Don't Fear Change, Build a Culture of Continual Optimization

Health plans that implemented a core administration system twenty years ago and have only taken technical upgrades for two decades struggle to efficiently operate in today’s market. The failure to design their processes around flexibility to adopt the enhancements delivered to them over the years puts health plans at a competitive disadvantage.

And while the system may look better today, it’s not performing any differently than it did in the ’90s. Furthermore, the health plan is not getting any value from the additional code they are paying for in their maintenance and licensing agreements.

CTOs and CIOs in this situation must ask themselves:

-         Why is your organization operating the same way as you did 20 years ago?

-         Why aren’t you taking advantage of any new enhancements?

The typical answer is that the time and cost associated with implementing the enhancement and learning how to use the new solution are too high.  Change is expensive unless we build a culture of continual optimization.

At some point, if payers simply let business users run the core administration system without focusing on the outcome of why they execute a certain process, it will result in “paving the cow path” and they ultimately just achieve inefficiency faster in a better-looking system.

Enhancements and upgrades add value, give health plans a competitive advantage, and allow organizations to operate more cost-effectively. Health plans must have the ability to adopt enhancements, have confidence they will work, and the flexibility to build on those functions and align their strategy to the Product Roadmap.

It comes down to whether a health plan has the culture that will continually take enhancements and not find themselves painted into that box twenty years later, wondering how they let so much time slip by.

I’ve seen this happen to numerous organizations, and I wonder what led them down this road? A health plan can look at a timeline of all the different versions of enhancements and upgrades that they ignored and correlate these milestones with potential opportunities they missed that could have advanced their business. Even though they had all the tools, answers, training, and resources at their fingertips, they just were not open to changing what they already knew and updating the way they operate.

For health plans that fear change, my advice is to embrace the upgrades that feed into continual optimization processes and allow your organization to make progress in the future.

About the Author

Dustin Rojas

Dustin Rojas, Senior Director of Sales Engineering and Strategy, HealthEdge
Dustin Rojas is a senior healthcare technology professional with deep expertise and extensive experience in many aspects of Healthplan Operations, and the Payer Software industry.  Dustin primarily focuses on collaborating with the Sales team and the overall organization to lend his collective experience to the achieve the overall strategic goal of "Crossing the Chasm.”  As Senior Director of Sales Engineering and Strategy for HealthEdge, he regularly works with Prospects and Senior Leadership to assist in current sales pursuits, in addition to collaborating and consulting on emerging services opportunities.  Prior to joining HealthEdge in 2019, Dustin spent 22 years in a variety of roles in the healthcare payer space with organizations that include Great-West Healthcare (Cigna West), and Cognizant/TriZetto.

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