HfS Network
Barbra McGann
 
EVP, Business Operations, Healthcare & Life Sciences 
Learn more about Barbra McGann
Moving beyond the numbers in healthcare to drive and measure change
July 21, 2017 | Barbra McGann

In many ways, health care has been impersonal for many years… the focus being on the illness, treatment, and cure, rather than the person who hosts that illness. With the increase in focus (and payment) on value-based care, though, the holdouts that have not thought about the whole person have to do so now. It’s time to realize if you haven’t already that considering the mental, economic, and social determinants of people’s lives is not just for “tree-huggers” but are proven to be critical for effective treatment and impact on health and medical outcomes.

Consider the rise of the “Walking Gallery of Healthcare” (shout out to Regina Holliday who has painted over 400 jackets with the representation of people’s health experience and medical journeys). These visual cues remind us of the people who house and treat illness and how their behaviors and attitudes have an impact on the cost and better, more empathetic care. They help create networks and community to share insights and lessons as well as emotional support. While metrics are important, outcomes can’t just be measured in numbers if you want to effect real change.  There also needs to be a “feeling” of momentum and community for realizing value-based care.

Photo of Regina Holliday with members of the Walking Gallery                           

How do you measure the impact of transformation?

Effective treatment and prevention of disease and illness are often measured in outcomes like lower rates of diabetes or heart disease, for example, a higher standard of living, reduced readmissions to hospitals, less use of emergency rooms, and overall lower cost of health and care per person. But it can also be measured in how people behave – a healthier change in the way they live and work, a “chain reaction” in that a patient becomes a coach or champion for others going through what they did, or a series of stories the inspire action.

Here are some of the ways we are seeing health care organizations explore these outcomes:

  • Visual Cues: An experiment explored the impact of a medication on patients by looking at photographs by a patient (note: not of the patient).[1] For example, before being on medication, a patient captured his story in pictures in an app (think Instagram story). The pictures showed the inside of his house, the television, pizza, a dog, dim lighting, and no other people. After being treated, including medication, the story changed and the pictures in the app showed a girlfriend, a road trip, and an app that he is developing to help other people with similar medical issues. It shows that he is more active, more engaged with other people, and feels empowered to work.
  • Experience through Simulation: Clinical and administrative professionals at a hospital near Boston spent a day together in a design thinking workshop focused on better understanding their patient population. They started by developing personas that represent members of the community they serve and then walking them through the journey the patients take in their hospital. A clinical manager shared: “We know who the people are who are coming through the doors. But as we built the persona for a person who comes into the hospital on an ambulance, into the ER, and eventually moves to an in-patient stay, we felt more and more how intense it must be for the patient. The number of touch-points gets exponentially bigger as they go through their experience, their journey. And we are not always thinking about it that way. It’s our day job, and we are used to it. But this person is sick and vulnerable, and here we are descending with advice, interventions, meds, and education…. It was really good to have the front line providers and staff from different departments involved in this act of re-creating the patient experience so we can support the patient and each other better during busy times on the floor.”[2] (link)
  • Connect with the Community: If you are a hospital or clinic, how do you interact with your community? A hospital invited members of a community that had a high incidence of diabetes in an open forum to discuss medical needs. They didn’t hear people say, “I wish I had a doctor and medication.” They talked about wanting a playground and healthy food options. The local community center partnered with the hospital to create a garden, yoga, and cooking classes, convert open spaces, and offer dental care.

Changing behaviors has an economic impact on business as well

Only viable businesses can serve health care consumers and patients and have an impact on the high spend in the industry overall. LGH, for example, is making the effort to connect with its community because they believe that by better understanding the individuals they can have an impact on the health and medical well-being of patients as well as the financial status of the hospital itself.  

Everyone working in the health care industry has an opportunity to have an impact – from the front lines of doctors, nurses and caregivers to the business operators in finance, facilities management, etc.  An approach that can get everyone focused on the health care consumer is to put empathy – walking in your patient or health care consumer’s shoes – at the center of the way you work.

The bottom line: This transformation -- incorporating empathy and addressing behaviors -- is required for health care organizations in order to remain financially viable as well as a trusted community resource.

Empathy is the core tenant of design thinking, which can help in revisiting workflows, building apps, and developing solutions that address real human needs. Start with observing, interacting with and thinking about your patient or customer. The practical and business-like side of us often takes over and asks: “what’s the real value”? Along with tracking metrics for reduced readmissions and patient satisfaction scores, consider how visual cues and social momentum are also valid measurements of the success of investing in innovation and change that’s so needed in the health care industry.

[1] IDEO webinar, “Healthcare and design thinking,” July 18, 2017.

[2] http://www.hfsresearch.com/pointsofview/inside-the-patient-experience-design-thinking-workshop-with-lawrence-general-hospital-and-sutherland

Off-Shore-Based Service Providers Look to Develop “Meaningful” Presence in the U.S.
June 22, 2017 | Barbra McGann

The pendulum is swinging back. Over the past year, we’ve seen the increasing focus from India-based service providers to invest in building on-shore presence and capability in the U.S.  While spurred on by H-1B visa limitations and in-flight policies regarding minimum wage and the politics of “protectionism,” the long and short of it is that the U.S. citizens should benefit from local investments. U.S. governments and economic development entities are offering incentives for partnering with these service providers as they seek out “hubs” central to current and potential clients. Two recent examples are Indianapolis, Indiana with Infosys and Jacksonville, Florida with Genpact, where the cities offer tax incentives and colleges and universities can provide a talent pool.

