The challenge in the workforce
The health plan industry faces a variety of workforce challenges. Organizations have conflicting priorities. Their business and IT teams are understaffed, and there’s a shortage of highly-skilled core admin platform contractors. Evolving federal and state regulations require continuous education and adaptation.
The desire to enter new markets or new lines of business requires configuration. This may include platform capabilities not currently being used or unavailable on their current release. Many times, much of the workload falls to the IT team. They must integrate new technology in the form of a core platform upgrade or develop custom code. This requires coordination to balance costs, workforce bandwidth and time from business resources to support market expansion while maintaining daily operations. As a result, health plans lose efficiency, experience increased costs and become noncompliant. Moreover, achieving their strategic growth goals becomes a challenge.
I recently encountered a scenario that’s a good example of these challenges. On a current project, we are converting business from a legacy platform of an entity that was acquired through purchase of a benefit administrator. This is a new line of business for my client, which brings the challenge of adopting new state regulations.
One of these regulations is to be able to receive and display the member's demographic information. The version of the client’s core platform, which is now a year old, does not have a place to store and display these fields. The current version of the client's platform that is now available for upgrading does have these fields available.
Upgrading this version is scheduled for next year due to conflicting priorities. These include the migration of new business, developing new ancillary systems and available resources. The solution is to create a custom database table, which requires a custom interface to receive and export the data. Cost estimates for custom work are approximately $120,000 for what could be considered an interim or temporary need. We also must consider the time needed by the IT team to develop, test and deploy the custom code.
The challenge in the workforce
The preferred solution would be to stay current with the vendor’s platform releases and use the available functionality. Staying current allows for adapting new state and federal regulations with configuration, as opposed to custom development. This leads to quicker implementation times and increased auto-adjudication and accuracy of claims processing. It also allows for the health plan to remain at the forefront of new product offerings. And that leads to competitiveness in marketing and increased speed to market.
This example highlights just one new regulation. Laws, regulations and policies are constantly changing, and the platform vendor provides quarterly releases of their software to accommodate for such. Given the workload of health plans to run day-to-day operations and create new market offerings, platform upgrades often get pushed aside or are not fully taken advantage of.
Optum Advisory provides an Upgrade as a Service product that addresses these needs. We help you get current, and stay current, using the newest platform capabilities with ongoing release management.
Watch our latest video from Around the Corner to learn more about Upgrade as a Service and the benefits of staying current.