Staying current on core claims systems releases

LOREN KOERBER:  Hi, I'm Lauren Koerber with Optum Advisory, and I'm here with my colleague, Alicia Thompson. Hi, Alicia.

ALICIA THOMPSON: Hey there, Loren. How are you?

LOREN KOERBER: So Alicia's also with Optum Advisory. We're going to talk about upgrade as a service today. If you work at a health plan invested in growth and scalability, then I think this discussion is for you. Now, more specifically, we're going to talk about the important growth within health plan operations regarding upgrading claims platforms or core admin systems. So let's get into it. Why is it important for health plans to stay current on their core admin system releases?

ALICIA THOMPSON: Well, first of all, most health plans are contractually required to stay current within at least a few releases. But these newer releases also offer new capabilities, such as value-based care. The upgrades also support new regulatory requirements, which is so important in the current regulatory landscape today. These newer capabilities help health plans remain competitive and support their growth goals.

LOREN KOERBER: So if health plans are contractually required to stay current, then what's the problem?

ALICIA THOMPSON: We're finding that many health plans do the technical upgrade, but they're not adopting that business capability. This leads to the continued use of custom code or manual processes, increasing their technical debt or falling behind their competitors. Health plans often rely on their operational staff who are running the day-to-day business, and they typically don't have the bandwidth to support these upgrades. It's often easier for them to keep doing what they're currently doing rather than thinking about how to adopt this new functionality.

LOREN KOERBER: And I get it. Changes is hard, especially in today's resource constrained environment. What other types of challenges are you seeing?

ALICIA THOMPSON: We're seeing the same thing with the configuration teams. They're focused on maintaining their existing system, and they often don't have the time that it takes to support these upgrades. Many health plans struggle to find the skillsets that they need, when they need them.

LOREN KOERBER: And earlier you mentioned that technical teams are often building custom code to support the business needs. So why is that a problem?

ALICIA THOMPSON: Well, every time they do an upgrade, they need to identify and update all of the custom code and integration points. So the more custom code they create, the bigger the impact for each upgrade.

LOREN KOERBER: It sounds like a snowball effect. The problem just gets bigger and bigger with each upgrade then.

ALICIA THOMPSON: Absolutely. The other problem is that if they don't catch all of the impacted code or correctly apply those fixes, then they run into additional production issues after they apply that upgrade.

LOREN KOERBER: And I can see why health plans might resist that change if they're introducing new errors each time they do an upgrade. So what can they do about it?

ALICIA THOMPSON: Well, there's several things. First, they should absolutely be using automated tools to identify all of the code that's impacted by these releases.

LOREN KOERBER: So that would certainly help to make sure they don't miss any needed updates. But what if they still break something that was impacted by the upgrade?

ALICIA THOMPSON: So it's also critically important that they do thorough regression testing to make sure that all of the existing processes continue to work as expected. It is time consuming, so that's why it's so important that they use automated testing tools to minimize the manual effort that's often relied on today.

LOREN KOERBER: And so how does that address the resource constraints you were talking about earlier?

ALICIA THOMPSON: Health plans need a team who know their business, understand the new technology, and is dedicated to these ongoing releases. They also need a staffing model that can flex up and down as needed throughout the year to support these upgrades.

LOREN KOERBER: How can health plans create that flexible staffing model when it's so hard to quickly find experienced resources who understand their environment?

ALICIA THOMPSON: Well, if health plans don't have these flexible teams, they should consider partnering with a firm who's focused on their account, has a deep understanding of their business and technical environment, and they can provide these upgrades on a regular cadence, at a predictable cost, including that business adoption. It's all about getting current and staying current in a cost effective way, driving the most value for their business.

LOREN KOERBER: Getting current and staying current. Great insight, Alicia. We're out of time. I want to thank you for providing all of this information on such a challenging topic.

ALICIA THOMPSON: Thanks Loren, and have a great rest of your day.