Navigating the healthtech growth paradox:
How to drive innovation while cutting costs
There’s a big difference between what’s possible and what’s achievable. And since we experience a new AI revolution every six months, the art of the possible gets more and more alluring.
This is especially true for growth executives and leaders in the wider healthcare industry, but particularly in healthtech. Conversations can sometimes sound like this: “Well can’t we just fix that with AI?” Or “That company over there is doing that with AI, so we should be able to 4X that too.”
Much of this is true. If we do our jobs right, everyone in healthcare—patients, members, health plans, and providers—all stand to come away with improved outcomes. But for many, especially at the enterprise level, the challenge is more about what’s realistic and achievable.
Maynd Jolly
CFO/SVP, Client Executive, Growth, and Partnerships
The barriers blocking innovation are well known: rising operational costs, aging infrastructure, and a complex regulatory environment. Regardless, we must still move forward in the face of a paradox—drive growth and innovation while minimizing spend.
Embrace a "startup" mindset and playbook
Many established healthtech companies carry the weight of legacy systems and overly complicated processes. However, a key to success lies in embracing the agility and customer focus of high-growth startups.
This does not necessitate a complete upheaval of existing systems, but it does warrant the rapid adoption of the ingredients that go into the disruption recipe.
Finding the friction: How we uncovered challenges in the auth process
After analyzing data, reviewing provider feedback, and sifting through patient surveys, we discovered a decent amount of friction holding back the authorization process. For patients, providers, and health plans, an inefficient auth process means:
• Delays in care delivery: Authorizations that get caught in the system translate into poor patient experiences and unrealized care. It also leads to higher costs for payers and unpredictable revenue cycles for providers.
• Unnecessary administrative costs: Manual tasks, duplicated efforts, and communication breakdowns cause significant drops in efficiency. Providers are taken away from what matters and health plans get bogged down in a backlog of tasks.
• Inaccurate criteria: Without a consistent auth process, patient data can come from many sources. Outdated or misrepresented criteria can lead to faulty cost assessments, wrong diagnoses, and higher admin costs.
•Convoluted communications: Patients, providers, and administrators all need to be on the same page for effective care delivery. Without a reliable communication process, there can be too many channels to monitor. Faxes, mail, and phone calls to name a few.
•Ever-evolving regulations: An inconsistent, manual auth process poses many regulatory challenges when it comes to compliance. Without a streamlined digital footprint, keeping up with regulatory changes, compliance standards, and audit timelines is virtually impossible.
For many in the industry, these challenges aren’t exactly surprising. According to McKinsey, “...clinical staff must devote considerable time to reviewing [authorization] requests. Meanwhile, doctors and staff report spending 13 hours per week on [authorizations]; many clinicians believe it undermines their clinical judgment and can inhibit timely care.”
Break down silos through internal realignment
This “do more with less” mandate is everyday life for startups who go on to become industry disruptors. The first step to realizing this external ambition needs to be internal realignment.
To keep up with smaller, more nimble competitors, traditional enterprises need to find ways to capitalize on established mind share. Siloed teams result in efficiency leaks, knowledge gaps, and slow productivity.
The siloes must come down, especially surrounding sales, marketing, and product teams. Why these teams? They are the ones responsible for interacting with the problems, needs, and desires of your buyers.
This is critical information that must be heard loud and clear across everyone in your org. And the message needs to stay consistent. Building, developing, and aligning these teams is essential for enterprise growth.
Rewrite the value story through product-led customer centricity
When under pressure, there’s a strong temptation to turn the narrative inward by leaning on company experience and history. Prospect interactions and presentations that start with this tack have likely taken a wrong turn.
Successful startups don’t have decades of experience and history, so how are they able to disrupt an entire industry? The value story needs to start with the audience. What are their problems and pain points? How does your product specifically solve them?
For enGen, much of our value story is focused on streamlining complex workflows; automating revenue-cycle management; optimizing reimbursements; and revolutionizing the claims process through AI.
Healthcare is NOT a zero-sum game. With today’s technological capabilities, everyone can win.
Everyone can come away a winner
As someone with decades of healthcare enterprise experience, I think it’s fair to say our industry has much to learn. And speaking for myself, much to unlearn.
One idea that needs to come to the forefront? Healthcare is NOT a zero-sum game. With today’s technological capabilities, everyone can win.
This is not wishful thinking because we’re already seeing the benefits. Our latest AI pilot is already showing reduced errors, automating repeatable tasks, faster claims processing and reduce costs to claims processing.
That means less complexity and more transparency for patients. It also means lower PMPM for health plans and reduced admin burden for providers. The cumulative result is far less friction and more time and money for better patient care.