It used to be “too expensive” for service providers to set up on-shore service delivery centers, but with the increasingly integrated and intelligent use of robotic process automation and cognitive computing and the motivation of politics and protectionism, this argument is fading. What is also relevant is when the partnership changes focus from outsourcing a task or point solution such as “collections” to business outcomes such as providing a better patient experience and increasing upfront payment (thereby reducing the need for collections), the service provider needs to be more integrated into the end-to-end process and business operation. That means having a local presence and interaction to provide relevance and create meaning and insight. (See “Recasting the patient billing experience” as an example). 

Our research (see Exhibit) shows the there is a significant drop across the board in the move to “offshore” business and IT work – finance and accounting and HR, in particular.  Case in point, we recently heard from a client about how Sutherland helped set up and recruit into a local service center for F&A services in a matter of a few months for a company that was separating from its parent.

Exhibit: Changing use of offshoring – shared services and outsourcing

 

Source: HfS Research in Conjunction with KPMG, “State of Operations and Outsourcing 2017”  Sample: n=454 Enterprise Buyers 

Click to enlarge

How service providers are expanding local, U.S.-based presence

Investments by service providers in having short- and long-term U.S-based capability for clients include local service delivery centers and increasing co-location delivery teams as well as work-from-home options; education support through curriculum development in local colleges and universities as well as programs for K-12 to “entice” and enable interest in STEM (e.g., code.org and Girls Who Code) to create the workforce of the future; and transitioning workforces from clients to their own organizations.

Examples include:  

  • Genpact: In July, Genpact will add to its network of 12 U.S.-based service support and delivery centers by opening one in Jacksonville, Florida. This one will focus first on mortgage service support with processing, underwriting, and closing services for residential mortgage loans for a leading financial services institution 
  • Infosys: A new entry into this discussion, Infosys has far outstripped other service providers in pursuing H-1B visas to date and is now refocusing on building local presence and brand recognition. Infosys intends to develop four locations in the U.S., centered in “client clusters” and focused on particular capability areas such as artificial intelligence, user experience, and enterprise cloud. Its approach is to partner with local colleges and universities and offer incentives such as investing in student tuition and curriculum development. Infosys is also preparing for more long-term needs by looking at ways to entice a broader interest in STEM. The first partnership in this effort is in Indianapolis, Indiana, the heart of the U.S.
  • Cognizant: Its recent acquisition of Health Care Services Corporation’s TMG Group adds Medicaid and Medicare support in offices in Texas and Pennsylvania. This move provides its clients access to more local resources – people with knowledge and depth in government health as well as infrastructure.

Bottom line: Indian-based service providers have been building near-shore and onshore presence for a few years now, but it takes on new meaning and significance now as the context changes – politics, the impact of technology, objectives for partnering, and changing priorities around the skill sets that are needed. As a service buyer or government, university or economic development organization, be creative and also take a long-term view as to how these service providers can funnel the investments they are increasingly willing to take to have value locally to grow their businesses.   

HCSC’s Sale of TMG Health to Cognizant Shows A Move to Focus – and Partner– for Better Outcomes
June 16, 2017 | Barbra McGann

Earlier this week, Cognizant announced its intention to expand its footprint to support U.S. Government health operations through the agreement to acquire the TMG Health subsidiary of Health Care Services Corporation (HCSC).  On the flip side of that announcement, HCSC has carved out its Government health support function to be run by a partner – Cognizant. HCSC can benefit from Cognizant’s dedicated, prioritized, and leveraged (cross-client) resources to manage the operations services. However, to impact the health, care, and financial outcomes of its healthcare consumer base, HCSC will need to partner with Cognizant in a way that creates the OneOffice™ – a seamless flow of data, insights, and infrastructure for the front, middle, and back office. 

TMG Health’s relationship with HCSC started back in 2005 when HCSC selected it to provide BPO services in support of its entry into the Medicare Advantage market. At the time, TMG Health provided some measure of enrollment, eligibility, claims, and billing support to a total client count of 30 plans covering 2.8 million lives. In 2008, HCSC acquired TMG Health for $100m, tucking in the BPO provider as a subsidiary. TMG Health has since added support for Medicare and Medicaid claims processing and member services and has local resources in Pennsylvania and Texas – for 32 health plans (+2 since 2009) and more than 4.3 million lives. TMG Health has not really grown its portfolio of clients although the footprint of services has expanded over time.  And public health programs continue to grow – in numbers and complexity as the industry moves to greater coverage and value-based care. The changes in the healthcare market driven by consumerism and compliance are driving healthcare plans to “rethink” their business and operations strategy.  

By exiting the “back office business,” HCSC can focus its investment and resources on becoming a more consumer-oriented company.

