting healthcare services at the fingertips of your patients and members
January 17, 2017 | Barbra McGann

“It is a truth universally acknowledged” that the healthcare experience needs to change – for consumers and clinicians. Part of this change is to make access to data, services, and transactions easier – more “at the fingertips,” if you will—and more relevant to their healthcare experience. In a word, mobility. Mobile is about the platform; mobility is about the journey, the movement of the person, and the experience while in motion. There are a number of mobile platforms on the market today, but who is using them to bring mobility to healthcare?

“…mobility is about understanding where I am, where I am going and what I want to accomplish, and helping to make that journey exponentially better,” said David Sable, CEO of communications firm Y&R in a Huffington Post blog.

Well said. There are a number of mobile platforms on the market today to help make this happen, from well-established technology providers like IBM, PegaSystems, and SAP as well as up-and-comers like Kinvey, Kony, and MobileSmith. And I recently had an opportunity to get to know one offering suite a little better – Skava, which was acquired by Infosys in 2015.

How can mobile platform technology providers bring mobility to healthcare?

Skava is well established as a mobile development platform in retail, powering mobile apps, kiosks, and mobile devices for Gap, Staples, ToyRUs, and others. Now Infosys is bringing this consumer engagement and e-commerce enablement platform to healthcare. It is developing a set of independent, modular, discrete functional units packaged as “Build Your Own Digital Platform” for healthcare providers and payers. (see Exhibit 1) Imagine consumers, patients, caregivers, pharmacists, and clinicians – among others in the healthcare community – being able to enroll, complete transactions like paying bills, scheduling, care management plans and alerts, etc. Then imagine having it integrated into the core healthcare management systems already in place.

Exhibit 1: The “Build Your Own Digital Platform” Play for Mobility in Healthcare

Infosys isn’t the only one with this capability, so if you are looking at walking down this path, take a look around for what best fits your needs. What I found with Infosys is that even though this solution set is not well established in healthcare, it does have a strong client base and proof points from retail, an industry that is heavily dependent on engaging consumers in transaction oriented interactions. The platform supported $1.5 billion in e-commerce revenues in 2015. Infosys also has depth in IT services across industries, including healthcare, so it has the capability to work with clients to integrated and customize apps and services as needed. The Skava platform does plug into current IT infrastructure. And, the service provider is also better integrating its business services and IT capability so that if you want on-going support that includes data management and analysis, you can tap into extended services and have a single provider.

One “miss” in the story line so far, though, is my earlier point about mobility and creating an experience versus offering a mobile platform. Infosys as a company is investing heavily in design thinking capability – an innovative approach to identifying and solving problems. Yet, when we engage in briefings and look at the materials associated with this solution set, there is no mention of starting first with – what problem are you trying to solve? What opportunity are you looking to address? How are you defining and testing out the proposed solution prototypes with the stakeholders – consumers and business? And that’s a critical first step to ensure that the use of the IT-based solution is truly to address the consumer experience and how that impacts the business outcomes.

Bottom line: If you want people to do something, make it as easy as possible for them to do it. Healthcare providers and payers need to make healthcare services easier for consumers to access, use, and pay for, and mobility plays an inevitable role.

Infosys can tap into its design thinking approach and IT services, and leverage the Skava platform in a flexible way to help clients get there. There are already a number of healthcare management apps and mobile capabilities on the market, so it isn’t new. It is something that if you want to truly be a healthcare consumer oriented organization, you’ll have to incorporate into your business, and partnering with a service provider with IT, business process, and analytics skills is a viable option.

Which Service Providers will help our healthcare organizations survive, even thrive, post-ACA?
January 10, 2017 | Phil FershtBarbra McGann

Have we ever lived in such unpredictable political times?  An unpredictable president-elect, with unpredictable policies in areas where it's hard to predict what will work... or what won't, whatever we predict. But one prediction is certain... HfS has a healthcare analyst who'll keep pounding away at the issues and challenges, where this industry needs to plug capability gaps to be effective... so over to Barbra McGann to give her assessment of the current services market landscape of providers jostling to be in pole position to pivot to support healthcare clients, however things start to unravel...

Much as I’d like to, I can’t foresee the actual future of the U.S. Affordable Care Act (ACA) or healthcare policies under President-elect Donald Trump… anymore than anyone could predict the true outcome of the recent U.S. presidential election. What I do foresee, however, is the increased need for partnerships to focus on what the ACA is designed to accomplish (regardless of its existence) – affordable, accessible, quality health care.

