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Olga Ziegler grew up in Moscow, Russia, during a time when the quality of healthcare was subpar and preventive healthcare was nonexistent. She witnessed family members delay care, which resulted in late diagnoses and limited treatment options. “The good news is healthcare has improved in Russia, but my past experiences continue to motivate me to be part of something even better,” she says.
Now vice president of revenue program management at Pittsburgh-based Highmark Inc., one of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Ziegler is leading the charge to close the gap between providers and health plans at point of care using the latest technology. She oversees Highmark’s risk adjustment operations and revenue reimbursements for the company’s approximately 240,000 Medicare Advantage members and 160,000 ACA individual and small group members (as of January 2020).
“The ultimate goal for my team is to ensure Highmark receives complete and accurate reimbursements from the government for our enrolled beneficiaries—critical to ensuring our beneficiaries have access to high-quality, affordable care and products,” Ziegler says.
Ziegler is also focused on supporting Highmark’s members by advancing point of care solutions through automation and improving access to comprehensive care. “If we can effectively partner with providers toward this objective, everyone wins,” she says. “But changing processes and behaviors takes time and effort, and understanding the technology landscape and the views held by each generation are important factors in effecting change.”
For example, a decade ago, the majority of medical records were on paper; now, 90 percent or more are electronic. Ziegler says widespread adoption required focused and collaborative effort and a behavior change by those in both the public and private sectors. “The adoption of EMR laid the foundation for future digital transformation,” she notes. “Automation and point of care solutions have quickly provided value through increased productivity and quality, eliminating unnecessary administrative burdens, which ultimately reduces healthcare costs.”
In 2017, Ziegler played a central role in the pilot of Highmark’s first point of care risk adjustment EHR solution to eliminate paper communication. She assisted Allegheny Health Network, a Highmark Health company, through a risk adjustment transformation journey that resulted in the implementation of new technology that has improved provider satisfaction, documentation quality, and accuracy of risk adjustment data.
“It was clear to us that care needed to be delivered in a new way to accommodate those at high risk or who were unable or unwilling to leave their homes.”
Sam Reynolds, medical director for quality for AHN’s clinically integrated network, was involved with the implementation of this new risk accuracy solution. “Olga was instrumental in advocating for and advancing the embedded EHR solution,” he says. “The adoption of this new technology platform has eliminated a complicated, retrospective paper process and replaced it with a streamlined method to address chronic medical conditions at the point of care. It reduces the documentation burden for our clinicians and actually saves them time.”
Ziegler says her team had strong support within Highmark and Allegheny Health Network—a necessity to pull off any transformational journey within healthcare. “We are facing numerous challenges, having to solve for compliance, privacy, and IT obstacles,” she explains. “However, irrespective of challenges, when payor and provider partners are committed to working together on improving healthcare delivery, we have proven to be successful. Success looks like a win-win outcome for our providers, members, and Highmark.”
Highmark’s investments in innovation are central to moving healthcare forward, improving clinical insights and outcomes while reducing costs, Ziegler says. “In the last four years, we have implemented various robotics process automation tools (RPA), which complete routine tasks that previously required administrative support,” she says. “These tools deliver consistent outcomes in about half the time, which reduces provider administrative burden and allows us to free up dollars and invest elsewhere. More importantly, this innovation is allowing providers to spend more time with their patients.”
COVID-19, of course, has brought new challenges to Ziegler, who has been tasked with understanding the implications of the pandemic while simultaneously ensuring members have access to care. When the pandemic hit, her team saw about a 30 percent decrease in doctor visits as members began deferring care to avoid the risk of contracting COVID. “It was clear to us that care needed to be delivered in a new way to accommodate those at high risk or who were unable or unwilling to leave their homes,” Ziegler says.
Telehealth was the solution. “With government support and a concerted effort to raise awareness across providers and members, we have been able to ramp up telehealth as a new visit modality,” Ziegler says. To ensure widespread access, Ziegler is piloting a program to lend devices to members who do not have the technology necessary to connect with healthcare providers remotely or do not know how to use the technology. Seniors, especially, need assistance to take advantage of telehealth.
Ziegler says continuing to innovate—bringing in new problems to the market and solving them—is key to making healthcare more efficient, accessible, and affordable. “Most of the entities—whether they’re a provider, health system, or health plan—have built their own approach to the healthcare transformation journey, strategy, and vision, but being able to come together and align on how we drive success is critical,” she notes.
“We must work toward payer-agnostic solutions so healthcare providers have the same set of activities they perform when a patient comes in,” Ziegler continues. “This represents an opportunity for all payers to put aside our differences and work together toward the common goal of making things easier and more efficient for our providers, and ultimately for our members.”
Expertise Spotlight
Arcadia is a healthcare data and software company dedicated to healthcare organizations achieving financial success in value-based care. Arcadia Analytics, our purpose-built population health platform, delivers enterprise-level transformational healthcare outcomes.
Arcadia and Highmark share a commitment to finding innovative ways for payers and providers to collaborate and find success in value-based contracts. Highmark wanted to enable multiple modalities to share actionable, real-time information with care teams, recognizing that each provider group may do things a bit differently.
Highmark implemented our Assess and Desktop notification applications across their provider community.
- Assess (“Eform”) helps care teams understand panel acuity and share data with the Highmark team. Assess is a flexible workflow tool automating distribution and capture of quality and risk gap information. Multiple configuration options allow different sets of users to interact with quality and risk gaps in different role-appropriate ways.
- Desktop brings insights into the point of care while a provider is using their EHR to improve adoption, support quality improvement, and close risk gaps.
Arcadia Analytics enabled Highmark to provide acuity insights at the point of care and within existing clinical workflows, helped providers accurately document patient risk during visits, and improved provider satisfaction.
Learn more at arcadia.io