While retaining a partnership with Cognizant for its support/back office services, we expect HCSC to focus on becoming more consumer-oriented; to channel its resources to becoming insightful, tech-enabled, and overall “savvy” to impact health outcomes for its constituents. In the meantime, it can rely on Cognizant to provide a steady and increasingly optimized rules-based foundation. We expect Cognizant to tap into the Medicare/Medicaid COE it told us about in our last Healthcare Operations Blueprint research. The consolidation of its subject matter expertise, IP, and tools in the COE is to help manage the tricky business of complying with government policies and the continued growth of Medicare, Medicaid, Medicaid Advantage, and Dual-Eligible consumers – providing support for eligibility, enrollment, billing, claims, and applying its solutions around quality and reporting (e.g., STARServe). Cognizant has the right experience plus industrialization and scale and has the Trizetto and RPA capabilities to drive increased efficiencies and free up resources to support new growth in the Government Health operations business.

The Bottom-line: HCSC and Cognizant will need to partner to keep – or establish – integration between front and back office to impact health, care, and medical outcomes.

One place this arrangement could break down is if the back office support that Cognizant provides is not integrated with the front- and middle-office of HCSC (and its other clients). In order to impact health, care, financial, and quality outcomes, healthcare payers need to be healthcare-consumer oriented – understand the health, financial, economic, and social determinants of their constituency. A lot of that data is part of those back office systems and processes, so HCSC and Cognizant will need to be partners in defining workflows of the future that will support an insightful, consumer-oriented business that complies with government standards and also enables HCSC to better manage the health, care, medical, and financial outcomes of its public health base.

Training for jobs that don’t yet exist: the AT&T story
May 30, 2017 | Barbra McGann

Let’s turn that common lament we hear of a “talent shortage” on its head. What if you created a pipeline of talent that fit the needs of your business as it is growing and changing? While at the Infosys Confluence event recently, I heard about how AT&T has been taking steps for the last two years to create the very workforce it needs to achieve its vision.

 

First, determine what skills and capabilities your workforce will need in the future

“Based on industry and corporate direction, we chose six areas, including big data, IP networking, and software-defined networking, that we specifically want to attack as the skills of the future,” shared Candy Conway, VP, Global Managed Services Operations, Business Solutions and International at AT&T.

AT&T defined a set of roles that map to these areas, determined the associated competencies, and evaluated employees against the future landscape. They identified over 100,000 employees who will need to have a different or a more varied or developed set of competencies than they have today. “We then developed a roadmap and plan for getting these professionals into a relevant and meaningful career path that maps to the future of the company and the industry,” said Candy.

AT&T is a little over two years into this program. At this point, each employee has a prescriptive program managed through a learning portal - it identifies the role they are in currently, the one they target the future, the associated competencies for each role and the learning and education path to get there. For example, an employee could be in the network center and want to be a software engineer, and has a learning path mapped out.

The nuances of the skill areas also change quickly. “It used to be that skills would change a decade at a time, and that’s now accelerated,” said Candy. AT&T designed a program that would offer a number of options and flexibility – from internal designed and led courses, to “nano-degrees” in niche areas like web development and virtual reality to online master’s degrees from Georgia Tech and social-media based programs with badges (157,000 options) awarded as people complete courses. 

Investing in future skills is of value to the employee and the company

This plan is mapped to what roles that AT&T believes it needs to have in the future…. so employees can look for open roles and bid on the ones they want to fill. There are no guarantees that these roles will be filled by employees desiring them at AT&T, but the program still provides an advantage to the employee since AT&T is defining these roles (such as data scientist) with a forward-looking view, and therefore helping employees develop these competitive and marketable skills. Certainly, having invested in the person’s training, AT&T has an interest in keeping these people in-house and this is a way of creating loyalty, stickiness and a workforce of the future.

This kind of investment can help a company attract and keep the “best and brightest” with the most potential for helping grow a company. Individuals who feel a company cares enough to invest in their talent development, keep their skills relevant (and competitive), and give them options in a career are more likely to stay with that company.  AT&T also will have skills relevant to the future – the future workforce – without having to go out and 'find them'. 

The bottom-line: Become a learning organization in order to be relevant to your customer base, stay competitive, and grow.

Take a look at the vision for your company. What do you want to be able to deliver to your customers? What experience do you want to create for them? What outcomes matter over time? Determine what roles and competencies, and what training, education, and mentoring will develop your workforce to achieve it.

Businesses need to be increasingly agile to address the rapid changes driven by consumer expectations and digital technologies. That means employees also need to be agile – and managed in a way that encourages and rewards-based learning.  The market is increasingly competitive for candidates who have future-oriented “soft skills” like critical thinking, problem-solving, and creativity, and the ability and interest in learning. This program provides a model for how a well-established, “legacy” brand can embrace a  learning culture to enable an agile workforce relevant for competitively positioning the company for growth long-term.

How EXL is taking a “grassroots” approach for incremental digital transformation - for itself and clients
May 25, 2017 | Barbra McGann

EXL is going broad and deep from its core strength in analytics. At its recent EXL Client, Industry Analyst, and Advisor Day, the service provider showcased its theme of “Accelerating Digital Transformation” driven by “look deeper” with analytics.