Getting to the heart of the problem –the cost.

There are many people who are upset at having to pay for “other people’s” healthcare costs – which they believe is because of the ACA. And there are many people who are receiving care who didn’t before and wouldn’t otherwise, because of pre-existing conditions or age, for example. And these are often people who when they did get sick, would go straight to an emergency room – an expensive treatment which by the way somehow had its cost passed in some way at some time to, likely, people who today do “not want to pay for other people’s healthcare.” Any way you look at it, costs get spread around.

So let’s look at this issue – cost – from a different angle... how about the angle of reducing or eliminating some of these costs?  Reducing the cost of ER visits or readmissions because we can identify and intervene in someone’s pattern of such use or events before they happen because of triggers? Or, increasing the possibilities of people being healthy because of proactive education around nutrition, exercise, and lifestyle?

Partnerships are critical to truly changing the nature and outcome of health care

Just as it “takes a village to raise a child,” it takes a community of partners to create a high quality, lower cost environment for healthy consumers. Those partners include people on the front lines of care everyday—the obvious, like doctors, nurses, pharmacists, social workers – and also professionals who work behind the scenes but have an impact on care and cost – such as billing coordinators, claims processors, and coders. If everyone is thinking about their work, and how changes to the way they work, can impact the healthcare consumer, we have a

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From Day One: Design Thinking the Patient Experience with Lawrence General Hospital and Sutherland Global Services
December 22, 2016 | Barbra McGann

There’s no two ways about it. I’m excited to be on the cutting edge of a Design Thinking-led services engagement in healthcare to address patient experience. Thank you to Lawrence General Hospital (LGH) and Sutherland Global Services for inviting me through the door and into this initiative…. and especially for agreeing to let me blog about it! We are constantly looking for where companies are “taking a detour with design thinking” and finding results to share. This time, we’re bringing you along on the journey.

We’ll start with a workshop led by Sutherland Labs, and follow their version of this human-centered, iterative innovation methodology over the next few months. The goal is to re-think the patient experience at LGH, and I’ll be sharing the progress here in my blog as we go. After months of researching, interviewing, and writing about Design Thinking and the value it can bring to a services engagement, I will be able to give you an inside look as well. If you have done this before, you can compare it to your own experience and perhaps find some new ideas; and if you haven’t, here’s a way to get some further exposure to a work in progress 

Design Thinking can play a strategic role in helping healthcare organizations to better service the consumer as the patient, member, caregiver, clinician, etc… and rethink operating (and business!) models.

We believe design thinking can help bring about a more healthcare consumer focused type of engagement, which is so needed in health care today. With the latest news burning the wires that in the U.S., premiums are going up yet again, healthcare consumers are just going to get more discerning about how and what services they are receiving for their money. Value – always defined by the beholder – is changing for healthcare consumers. Being aware of that, and aligning the organization –front, middle, and back office – is simply becoming an imperative to the future health and success of healthcare providers, period. And service providers can play a role in doing so.

Despite the potential, and early success stories in and outside of the industry to date, the use of Design Thinking in healthcare for impacting business outcomes through operations is fairly nascent, as seen in Exhibit 1 from our recent Intelligent Operations Study, which included 45 Healthcare Operations Services Buyers. Only 23% of the respondents say they are using Design Thinking today, so we see LGH and Sutherland as pioneers here. For those of you who have not yet jumped into the waters, you can also find some ideas on how to get started in my recent interview with Charlotte Bui, Global Lead of Design Thinking at SAP… and stay with us here as this story with Lawrence General Hospital and Sutherland Global Services develops.

The LGH and Sutherland partnership to put patient experience at the center of reimagining the hospital business operations – the use of Design Thinking – exemplifies one of the 8 Ideals that HfS Research considers critical in the move to more “intelligent business operations.” As it is also one of the least mature of the Ideals in this services industry, they are breaking some new ground here.

Exhibit 1: The Maturity of Design Thinking in Helping Achieve “Intelligent Operations” in Healthcare Organizations

At the same time, fellow HfS analyst Hema Santosh, and I will be launching an update to the Design Thinking for the As-a-Service Economy Blueprint we published with Phil Fersht in early 2016. We expect to hear more about how service providers are using Design Thinking and incorporating innovation into their engagements, to be more forward thinking and investing in the long-term value of outsourcing services partnerships.

