Technology, especially next-generation technology, plays a massive role in allowing health plans to embrace change, innovate, and remain competitive. However, when it comes to significant technology purchases, in most instances, the decision-making authority does not reside with one person. Major decisions involve a group of key players —c-suite, technology leaders, board members, and more—who, at some point in time, are instrumental in a comprehensive, enterprise-wide investment.
I recently moderated a webinar featuring HealthEdge customers Independent Health and NeuGen. John Church, VP and CIO of NeuGen, provided some advice for those thinking about moving to a new core administrative processing solutions (CAPS). “When you evaluate a new CAPS, it’s taking what technology best fits your lines of business, your business model, and how quickly, as an organization, you need to push products out into the marketplace. [Next is] aligning those requirements back to which is the best technology out there for you, because with that, you will see longer-term savings in budgets, you will see shorter times to market.”
For Independent Health, Eric Decker, SVP of Information Technology said his organization saw potential in switching to a new CAPs and took time to look at their options.
“About ten years ago, the Affordable Care Act created uncertainty as to whether our legacy system could handle things like member level benefits, or how it would perform and integrate with exchanges,” said Eric. “We closely evaluated different products in the space at the time and immediately realized HealthRules Payer® would enable us to significantly cut down the time of our new product development. Now, what used to take weeks and months actually takes hours or days.”
Although the process can seem daunting at first, the results can be transformational. To get all key stakeholders on board, technology leaders must help the decision-makers understand that moving to a new core system will benefit the organization at all levels.
“Organizations need cross-functional support between IT and the business involved in evaluating the platform to ensure they are aligned,” said John. “As we look at the success we have with our HealthEdge claims processing system, our billing system, and our eligibility requirements; there is shared coupling between IT and the business.”
Eric agreed with the importance of a tight partnership between IT and the business, not only in what the operating model will look like after the organization completes the migration. “Our system configuration teams, operations teams, and IT work closely together to evaluate upgrades, evaluate new products that our sales team wants to implement, and how it will fit into the core administration platform.”
“The long-term operating model of how you’re going to support the system is key,” added John. “In what was traditionally all core IT functions before, now can reside in the business, and there are good reasons for them to….getting the right people together can be successful and have a lot of long-term efficiencies.”
When it comes to efficiencies, both Eric and John mentioned their high auto adjudication rates, both in the low 90s. John gave credit, once again, to the solid understanding and relationship between IT and the business.
“We can’t get to these numbers with just claims, or just IT. Everyone needs to work together, identifying how we’re going to get there, and [within] the timeline we want to achieve it,” said John. “The key thing is to be in lockstep. If you have a partnership, you will get there. Without a partnership, you will struggle.”
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