We heard from both EXL and clients during the day that while clients appreciate that “digital” can help “transform” their staid businesses into one seamless capability that is more flexible and responsive, it doesn’t feel real or short-term. Their businesses are too siloed, risk averse, and focused on the day to day. The sense I got from the day was that EXL is “right there” with its clients facing these challenges – meaning, it is not behind, and it is not way ahead and looking over its shoulder. EXL is working shoulder to shoulder with its clients -- at the grassroots level-- to figure out the vision for a more customer-centric, insight-driven, and agile business, map it out, and take the steps to get there. The service provider is doing this by keeping its focus on the core strength of analytics, and addressing gaps it has had in data management and automation in particular.

 

The front office is only as effective as the middle and back allows it to be

EXL’s traditional strength is in the middle office with industry-specific services support and analytics and in the back office with finance & accounting BPO. The front office cannot be effectively customer centric—responsive and personalized—if it doesn’t have a flexible data infrastructure through this middle and back office to drive context and act with speed, precision, and fluidity. EXL is working with clients where it sits – in that middle and back office, particularly in insurance, healthcare, and financial services.

For example, with one client that started as a headcount-based cost reduction BPO play in F&A, EXL proposed a number of workflow process and “digital” enablers such as RPA and chat to have a more interactive and responsive function. The client has been able to remove itself from a fairly heavy-handed “oversight” of the day-to-day and EXL has been able to find and implement efficiencies for faster processing, fewer errors or points of confusion, and greater satisfaction all around. A key solution element here was the human-centered approach: the team took the time to interview people involved in the current process at the client and at EXL, understand what was not working, and design and test out solutions that were people, process, and technology oriented (a.k.a. design thinking).

Building out the data chain

Over the past couple of years, EXL has hired, acquired, and developed a broader spectrum of capability in analytics modeling and reporting to build out this core strength. It’s been a differentiator for execution, but not across the full analytics spectrum and not at scale. Now it’s expanding upstream into data and data management, built-in proprietary technology and partnerships for “bots,” and supplementing the shift through its data acquisitions such as RPM Direct and Datasource.

Its viewpoint of the impact of data and analytics was demonstrated through an example in the middle office of an insurance client. EXL created a digital interface for customer acquisition, combined it with its LifePro policy admin system and data analytics. The client uses the database to target and segment customers for campaigns. Interested customers can use mobile or internet portal access to apply. Based on the back end integration with the underwriting and pricing engine, the customer gets a quote and the company can bind the policy online.

The role of robotics

The conversation around robotic process automation and artificial intelligence (the latter less of a focus and still a point of view to be developed, it seems) is constantly tied to analytics.  EXL’s observation is that “clients now seem to be taking a more pragmatic approach to intelligent automation” – how to institutionalize it, not just use it. One client example was of setting up a COE in a “build, operate, transfer” approach where EXL initially builds out the automation strategy, governance, use cases, service orchestration layers and bot skillsets. If you are interested in this approach, it’s one that we haven’t heard quite as clearly articulated from other service providers, and an area that we do hear is a challenge for global business services centers, for example. Some companies like Ascension Health and SEI Investments have to take the leadership on their own, but others may appreciate this kind of support to get RPA not just used but infused into the organization. I do get the sense this is a newer offering for EXL, so do your due diligence on the availability of skills and capabilities across different suites, but we often hear from clients that EXL makes a responsive, transparent partner.

Another place EXL is building scale is in its library of function- and industry-specific bots and partnerships with third parties including WorkFusion, Automation Anywhere, and Blue Prism. With automation, the service provider is willing to guarantee productivity and cost benefit, and change the traditional BPO engagement model. As you consider how you want to partner with EXL, take a look at its bot library, its subject matter experts, and consider the balance with your own capabilities. When you look at solving a problem and impacting an outcome and then designing the solution in between, rather than the previous outsourcing approach of lift and shift, you have more flexibility in your business.

Bottom line: Rethink your partnership style and challenge EXL.

Tap into these areas where it is investing: analytics; platform-based services; “advanced automation”; and human-centric digital transformation.  What to watch: the need to scale in these focus areas and become a more credible powerhouse in consulting to lead the charge.

“Igniting Innovation”: KPMG features an experiential approach to digital transformation in its Analyst Day
May 05, 2017 | Christine Ferrusi RossBarbra McGannMelissa O'Brien

Just about 90% of CEOs who participated in a KPMG survey are concerned with the issue of changing customer loyalty, and the majority believe current their company’s products and services won’t be relevant to current customers in 3 years. That means they need innovation – now. They see technology (often referred to as “digital”) as an opportunity to move, but 85% of the surveyed CEOs feel they don’t have time to think about disruption and how to respond to it with innovation. This sets the scene for KPMG’s Analyst day recently in Boston. KPMG looks to bring purpose and passion for helping clients be successful in making innovation a part of the core of their businesses – through a diverse workforce, solutions, and collaboration.