If you have a story to share, questions to ask, or challenges to pose, please fee free to post them here, or contact me at [email protected]. And, stay tuned…

What Pokemon Go! can teach us about outcome-based performance management
December 08, 2016 | Barbra McGann

How do you change a workforce and shift performance management from status reporting and check-ins to an outcome-based approach?

With Pokemon Go! hot news in the press and, frankly, in my house, this summer, I was reminded of an example of gamification used effectively for performance improvement, financial impact, and employee development and engagement at a US healthcare system.

The director of revenue management and patient financial services brought in gamification, along with training and outcome-based performance management, as part of a change and quality management program. Along with an increase in AR staff productivity and engagement, the impact on the business included an increase in payments, a decrease in net days in accounts receivable, and a decrease in denial turnaround time.

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How has RPA played a role in increasing data accuracy and predictability in your healthcare operations?
November 15, 2016 | Barbra McGann

Are you using robotic process automation (RPA) as a way to drive better outcomes for your healthcare organization? 

In our research, we are hearing that companies using RPA find the greatest value from it in the quality, predictability, and speed that results from the use of the software to automate rules-driven business processes (there’s your definition of RPA, by the way). And we’d like to hear more examples –stories to share –of how it is being integrated into healthcare operations to impact health, medical and financial outcomes.

Notice in Exhibit 1, that 65% of the respondents in our cross-industry survey say the most value they get from RPA is in driving more predictability and quality in the processes, and half add that speed is of value, while rounding out the top three is freeing up staff to move to other projects. Healthcare respondents mirrored this top three, adding that number four is “creating more reliable data sets for analytics.”

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How deal closure can increase when sourcing and sales teams work together
October 31, 2016 | Barbra McGann

Breaking down the barriers between the end-customer and the business support functions is so pivotal for success in today’s world of the OneOfficeTM. And one place to start is by identifying the potential intersections where there is a shared outcome. We’ve seen how this approach can work for sales and procurement, leading to increased sales and compliance.

In my colleague Derk Erbe’s post, Why We Should Love Procurement, he encourages the much maligned procurement organization to “be a business facilitator” and the business to be a partner with procurement to contract, buy, and use services from third parties in the most beneficial way for the business.

Just recently, I heard three good reasons to “love procurement.”

This story of collaboration between procurement and sales led to (1) increase in closed deals for sales, (2) increase in compliance, and (3) increase in mutual respect. It also, by the way, caught my attention as an example of using Design Thinking for an internal function, taking a stakeholder-centered (empathetic) approach to defining and solving a problem. 

Thinking “outside the box” on how the skills of a sourcing professional are relevant to the business more broadly

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How to Get Started With Design Thinking in Shared Services and Outsourcing
October 23, 2016 | Barbra McGann

From An Interview with Charlotte Bui, Global Lead of Design Thinking at SAP

Recently a colleague in common introduced me to Charlotte Bui, Global Lead of Design Thinking at SAP, and I chatted with her about how design thinking is used with SAP clients. I’m sharing snippets of this interview to get you thinking about how to use design thinking in your work, and in your partnerships and outsourcing engagements to drive new levels of innovation and impact from them. Consider it a way to address the challenge Phil laid out in his October 2nd blog: “let’s make outsourcing great again”… because there is a lot of untapped potential …

Charlotte, how do you bring design thinking into your work?

We ask questions to uncover and discover the true needs of our customers as it relates to their business and their customers. What that means is that we often dig deeper to better understand the “why” behind their needs, their motivation. We ask questions about how the work they do impacts stakeholders and customers, such as: Why do they need this? Why do they care? What’s missing? These questions can be applied to any situation to get focused on how to solve problems with a human-centered, customer first approach, versus a business-centric, solution first approach. And by leading with listening, we work with them to help uncover what’s missing or even what could potentially change their entire business model.

Business process services and IT services is a process driven industry; what can you tell us about how to structure an approach to work that uses design thinking?
We share customer stories and we talk through our method; there are many design thinking methods that all share a same common theme. At SAP, we use “look-think-do.” (link) It is about understanding WHO you are doing it for, cultivating ideas, finding the one (or more) that is real and can be implemented, and execute it. That last step is where the value is realized from the design thinking driven work. We use design thinking to understand what clients need, then work to define and apply the right solutions to bring those ideas to reality. 

