Change, Complexity and Compliance in a Pandemic

Written By: Michael Koory, Regional Vice President of Sales – Mid America

Does anyone else want to start 2020 all over again? Roll back the time and start over?

Take a minute and think back to your 2020 planning session. Were you were making plans for managing a global pandemic?

Despite our planning and all our controls, a large unexpected force came and rocked everything. It is said, “The only thing you should count on is uncertainty and the only constant is change.” Healthcare workers know this perhaps better than anyone.

“Change” is truly a “constant” in the healthcare industry.

At SpendMend, we began investigating the issues and forces that hinder efforts to preserve controls and drive operational improvements. Over our 25 years, we have identified three primary pressure points exerting forces that all systems must endure – Change, Complexity, and Compliance. We named them the 3 Cs. Now, a fourth one has shown up and demonstrated the power of the 3Cs. As we seem to be moving down the backside of the flattened curve, it is an opportune time to review the 3 Cs again and how COVID-19 amplified them in 2020.



One uniquely human characteristic is our ability to withstand a massive shift or impact on our plans. Often, we play no role in causing the issues that affect us. We take the hit.

You have heard the saying; Life is 10% what happens to you and 90% how you respond, but how do you react to something as massive as Covid-19? You start by making a damage assessment. You gather information, review your goals, and start planning again.

Over the past few months, “change” has demonstrated its power. It cannot be contained. We can only take the hit, take stock of what is left, and move forward again. The only other option is to quit, and in the healthcare industry, we don’t quit. We are committed to saving lives and improving the well-being of patients. Our mission never changes.

Other industries can pivot; they can change product offerings or move into new platforms. But in healthcare, there is no other pursuit outside of saving and improving lives. We must remain vigilant in protecting life.

In healthcare, when a significant force changes the landscape, we must double down on our mission and brace for the impact. In the face of change, we must continue operations as usual, which has a high impact on our staff’s health and our ability to support revenue-generating activities such as elective surgeries. Change affects healthcare under normal circumstances, COVID-19, and the “new normal” has increased this reality by a magnitude.



As if health systems leadership and operations were not complicated enough, mixing a significant relocation of staff offsite to work from home adds to the complexity. Our large-scale rapid experiment of working from home tested many IT systems ability and many leader’s patience over the past few months. By now, we have chuckled at the viral videos of spouses, children, and pets wandering into the background of our team meetings. While these episodes have been good for a group laugh and to relieve some of the stress caused by change, they are also all previews for our new normal.

When teams were deployed to a remote working environment, IT security was tested. As we begin our return to work, the partners you choose must have high levels of data security and the flexibility to adapt and even thrive in complex environments. I was proud of the work the SpendMend IT team did to ensure client data security while deploying our 150-person team, seemingly overnight. We left the confines of our building to our dining room tables, bedrooms, and home offices without missing a beat. We were not alone in this move. Across the United States and around the world, administrative teams not directly involved in patient care moved to remote work.

IT teams all over needed to manage the complexity of a dispersed workforce. The amazing part is, the vast majority did it without missing a beat. These moves protected employees while also protecting data and finances of the many health systems in the USA.

One of the biggest fears discussed regarding remote work, “How do we check on the team? How do we keep on schedule?” Visibility is key to human interactions. We want to see each other. We want to see what is happening in our workplace, families, and community. Complexity is difficult to manage because humans are involved, and we need to see each other and have control over our environment.



Typically, any healthcare organization is burdened by managing compliance with a host of internal and external regulations. The same burden applies to process and system controls. A couple of the most prominent players spring to mind: HIPAA, HCQIA, HRRP, and Medicare. Indeed, the list goes on and seems ever-expanding. And now COVID19 and the Federal Government have dropped the CARES ACT right in our lap.

At first glance, the CARES ACT does a great deal to help healthcare organizations and to offset the unexpected expenses and profit losses associated with COVID-19. But upon further inspection, the processes, personnel, and expertise that must be developed internally to remain compliant are significant. Compliance means applying resources toward the Cares act instead of another endeavor.