With this backdrop, four themes stood out to us during the day about how KPMG is working with its clients:

  1. A vision for “OneOffice” – work designed to address customer needs using “digital labor” and systems. Digital transformation is (finally) moving from the front office (customer touchpoints) to include the middle and back office (business functions and transactions) – and talk is moving from “how do we use ‘digital’” to “what problem do we want to solve for our customers and how do we use the possibilities of talent and technology to do it.” At HfS, we refer to this concept as “OneOfficeTM” – the need for businesses to break down silos in their organizations to create a more effective data and workflow for business outcomes, so this theme resonated with us.

As we are focused on “ making it real” and providing examples of where it is happening, we appreciated the story that KPMG told about a client they worked with to map out the customer experience. They registered a number of customers on an app and these customers recorded their experience in real-time, as did employees. KPMG captured the data in the Pathfinder tool and used it as input during a journey mapping session with employees from across the organization, front and back office, including a finance director, a customer service manager, and a valet. They talked through the points in time when the customers and employees had a poor experience and came up with ideas that were then prioritized for addressing through the client’s own innovation management approach. What stands out here is the breadth of people included in capturing the experience (customers and employees from different business units and IT) and the way the experience was captured (an app in real-time), which led to in-person workshops to map out various customer journeys and an action plan.

 Additionally, staying true to the “ embedding innovation” theme, KPMG trained a number of the employees in departments throughout the client on the design thinking principles and methods used in the initiative. These people are networked as a COE. The team also has access to an analytics tool to continue to capture and analyze data on their journey.

2. A focus on defining and enabling the evolving role of workers and work. “Even in a digital world, humans are still the most important investment, the secret element of our brands, and the magic asset in the company,” said Robert Bolton, capturing the tone of the recent day. One example of a workforce transformation in progress was launched when a client started a discussion about the size and shape of the workforce of the future. This has led to questions such as “How do you know you have the right size?” “How does it have to change because of the advent of RPA and artificial intelligence?” “What are the impact on entry level jobs and the way those jobs provide a launching pad for careers?” “How does it impact learning, training, career paths?”

KPMG is not just working with clients to address these questions but shared its own experience in a changing workforce through the use of digital labor. For example, instead of having new hires who are eager, smart MBAs do mundane and repetitive audit work while they “pay their dues,” KPMG is able to automate much of that work and provide a more stimulating and challenging role for the talent they’re bringing on board.  It’s changing the culture and employee work allocation models.

This area of “ digital labor” is one that the shared services and outsourcing group at KPMG is hearing a lot of questions about as well, according to the group’s global head, Dave Brown. Digital labor and cognitive are on the forefront of activity in evolving operating models and defining who (or what) does what. “Digital labor, simply put, is another form of outsourcing,” said Dave Brown.

4. Innovation starts with culture. Innovation needs to be a way of working in companies – it can’t just be siloed in one department or area. Key features of a culture that embrace innovation include diversity – of workforce and partner ecosystem; collaboration; and experimentation (these are also principles of design thinking). Having a culture and environment where it’s “OK to fail” is also a lynchpin of innovation.  To provide a “space” and showcase for innovation, KPMG has broken ground for a new facility in Orlando to provide its clients and train its workforce with a multidisciplinary, hands-on, collaborative, high-tech experiential approach. And it’s partnering with the academic community to help develop (via technology, data sets, and case studies) the future workforce during the university years – for example, combining soft skills like teaming, collaboration, and critical thinking with critical technology skills for analytics and the subject matter expertise of accounting.

5. Deep investments in software to improve and automate complex processes. KPMG’s Spectrum unit created several “business intelligence engines” to automate and analyze several complex corporate processes like third party risk, contracts, and regulatory compliance like Automatic Exchange of Information (AEOI.) Beyond Spectrum, other tools KPMG discussed at the event include its KPMG Digital Responder, for security threat discovery and analysis and its KPMG FIRE regulatory reporting automation tool. While the KPMG teams mentioned a number of tools and IP throughout the day, and showcased a handful, a little of it felt “mysterious” – they were referenced by name and not explained or shown. These days when everyone is still exploring what digital really can do for them, showcasing case studies and tools can be really impactful in getting the message across.

What does this mean to you?

Digital transformation and innovation continue to dominate corporate boardrooms as buzzwords. But actually implementing requires a lot of complex detailed decisions that spur significant changes to the ways companies operate every day. What’s impressive about KPMG’s message is the firm’s ability to talk at the 100,000-foot strategy level but then dig into the last mile delivery details.

For clients that already work with KPMG, if you’re not seeing the kinds of messages the firm presented at the analyst day, then it’s time for a meeting with your account team. Talk about how some of KPMG’s new (and even not so new) techniques are being or could be, applied to your engagement. Don’t take it for granted that your account team will automatically propose new ideas so be proactive in asking for innovation.

For non-clients, take a look at Spectrum and other KPMG tools as stand-alone solutions. The Spectrum team told us they do sell the tools separately – they don’t just get embedded into larger services deals. This gives you the opportunity to get access to KPMG IP and operational expertise without having to exit any existing services engagements you have in place.

For an organization that candidly admits it was on the slower end of developing a stake in front office, its recent investments and acquisitions (a whopping 51 in the last 3 years) show that it’s quickly catching up, and also tying together the concepts of front, middle and back office nicely and in a forward-thinking way.  Using their own interpretation of OneOffice, KPMG is forging ahead to help clients (and itself) break down the legacy barriers to become more intelligent and responsive client-centric enterprises.