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So what should healthcare operations do when IT hinders rather than helps?
October 11, 2016 | Barbra McGann

Focus everyone on the shared outcome: The healthcare consumer experience

“We are, frankly, still at a stage in which healthcare technology often hinders, rather than helps, physicians trying to provide better care,” says Andy Slavitt, Acting Director of Centers for Medicare and Medicaid. The examples he shared at HIMSS16 still resonate with me: feedback from physicians who have told him, “To order aspirin takes 8 clicks on the computer. To order full strength aspirin takes 18.” Another said, “I can’t track my patient’s referral; I sent them to the hospital and can’t track them.” 

Despite the increased, even prolific, use of IT in healthcare with member and patient portals, electronic records, and online billing and payments, the clinician or healthcare consumer experience has yet to change fundamentally for the better. To truly become digital, healthcare organizations have to rethink their use of IT. In many cases, where they have software vendors and service providers involved, they also need to revisit their engagement strategy, especially as the industry shifts to value-based care and payment based on results.

A single-minded focus on the customer—patient, member, employee, clinician, etc.—can break down the barriers in and across organizations to drive meaningful processes and use of IT

Digital healthcare, in its purest form, is all about transforming the healthcare business to create, support and sustain the healthcare customer experience – customers being, at times: plan members, patients, physicians, caregivers, etc. The “end user” can be the same person in different roles, or working with people in other roles, creating a complex network of constituents with varying wants, needs, and motivations. So, creating a healthcare experience is not a job for a solo artist, either – it takes the whole orchestra playing together to create a musical masterpiece and not just a cacophony of sound.

Simply stated, a pivotal factor for being truly effective in delivering the vision of better health and care at a more reasonable cost for the industry is a coordinated, interactive, and interoperable approach in operations, what we at HfS call the Intelligent OneOffice. OneOffice is all about how people use data and digital technology to bring together the front, middle and back office to enable a user experience that matters, thereby having an impact on health, care, and the viability of healthcare organizations and businesses.

Everyone in the industry has a role to play in supporting this person-centered approach. In some cases, the impact is more obvious and intuitive, such as the front line staff of doctors, nurses, and pharmacists directly discussing a patient’s care plan, therapy and medications. However, roles that are more removed from these direct touch points also have an impact on health, medical, and administrative outcomes. For example, operations support staff processing claims are analyzing data to identify care gaps and opportunities for new interventions, making sure patients are informed through the design and input into systems that automate outreach and reminders through phone, email, or text, for example. So much of how the touch points in healthcare can be more effective depends on the data, digital technology, and relationships that extend from “hidden” roles in “the back office.”

People who can identify and articulate problems and coordinate across internal and external organizations to focus on the end-consumer, are key to bringing together IT and operations

Generating the kind of synchronistic flow from less customer-facing processes to support the healthcare customer experience is no easy task. What will help drive change is finding and/ or cultivating “brokers of capability”—people who can articulate a business problem or opportunity, the desired outcomes, and then coordinate and facilitate across internal and external entities to reach those results. In healthcare, we see brokering going on to create networks such as for ACOs and hospital systems leading to data stores and insight-driven interactions to better manage a patient’s health and care, end to end, covering socio economic/financial and medical needs.

Who are your brokers of capability? People you identify in your organization with critical thinking and networking skills, people who put people first. Taking this approach also creates a more attractive workplace and can play on a naturally altruistic synergy as many people enter the healthcare profession to “help others.” No matter what role they play, as a nurse, doctor or physician, or a claim processor or medical coder, there is an opportunity for everyone to impact the customer experience and gain a greater level of satisfaction and engagement.


Note to readers: Our study on achieving Intelligent Operations, with input from Cognizant's Center for the Future of Work and Business Process Services practice, canvassed 371 major buy-side enterprises and had 45 healthcare executive participants. Link to The Journey to Intelligent Operations in Healthcare and download for free after registering on the site.

Governing a Core Automation Strategy as the Operations Backbone … And a Catalyst for Change in SEI and NIIT Technologies Partnership
September 20, 2016 | Barbra McGann

How can enterprises make automation core to their operations strategy and not merely a peripheral activity? Let’s be blunt here, many service providers have been automating routine tasks with their clients for years, yet as my HfS colleague, Tom Reuner, has noted, the innovations referenced by the notion of RPA and Intelligent Automation are “often at sub-process levels…not at the heart of a delivery backbone.” We are seeing the momentum pick up here, though, particularly when automation is a shared strategy between service providers and their clients. We heard one such case highlighted by Peter Quinn, Managing Director of Automation at SEI Investments Co., (NASDAQ: SEIC) a wealth management solutions company, at the recent NIIT Technologies Industry Analyst/Advisor Day.

