Chris Simchick and Scott Barnyak Bring Payers and Providers Together at SDLC
New models of payment and care, such as integrated delivery networks and population health management, are driving innovation. In addition to needing concrete ways to control costs, personalize care, and improve outcomes, new approaches are blurring the lines that traditionally existed between payers and providers. Collaboration, communication, and information sharing means that every player in the ecosystem can better manage complex, high-risk patients while achieving better outcomes and improving member or patient experiences.
SDLC Partners knows how to leverage all that data by creating customized solutions that work with an organization’s existing infrastructures, including systems such as Epic and PEGA.
“Traditional systems aren’t agile enough to rapidly produce the information needed to address individual needs of those in specific cohort groups,” says Chris Simchick, SDLC cofounder and CEO. “We can customize solutions that identify the most appropriate information and then repurpose and reintegrate it to support specific, practical actions.”
Scott Barnyak, cofounder, chief sales and marketing officer, goes further to explain how working with both payer and provider information creates a whole that is greater than the sum of its parts.
“If we aggregate medical data with payer records, such as claim histories, we can link compliance requirements, clinical patterns, and individuals’ preferences and behaviors,” he says. “One data set without the other is inadequate since the real value is created at the intersection where they come together.”
Personalized solutions can be developed surprisingly quickly—in as few as ninety days. This is particularly significant for health systems that are struggling to develop protocols to
address issues such as the nationwide opioid epidemic or the increase in the number of Type II diabetes patients. These are often tackled through spreadsheets and manual calculations to identify patterns and best practice treatments and strategies.
SDLC Partners can automate those types of tasks, as well as produce custom, actionable recommendations for the next best action needed. This could mean that rather than standard monthly reminders to each patient about physician appointments, one patient is contacted weekly, another monthly, and yet another only once a quarter.
Barnyak is quick to point out that such solutions are intended to complement existing IT systems. “We’re not looking to replace EMRs or larger traditional care management platforms,” he says. “We add capabilities and custom functionality that integrates with them so that care can be facilitated more efficiently and in more concise ways.”
This is accomplished through a collaborative design process based on clients’ clinical flow and processes, compliance requirements, patient environments, and desired outcomes. Targeted discussions with executives and clinicians follow human-centered design best practices to gain firsthand perspectives on the immediate challenges.
“We have the advantage of looking in objectively from the outside when we develop recommendations and solutions,” Simchick says. “We can act as a catalyst to help clients uncover the best opportunities for addressing their most pressing needs.”
In one instance, this resulted in a mobile application for clinicians making in-home visits to Medicare patients. The tablet-based solution was flexible enough to accommodate the natural flow of conversation by accepting answers to required questions in any order that patients raised them, whereas older technologies were only capable of working through the questions in a gated, consecutive order. In the rural areas where many of the patients lived, internet access was unreliable, so the application could function offline with results uploaded when clinicians return to their offices.
In addition to improving workflow and data access at the point of care, SDLC Partners can provide technologies to address performance, quality, and compliance issues. Along with gaps in care and their potential impact on ratings, dynamic suggestions for how best to address them can also be identified. “Death by Dashboard” is avoided by visualizing performance and delivering insights for each user in ways that fit his or her workflow and priorities, Barnyak and Simchick say.
Such details have practical and immediate consequences, according to Simchick. “From a Centers for Medicare & Medicaid perspective, you can monitor spikes in claims for a specific timeframe or region, or other trends,” he says. “Triaging those issues then results in fewer ER visits, lower overall costs, better outcomes, and improved Stars ratings and payment advantages.”
Evolving capabilities in artificial intelligence and machine learning can also provide transactional benefits in very specific circumstances. For example, solutions can support both payers with claims management systems and providers with physician reporting or patient logistics. This is accomplished by automating simultaneous data entry into multiple systems, creating communications that can be sent automatically, as well as populating multiple systems with reporting metrics.
Last year SDLC Partners created a center of excellence focused on robotic process automation. Through that center, the company has ramped up certified resources to accommodate the demand for artificial intelligence that yields practical returns on cost and efficiency. The company is currently engaged in several projects to develop applications that leverage these evolving technologies.
In addition to techniques and technologies, SDLC Partners is tackling the critical security, privacy, and compliance aspects of digital transformation. It created CyLumena, its HITRUST CSF certified security arm. Its focus is on protecting health information that may be stored in medical devices, as well as security vulnerabilities those devices might create.
From developing practical solutions to harnessing cutting-edge digital transformation, SDLC Partners is able to help clients manage the exponential pace of changing technology. Simchick points out that in any change effort, alignment is important. “If you don’t have a road map to help guide incremental change that’s based on value, you can actually wind up not achieving any movement at all,” he says.
His cofounder agrees. “Having an outside perspective to help identify the optimal path to ROI is very advantageous,” Barnyak says. “What SDLC can do is provide innovative ways to leverage client information, then develop unique insights and tailored digital tools to address the most pressing challenges.”
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