"How was your experience today?” Using a design thinking exercise for quick and meaningful feedback “in the moment”
April 28, 2017 | Barbra McGann

The time a person has the most interest and insight into an activity is when they’re doing it. Did you just finish helping someone or facilitating a meeting and wish you could quickly get feedback on what the person or attendee is thinking?

What did they like? What did they wish you did differently, more of, eliminate, change, or add? What bright ideas do they have that you just wouldn’t think of yourself? Sometimes people’s quick thoughts and reactions can be the most valuable feedback. In the moment, you are also likely to tap into the “gut reaction” and how they are feeling.

To get feedback in the moment, we’ve been using a design thinking exercise in our HfS Summits. The exercise we use is based on the simple and useful questions in the Stanford d.School toolbox (link).

Source: Tools from Stanford d.school

Here’s how we use it: We put pens and sticky pads on all tables, plus a flip chart or whiteboard somewhere in the room. (When you start to do more design thinking you’ll realize that sticky notes and design thinking go together like water and ducks.) Then towards the end of the day we do this exercise to get feedback to confirm, challenge, and share on our objective.

Our question: How can we evolve the HfS Summit to be more interactive, engaging, and meaningful? In the next 5 minutes, write down what comes to mind to finish the following:

  • I liked…
  • I wish…
  • What if…

Then we encourage attendees to get up and put their sticky notes on the flip chart pad under the phrase that starts the same way. Soon, we have people up and milling around, colorful walls, and energy flowing.

Almost everyone writes something – either because they have something to say or perhaps because they feel peer pressure to perform. By asking these questions, we get specific feedback on sessions, logistics, and content – the good, the bad, and the ugly. The insights, ideas, and feedback also show us themes among what on the minds and in the interests of our attendees, and we see where there are really strong feelings.

This feedback is an addition to the formal surveys. The design thinking exercise engages attendees in a way that the formal survey doesn’t. For example, any event organizer will tell you their frustration with attendees who leave the “what else would you like to see?” or “anything else you want to tell us?” sections blank. But in the moment, when everyone is still engaged in the event, they easily share ideas and commentary.

I often get asked how to get started with Design Thinking. Although the tendency is to attach design thinking to a workshop – and there are proven benefits to taking a day or more out of your regular schedule to do this – you can also incorporate design thinking principles and activities into the way you work on a regular basis. This is one example of an activity that is so easy and simple, that you can immediately start to use it in meetings, in conversations, with sticky notes or even electronic questions in text messaging.

Bottom Line: If you want to understand someone’s experience and get feedback that you can wrap into a future interaction, meeting, activity, or event, ask: What did you like? What do you wish for? What if?

WNS and Its HealthHelp Acquisition “Will Not Deny” Health Care
March 27, 2017 | Barbra McGannReetika Joshi

“Denial is not an option.” Contrary to the typical (and here, oversimplified) pre-certification, “approve” or “deny” approach to utilization of services in health care, HealthHelp launched a new model of utilization review based on the premise of non-denial procedures, and that utilization management is about collaboration and education. HealthHelp taps into its evidence-based database and network of physicians and academics to review and approve or to recommend alternatives to procedure requests. In tandem, HealthHelp drives studies and education opportunities to lead to better medical and financial outcomes when providing or using health care services. In short, the company that WNS just acquired is building out a patient- and healthcare provider-centric approach to utilization management designed to match procedure and treatment to the patient’s needs and network.

HealthHelp took roots in the founder’s own pain 

The HealthHelp approach is tied to the experience of its founder, Cherrill Farnsworth, who found the number of denials and appeals she managed for radiology procedures discouraging and painful. Thinking about “how to do this differently… why do we have to deny”? Cherrill tapped into her network of people at medical centers and universities, creating a collaborative model on the premise of using data, insights, and education. Instead of a review, approve/deny, the approach is review, approve and/or educate and/or recommend. The approach uses an increasingly sophisticated system of data, digital technology, and relationships. HealthHelp is taking product development further into the realm of machine learning and artificial intelligence, as well.

What gives HealthHelp the “right” to make recommendations to healthcare providers and patients?

An approach like this one—essentially, a break from the norm—depends on the credibility of the data, technology, and people involved. HealthHelp faced the challenge in the early days of people not being sure that a “non-denial” approach would be effective for containing costs. With 15 years of data, though, the company has been able to ingrain a lot of experience and knowledge into the approach and platform, to the extent that now 75% of prior authorization requests get approved for providers or are responded to with recommended changes that are approved by providers, without any human intervention. In about 25% of the cases, it goes to nurses for review; 6-7% of which are forwarded to doctors, and after that, the provider has the option to and can still disagree and go with treatment, which happens in under 0.5% of cases.