Service buyers want to partner for automation, but where - and how - is it actually working?

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Why An Outcome-Based Approach Can Shatter the Watermelon Effect of Outsourcing Contracts
August 29, 2016 | Barbra McGann

In her recent blog on outcome-based contracts, Christine Ferrusi Ross challenges the industry with Outcome-based Contracts Are A Nightmare --Do Them Anyway, and offers guidance and experience to rally the troops. What is also intriguing about this outcome-based approach is the potential to shatter the so-called “watermelon effect” that often takes shape in an outsourcing engagement that is based solely on key performance indicators (KPIs) and service level agreements (SLAs)… and use those traditional metrics as seeds for new value-based engagement. 

What Is the Watermelon We Want to Shatter?

The outsourcing industry grew up on contracts that clearly articulate KPIs and SLAs, providing an agreed upon set of targets for the service providers to get the work done at a level that is satisfactory to the client. As transitions take place and Lean, Six Sigma and continuous improvement methods iron out processes and make them more efficient, these metrics regularly appear “green” on the scorecard. But, even when all the indicators are green, service buyers can be left feeling red—the so-called watermelon effect of green outside and red inside. There is often a sense that while all the targeted metrics for turnaround time, uptime, and transactions processed are being met, clients and service providers “feel” value is still missing.

This effect often leads to questions about the value of the contract and challenges for achieving innovation, price reductions, and competitive re-bids. The key issue is that perceived value changes as relationships evolve; therefore, the benefits received and the associated metrics to measure and manage real performance need to change with it. We once joked that “if outsourcing was an employee it would be fired,” meaning if you took a job and were judged on the same performance metrics every year, you wouldn’t last very long!

There is a Step Along the Path to Outcomes-Based Contracts

As Christine’s blog points out, outcome-based contracts can be incredibly difficult to create, but you can still address the watermelon effect right away while sorting out the outcomes desired. In one such example, we heard of service buyers and providers addressing this point by including a metric and payment based on Net Promoter Score in the contract. That way, all parties in the engagement have to figure out, and proactively address, that feeling of missing value. An example is a simple performance evaluation, on a regular basis, that asks for a rating of partner satisfaction on a scale of one to three. If the feedback comes back as a one, a percentage of the payment is held back, if a two, no movement of money, and, if a three, then a percentage bonus.

The intent is to drive the right attitude, behaviors and cadence of interaction and measure, not just the service levels and performance indicators, but that “feeling.”

Yes, it’s subjective, but isn’t any relationship subject to “feelings”? This “feeling” can be an indicator that the engagement is at a stalemate—that the engagement is no longer driving step change, helping the business to improve or address what matters to their customers today.

Using KPIs and SLAs As Seeds to Grow Outcomes-Based Contracts

How does a business outcome differ from a KPI or SLA? In practice, a business outcome often encompasses multiple KPIs and SLAs. For example, a business outcome in retail could be “increased sales closed by visitors that start a shopping cart,” versus an SLA which could be “ensure website has availability of 99.999%.” In healthcare, “decreasing the cost of care for a targeted population” could be a business outcome, while a KPI may be “percentage of targeted population enrolled in a relevant wellness plan.” They are not mutually exclusive, and when used together, can help advance an outsourcing engagement towards a structured, but more interactive and flexible arrangement for today’s dynamic business environment.

Looking at business outcomes puts the focus of the outsourcing engagement directly on the client and the client’s customers and stakeholders—the ones who are judging and measuring the client’s performance. The business outcomes for an outsourcing engagement in operations are broader than simple transactions, like website uptime or number of bills, invoices or claims processed. Using a healthcare industry example, what matters to a healthcare payer today could include retaining members in their plans, and that means KPIs that could include member satisfaction scores, and SLAs like payer web site uptime, claims processing throughput, and accurate provider data.

The Bottom Line: The point is not to move away from KPIs or SLAs in a contract, but to use them as building blocks for achieving real outcomes that make a difference to the client’s business goals… and in a way that can flex and change in order for the partnership between the service buyer and the service provider to stay relevant over time.