For many healthcare startups and established vendors, partnering with payers is a crucial part of their business plan. And as we know, selling in healthcare is hard. It’s even harder when you don’t understand how these large corporations work. What do they want? How do they set priorities? How do they make purchasing decisions? How long does that process take? The list goes on, and if you’re strategizing without this knowledge you’re going to struggle. That’s where this episode comes in.

Today we’re talking with Andrew Adrian-Karlin, Director of Business Platform Product at Highmark Health. Andrew sheds some light on how payers decide what to do and who they decide to do it with. This episode will help you build an effective framework for preparing, approaching, and successfully partnering with payers.

You’ll Learn

• What are “products” from a health insurance point of view?
• What is the purpose of health insurance? Note: This is the same question we went deep on with Steve Krupa from HealthEdge on Episode 145. Steve’s answer is also worth a listen.
• What are some things that payers are interested in from a “business processing” perspective?
• How do payers set priorities?
• What’s the typical timeline for bringing on a new vendor and what factors contribute to it?
• What are the challenges, both internally and externally, that need to be managed when bringing on a new vendor?
• What can/should vendors do to minimize these challenges and shorten the timeline?
• How do external factors like the CMS Interoperability Rule or the COVID-19 pandemic impact your priorities? And a little bonus here: Why no one – not payer, not vendor, not lawmaker, and not even the regulator – fully understands new regulations and how that creates an early mover advantage.
• What are the best ways to keep a pulse on what a health plan is trying to do so that you can partner with them? NOTE: For more tactics on this one, Jeff Byers gave us the journalists take on Episode 62.

Andrew Adrian-Karlin

Andrew Adrian-Karlin helps companies do new things by better applying technology. I’m proud to be transforming healthcare at Highmark Health.

As the Director of Business Platform- Product at Highmark Health, Andrew focuses on building cross-functional teams and leading Product Managers. He is accelerating speed to market for new products, reducing the cost to market, and delivering improved experiences to Highmark’s members.

Andrew has more than 10 years of experience in Information Technology. Prior work has included diverse areas like data analytics, cybersecurity, post-merger integration, and system development. He holds a BS in Accounting from Case Western Reserve University, an MBA from Carnegie Mellon University, and a number of professional certificates and certifications.

LinkedIn: https://www.linkedin.com/in/andrewadriankarlin/

Highmark Health

One of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to create a remarkable health experience for customers. Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of 5.6 million members in Pennsylvania, Delaware, and West Virginia.

As an industry, health care poses new challenges every day that require deep insights, constant innovation, and new solutions. The Health Plan business has boldly forged ahead with doing things differently, piloting new approaches, and breaking from the pack.

Web: https://www.highmarkhealth.org/

Links and Resources

• Episode 145: How Payers Can Master Core Administrative Transactions and Deliver a World-class Experience to their Members and Providers w/ Steve Krupa
• Episode 141: The State of Payer Data with Jordan Bazinsky
• Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1)
• Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2)
• Episode 96: The CMS NPRM: Opportunities from the Payer Perspective
• Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli

The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.

Music by StudioEtar