True Disruption: Three Ways the Pandemic has Shaped Risk Adjustment Technology

nlp risk adjustment software The concept of disruption by innovation is a cliché in Silicon Valley technology companies. Over the past six months, though, we’ve encountered an external disruption that is, instead, driving innovation. Today, I want to discuss how Health Fidelity has worked to recognize the long-term impacts of this pandemic on healthcare, and how we’ve sought to support our current and future customers experience with our risk adjustment technology going forward.

Previously we discussed how adapting to a rapidly changing market due to something like COVID-19 is only the first step, and that waiting in an adapted holding pattern is not an option. The conclusion that there’s a new normal coming is almost certain, and the assumption that after a vaccine is developed, the world will be exactly as it was pre-COVID is not productive. Anticipating what the market (and the world) is going to look like in order to meet its needs is crucial. So, to differentiate between permanent changes and temporary challenges, one of the first things we did was validate our current market and our role in it. We know some things are sticky enough to assume: Is risk adjustment still a necessary element of healthcare in the US? Yes, arguably more than ever before with disruptions to fee for service. Is our risk adjustment technology still the best at supporting across different products and market segments? Yes, again.

The discovery process started with extensive talks with our clients and hearing their immediate needs and long-term concerns. We concluded that our current strategy works, and our vision to continue to develop innovative provider and payer solutions around our core NLP platform, Lumanent Insights is sound. So, now, the question is, “What are the permanent impacts of COVID-19 on us as a society and, in turn, our healthcare system? And what among those can we impact?”

First, we know that telehealth is a genie that won’t be going back in the bottle; it’s now a permanent addition to care delivery, and it has its own coding complexities. This is a relatively straightforward change; in that we expand the NLP’s capabilities to account for telehealth encounters.

We also know chart chase has been heavily impacted by staff furloughs and shelter-in-place orders. This is a more interesting one that speaks to the nature of external disruption and its impact. Chart chase has been an outmoded, heavily non-expert driven manual process that was costly, but not enough of a burden to overhaul. Now, though, with it being expensive and disrupted by COVID-19, it’s now a higher priority to retool. Because our core products and processes are involved in chart chase, it obliges us to offer a solution for our clients and the market.

Finally, there’s an internal innovation: remote solutions deployment. In the same way that there were legacy approaches to chart chase that require people to physically travel to do relatively straightforward tasks in person, how can we update our own processes and products to deploy more, if not fully remotely? Not only does doing so help keep us able to fulfill customer needs even under the most stringent and necessary lockdown protocols, it helps us reevaluate our implementation process and refine it in a way that we never would have without an external force “disrupting” the market.

In each of the above cases, they’re all projects we’d likely tackle one day, but an external crisis dictated that they become part of our strategy much sooner. Telehealth was the outcome of necessary regulatory change, chart chase became not just costly but broken, and the question around our industry’s capacity for fully remote implementation became much more real. The takeaway I want to share with anyone leading a technology start-up is this: when a crisis strikes, it’s not enough to assume that a new normal is coming, you have to consider what it’s going to look like before it’s here, and already be building towards it before it arrives.