The truth is, our best efforts at controls still have gaps due to human interactions, and the two other previously mentioned Cs. To remain operationally sound, we need a significant amount of trust and a method to come around and validate. A sound system check keeps everyone involved up to speed and able to operate in their lanes. Teamwork thrives, and people are at their best when everything is running in compliance.



COVID19 has impacted our country, community, and the world. However, we are beginning to move past the most significant portion and get somewhat back to life as usual. Only it won’t be typical for a while. The pandemic demonstrates the power of Change, Complexity, and Compliance.

We are experiencing the 3 Cs and their impact on our lives. We see the need for truthful and actionable information. We can learn from any situation, bad or good, if we can garner information and insight from the experience.

We are learning that flexibility, coupled with security, is a useful characteristic of operational success. When deployed with visibility and information, it becomes a method and system for withstanding the impact of forces like Change, Complexity, and Compliance.

Caring and Preparing – A Challenge Unique to Healthcare

Written By: Michael Koory, RVP of Sales- Mid America

To all people working in healthcare – Thank you!

Recently, I read an article and listened to some audio relating to PWC’s recent survey on what is keeping CFO’s up at night amidst COVID-19

Find the link here:

The survey included several non-healthcare industries, but I could not help but recognize how applicable all this is for our healthcare clients as well. I am struck by how much this parallels the recent strategy conversations I’ve had with a few major GPO’s and U.S. hospitals about post-COVID-19 planning.


The key bullet points from the article and podcast were:

  • Liquidity & Cost Savings
  • Workforce Issues
  • Government Programs (CARES Act)

From my perspective, these strategies reflect steps I am seeing health system executives undertake to minimize losses and begin to find a way forward. Healthcare providers have a more difficult job since they are on the front line caring for patients while trying to re-orient their budgets and revenue plans for 2020.

It is during times of crisis and disaster we realize what a gift it is to have a healthcare community like we do in the United States. After the initial shock of mobilization to prepare for an onslaught of patients, finance and supply chain leaders quickly began to pivot toward stabilization and optimization. Simultaneously caring and preparing for the massive impact this crisis will have on the healthcare system.


Liquidity & Cost Savings

As soon as elective surgeries were canceled and shelter in place orders placed, health system providers absorbed a massive revenue hit. Layoffs in the healthcare market were a leading indicator of what would follow for other businesses in the United States. As of April 22, Becker’s Healthcare is reporting layoffs at 171 health systems across the United States. Adding to the challenge, some of these layoffs are occurring in COVID-19 hotspots like Detroit and New York.

With the topline revenues cut due in part to the loss of elective surgeries, leading executives are looking for cost-cutting strategies to protect their bottom line. In the past week, we have seen a spike in interest for our Recovery Audit services from our GPO partners and leading health systems.

Beyond the fast influx of cash (25 days on average), the best reason to implement this strategy is the increased visibility into the supply chain costs. The increase of purchases of Personal Protective Equipment and other pandemic preparedness items create the opportunity for pricing issues and duplicate payments. The increase in visibility offers healthcare leaders greater control over the entire supply chain and creates a position of strength when negotiating with vendors.


Workforce Issues

SpendMend deploys our workforce remotely to preserve our health and that of our community. Many of our clients have been dealing with setting up remote work operations for the administrative teams in the health system. It can be challenging to manage a remote workforce, but undoubtedly it will be more common as we move into our new normal.

One of the challenges with remote teams is communication. Team leaders need to begin thinking about information sharing and communication in a remote environment. Also, policies for remote work and data security need to be set up or updated. We could see a net increase in productivity by enhancing the remote work capabilities of administrative teams.


Government Programs (CARES Act)

The CARES Act has provisions that add $100 billion to the Public Health and Social Services Emergency Fund. Eligible healthcare systems can seek reimbursement for lost revenues and healthcare-related expenses incurred due to COVID-19. There are also accelerated and advance payment programs within the CARES Act. These funds are intended to supply a bridge between any disruption between claims submission and claims processes. These provisions will need the ability to account for the costs and track the available payments. Not an easy task while trying to battle the virus as well.

There are many challenges seen and unseen associated with this current crisis. At SpendMend, we are continually amazed by the innovation and desire to serve within the United States health systems. Our mission is to stand with our clients and help drive cost savings back to their organization to fund patient care.