Ensure You Partner With Problem Solvers, Not Problem Finders

Proactive problem-solving is about identifying early warning signs that indicate you might have a problem and finding solutions before the impacts are felt. Working with a technology vendor can go a long way toward doing just that, but not all vendors are created equal. Some will go above and beyond to get ahead of problems, while others are simply reactive to customers’ needs.

To help your organization separate the problem solvers from the problem finders, outlined are five characteristics to look for when selecting a risk adjustment vendor.

5 Key Qualities That Differentiate Problem Solvers From Problem Finders

1. Act proactively, not reactively

The most important quality to look for when selecting a risk adjustment partner is proactive service. A problem finder will wait until you discover an issue before taking steps to resolve it. A problem solver will seek to understand potential problems at the source and drive tangible outcomes with that knowledge. They will keep your needs top of mind throughout the entire customer journey and will go the extra mile to identify and recommend solutions before problems occur. At all times, they will aim to exceed expectations and take initiative to address issues you might not be aware of. This is the definition of a problem solver.

2. Lead with data

Outside of proactive service, the second most important quality health plans should look for is a vendor with strong data analytics capabilities. A problem finder will be quick to jump to educated guesses without thoroughly looking at the data. A problem solver will seamlessly aggregate all your data into one easy-to-use platform and then use that information to uncover key trends and insights, including average risk adjustment factor opportunity, member condition analysis, visit completion performance, and chronic condition recapture rate. These insights will allow your organization to efficiently manage patient populations and lead to better health and financial outcomes.

3. Get to the root of the issue

Managing the health of member populations can be challenging, especially for plans working in the ACA or Medicaid space. Problem finder vendors might identify issues, but not always the right ones because they stop at the question “why.” In contrast, problem solvers fall in love with the problem — not the solution — and seek to understand it from all angles. They keep asking questions until they know the full scope of the issue and will leverage all the tools at their disposal in the process. This should include a combination of risk adjustment experts and advanced technologies that can segment complex member data into digestible insights, allowing you to prioritize the most impactful interventions for your patients.

4. Communicate regularly

Communication is key to any vendor-health plan relationship. A problem finder will wait for you to communicate your needs and bring issues to their attention. A problem solver will establish regular touchpoints to identify blockers and improve outcomes, even when there is not an issue at hand. Such a vendor will involve in-house teams by asking for and implementing feedback in the product development process. This creates a true strategic partnership between the health plan and vendor rather than a transactional relationship that might meet — but never exceed — your expectations.

5. Offer curated solutions

As the risk adjustment landscape grows increasingly complex, health plans must continually look for ways to streamline processes. A problem finder will offer ready-made solutions targeted toward a wide range of clients. A problem solver understands that what works for one health plan might not work for another and will implement curated, efficient tools to improve risk adjustment program performance. They will enlist a team of experts to stay abreast of the latest industry trends, allowing you to focus on interventions that produce the greatest impact on risk scores and patient outcomes.

Hindsight is always 20/20. Unfortunately, no crystal ball can predict the future. Though, partnering with a vendor that is a problem solver, it becomes possible to anticipate and insulate your organization from problems before they arise.

Andrew Perlstein is the senior vice president of customer success at Episource. He is responsible for Episource’s Client Services division and ensures that client organizations derive maximum value from their partnerships.