THE 'EDGE REPORT BLOG

Achieving Speed to Market

“The healthcare environment changes dramatically and very quickly,” according to Dave Mika, Director of Enterprise Core Systems Operations for non-profit insurer Independent Health, and a HealthEdge customer.

Mr. Mika is not alone in his perception of the market as it exists today.

Health insurers have relied on predictable market behavior and extended lead times for developing new plans, setting rates and responding to customer needs. Today’s market is experiencing rapid change in many critical areas. Regulations and administrative rules seem to change at the drop of a hat. The growth of value-based reimbursement (VBR) is driving demand for more and faster, in some cases real or near-real time, information acquisition, analysis and distribution for multiple constituencies.

In addition, M&A activity, the potential development of association health plans or limited duration plans, and other potential market or policy-driven changes could very well impact the design of insurance products in late 2018 intended for rollout in 2019.

In this environment it is absolutely critical that health plans have the capability to turn on a dime, change rate structures, benefits, provider network agreements and much more, in time frames that are significantly shorter than the not-so-distant past. Minnesota-based, Medica, a HealthEdge client, used the next-generation core administration solution HealthRules Payor to create 81 new plans in 10 days in response to last minute proposal changes put into place by a potential client. Health plans using complex legacy core administration technology would simply have been unable to respond at that speed and lost the potential new business.

How was a health insurer able to build new plans so quickly? HealthRules Payor is the industry’s only next-generation core administration system that uses a patented, English-like language that enables analysts to build plans and dramatically reduces the need for discreet coding. They do this by picking and choosing information modules and combining them into unique plans that meet client demand. The information modules are reusable and can be utilized in any combination, depending on the need.

Legacy health plan information systems were designed when insurers had a year or more to develop plans and make changes. Those days are gone. Speed to market is a key determining factor in who wins or loses business in the current market.

“One of the things that was a driver for us was speed to market for our products,” said Mika. “Independent Health wanted to be able to react quickly from a product development standpoint and a product implementation standpoint so that we could adapt to changing needs very readily and very quickly.”

This theme, having the ability to change at the pace of the market in order to win or keep business, is consistent across the HealthEdge customer base and a market force impacting health plans everywhere. University of Maryland Medical System Health Plan has a similar perspective.

“We’ve been able to go back and make changes, so decisions that we made initially before we actually went live, we were able to quickly adjust and correct after we went live. This is something that has been ultimately, supremely important, the fact that we can alter our path so quickly,” said Jose Vazquez, VP Solutions for the University of Maryland Medical System Health Plan.

One of the reasons behind the platform’s speed and agility, is its ease of use. How many times have you heard about an amazing software capability, only to see it go unused due to its complexity?

“The IT folks really liked the HealthRules language, and the ease of configuration that the system provided,” said Craig Azoff, VP Health Plan Information Services at Elderplan. “Setting up benefits structures, all of the key financial elements and how claims were adjudicated were easy to set up and learn.”

Simply put, the days when healthcare insurers could take months to consider market data and rely on consistent and predictable policy positions from year to year are over. Legacy technology that does not support rapid plan development and change has become a barrier to success. That said, new business opportunities abound for agile organizations that use next generation core administration systems to operate at the pace of change.

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