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Cloud-Based Technologies for a Competitive Advantage

Unlike a startup or smaller regional plan, many national health plans have grown their businesses by acquiring multiple smaller health plans along the way. While national plans gain new members through these acquisitions, they also often accumulate older and disparate technologies. As a result, national plans are often disjointed in terms of process and workflow.

Whether they are looking for operational improvement, administrative efficiency, medical savings, or any other initiative, it can be challenging to move quickly. Even with adequate resources and funding, national plans’ size creates more steps they must take internally and, in the industry, to transform their business. As a national plan continues to grow and increase the number of people, departments, and locations, these decision-making hurdles and issues escalate.

I often hear national plans ask, “how can we bring these different areas together to make things easier and improve operational efficiency?”

To modernize and innovate, national health plans need interoperable solutions that seamlessly integrate and connect their operations across the country. Cloud technology and cloud-enabled software can bring all these different areas together, even while physically separate from each other. With cloud-based solutions, everyone at a health plan is always working with centralized data and up-to-date information, reducing maintenance delays and potential errors.

This is extremely valuable for larger health plans. Once everyone at the health plan is working on the same tools, it makes collaboration easier and more streamlined.

The COVID-19 pandemic highlighted where outdated technologies present administrative deficiencies and the need for cloud-based solutions.

The pandemic created an entirely new regulatory environment that health insurers needed to accommodate immediately. Things were changing quickly. A large plan with disjointed systems did not just need to make changes in one place; they had to make them in several areas. The health plans that invested in cloud-based solutions had the flexibility to react quickly to the regulatory changes with minimal business interruption.

Cloud-based solutions can completely transform a national plan; however, it takes investment for progress. Health plans need to think differently about where they want to be in ten years, partner with next-generation technology creators, and invest in their future.

About the Author

Jared has been working in the payer reimbursement and payment integrity sphere for around two decades. As chief strategy officer at HealthEdge Source, Jared continues to work closely with health plans to understand their unique challenges and deliver solutions that can achieve their long-term goals.

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