Results to date show improvement in the quality of care, which impacts Star and HEDIS ratings and reduces the cost of care by making sure the right kind of care is provided versus the lowest transaction cost at a point in time.  Also, in a fee-for-service model, a healthcare provider gets paid for the procedure regardless of the result. As the industry shifts to value based care with payments tied to outcomes, approval based on evidence or alternatives becomes more strategic to positively impacting outcomes (and payments). This approach, therefore, seems to have further credibility in the value-based care model and can help healthcare providers move into the new world of healthcare.  HealthHelp worked with CMS to get approval to qualify this program under provider education/quality improvement initiative and thus be included in the 85% Medical Loss Ratio for health plans.

The acquisition by WNS brings a complement of resources to both organizations and its client base

The healthcare industry is so ingrained in a yes/no approach that it took a few years before the model got adoption, primarily with mid-tier healthcare organizations. Joining with WNS gives HealthHelp the opportunity to scale and support a broader range of payers and providers. WNS also has a wealth of analytics capability, talent development and industrialization expertise that is complementary to HealthHelp, with resources that can help expand and develop the services and technology platforms to impact healthcare outcomes more broadly.

The acquisition of HealthHelp is part of the WNS strategy to shift attention from the cost of transactions to the cost of quality care and support—towards patient centricity. To date, WNS’ work in healthcare has been mostly analytical and transactional services: billing, collections, provider network services, and claims processing. HealthHelp brings in clinical and operational expertise to impact medical, as well as administrative outcomes, thus closing the loop. It also brings a human-centered (aka design thinking) approach to solving problems and developing a new business capability that the healthcare industry needs.

Whatever the fate of the ACA, Consumerism in Healthcare is here to stay
March 16, 2017 | Barbra McGannMelissa O'Brien

While we wait for the new Obamacare “replacement” bill to sink or swim, we can’t help but ponder the implications of whatever outcome on the healthcare industry and the services ecosystem that supports it (especially since we get asked!). Amid all this uncertainty, one thing that is sure not to change is the consumerism that has taken a strong hold within the healthcare industry, which would be the case with or without the ACA. As consumers, we are wondering, if I can order merchandise from many different suppliers on amazon and pay in one place, why can’t I see all my clinical data and lab images and send them from one doctor or clinic to another? If I can send the record of my dog’s shots to a boarding kennel electronically, why not send my children’s immunization record to schools and summer camps just as easily? Yes, we know about interoperability and security issues. However, we have come to expect the same access and convenience in our healthcare experiences as we do in all the other aspects of our lives. 

Healthcare providers and payers are challenged to meet these increasing expectations—and are investing accordingly in digital enablement. HfS’ recent state of business operations survey indicated that 42% of healthcare companies are planning a significant investment in analytics to better understand what are the issues for whom, what are the opportunities to interact and impact members and patients and administrative support; and 36% are investing in social/mobile/interactive enablement to redefine, “modernize,” or create the customer experience. Despite all this planning and rhetoric, dealing with the healthcare system often feels like the dark ages rather than a modern customer experience. Our recent research found several examples of service providers and buyers working together that are hopeful of experiences to come:

  • Creating the digital customer experience by connecting front and back office: Due to ACA regulations, healthcare payers have needed to adjust to dealing with consumers (versus employers’ HR departments.) Many have set up retail storefronts including mobile centers where people can come in for enrollment (majority), questions and paying bills.  Teleperformance uses a proprietary software, TLSContact, to manage the process and workflow of the customer retail journey.  Representatives are able to access the initial app that the customer started online, and the workflow software helps identify the bottlenecks and how to better staff these centers.  For example, they can look at and analyze the processes to find out why there are long wait times—enabling clients to improve the process and better staff to meet demand.  
  • Developing customer journeys that look “outside the hospital walls” and building solutions that support the journey: Approaching healthcare in a consumer-centric economy drives healthcare organizations to look at how to initiate and keep the customer relationship over an extended period of time, not a point in time. Emergency rooms are designed to address a “point in time,” but we know that a health incident starts before a person arrives at the ER. VCU Health neurologist Dr. Sherita Chapman Smith is championing an effort to use telemedicine as a way to do assessments on stroke patients while they are in the ambulance, on their way to the hospital. (link).  In pilot simulations underway, the hospital is using trained actors to simulate stroke symptoms to test out the platform during ambulance rides to the hospital. “Patients” are picked up in an ambulance and connected via teleconference to the neurologist in the hospital, who conducts a remote assessment; and when they get to the hospital, they are quickly advanced to the next stage of treatment. The approach creates faster interactions between the points of care and speeds the time to treatment.
  • Using digital technology to make the users life easier and more real-time interactive with support systems: A healthcare organization that has partnered with NTT DATA Services described a consulting-led project which was aimed at the total redesign of the patient’s journey in various medical use cases (i.e. bariatric surgery, knee or hip replacement) in order to personalize that patient’s journey whenever he/she logs into the mobile app or accesses the website.  This means drawing together an understanding of that patient’s journey from start to finish, and knowing what stages they are in throughout their course of treatment, and what their needs might be. This hospital relied on the provider’s experience mapping expertise.  

It’s clear that healthcare isn’t getting less complicated any time soon. Whatever the fate of the ACA, the current political tone is foreshadowing more complexity and anxiety. Whether people are going to be uninsured or underinsured as critics of the current bill claim, or need to switch plans or providers, we can be sure that activity in the healthcare systems will increase. We can also be sure that that emotion will be at an all-time high, with the anxiety and fear that comes with people uncertain about what the changes mean for their lives and their loved ones: all the more reason that healthcare organizations need to be more nimble, intuitive and empathetic to that customer experience. Unfortunately, examples like the ones we highlighted above are the exception rather than the norm.

Bottom line: It’s time to think of and treat patients and members as customers you want to attract and retain, whether you are a health care provider or payer or a third party service provider partnering with a healthcare organization. Now we need to roll up our sleeves and partner in the effort to create a healthcare experience that puts the customer at its center.

 

 

How Design Thinking plays an integral role in increasing the value of outsourcing, service design, and delivery
March 14, 2017 | Barbra McGann

In business operations, global shared services, and outsourcing, the mantra has been: centralize, standardize, industrialize, globalize. Traditional shared services and outsourcing contracts have been developed to focus on “lift and shift” and how to make processes increasingly more efficient and effective, measured by service level agreements. But what happens when the SLAs are green but customer or stakeholder satisfaction is level, stale, or down? When you feel that “innovation” is lacking? That the world is shifting to become faster, more flexible, and in-touch—but your business delivery isn’t and you just don’t have the time to think about it?

The answers to those questions are more and more often to use Design Thinking as a catalyst for innovation and continuous change. And it is the reason we explored the integration of Design Thinking into business operations and outsourcing design and delivery. Insights on how Design Thinking plays a role in creating a different experience—a different way of working and new insights for operational excellence and expansion—and 11 service providers are profiled in the recently published HfS Blueprint: Design Thinking in the As-a-Service Economy.

All of the service providers in the blueprint we’ve just published, Design Thinking in the As-a-Service Economy, are increasingly incorporating the principles of Design Thinking—human-centered, collaborative, action-oriented—into the way they work. Just like the increasing attention to robotic process automation and cognitive computing, experimentation has been going on for a while now… and so it is no longer “new” to many of them.

Design Thinking is a complement to, not a replacement for, operational excellence and solutioning for service design and delivery

You can use Design Thinking to understand what’s really causing problems or issues or expenses, by better understanding what people are actually doing –or not—and feeling. What is their experience? And then working through ideas that may revise, or replace, or eliminate process; that may change what people are doing and how; and could use current technology better, or new technology.  As one shared services executive told us, “we already know how to make something efficient [with Lean Six Sigma] and we required a new way of thinking in some specific areas.” Along these lines, we are not anticipating an end or replacement to Lean Six Sigma or “operational excellence” but adding a way of stepping outside the process to identify trouble spots and new solutions.

With Design Thinking you focus on understanding who is involved in whatever process or problem you are looking to address, and what are their expectations and needs (the “human” side)? And what is the industry and corporate context, the business outcomes to impact (the “business” side)? And what are the technology enablers? Then bringing it all together in a solution through a series of prototypes and tests. (See Exhibit 1: Incorporating Design Thinking Into Business Context for Shared Services and Outsourcing) Sometimes the solution is a quick fix, like changing the day of the week or where a request from a consumer is directed in a system; and sometimes it will help you identify a new way of working or a new service or solution.

Exhibit 1:

 

Bottom line: By using Design Thinking, we are moving a more human-centered, business-outcome oriented, and questioning approach to defining and delivering services in consulting and outsourcing, just the way the world is doing in general.

Using Design Thinking “was helpful because we make assumptions about people,” said an insurance executive interviewed in our study.  Taking the time to empathize with the end user through interviews and observations “helped us to make sure we understand not just what we do for the consumer but how it makes them feel.”  In other words, it’s not just about what you’re doing but the relevance of it to your end user. If you want your customers and your stakeholders to work with you to reach your business outcomes, then look for ways to make it easier for them to do it – and that means understanding them better, and that’s a role that Design Thinking can play.

Where is the outsourcing services industry on the path to integrate Design Thinking?

We want to help you, through our blueprints, to make the right match for a services engagement – short or long term. While that effort used to be about “we as a buyer post a list of requirements and look for cost reduction” and “we as a service provider will tap into our best practices, tell you about our features and functions, and hire or assign people who can process transactions” … times are changing.

Now, engaging a service provider or providing services to a business means understanding the context, the challenges, the outcomes desired, and how to broker and define a solution that can be flexible and change as the market changes.  We’ve been calling this movement the “As-a-Service Economy.” Design Thinking can play a role in this movement towards a new way of working as partners. But because it is a new way of working, it does take time – trial and error and willingness to work in a new way. It impacts roles, governance, budgets, and contracts. And equally important, you need to have alignment in the expectations and cultures of the partners involved in order to feel as though this way of working can work – to deliver results. 

In the Design Thinking in the As-a-Service Economy Blueprint, we look at the relevance, use and impact of Design Thinking in services engagements as it takes shape as an integral part of business operations and outsourcing solution and service design and delivery.  It includes coverage of the following service providers in terms of Design Thinking integration into the way service buyers and service providers are working together: Accenture, Capgemini, Cognizant, Concentrix, EXL, Genpact, Infosys, Sutherland, Tech Mahindra/BIO Agency, Wipro