The 'Edge Report Blog

How Successful Health Plans are Transforming their Business

The health insurance industry is changing faster today than ever before. The constant introduction of new regulations, changing customer expectations, and the need to adopt value-based reimbursement (VBR) models are three examples that are driving change. To meet these challenges head on, innovative, high-performing health plans are transforming their business operations — discovering ways to better meet market demand while reducing costs and achieving the best efficiencies possible.

So, what do we mean by “business transformation?” Business transformation means that there are “no sacred cows.” It requires your organization to objectively examine the people, processes, and technologies that drive your core business with an eye to automate, automate, automate. Changing market dynamics continue to drive health plans to grow their businesses, develop new services, grow membership, and ensure that all members continually enjoy the best customer experience. The first step in reaching these goals is with a modern technology partner that helps plans adopt new business models as quickly as possible and automate processes to achieve optimum operational efficiency.

If your organization is looking to take the first step in transformation, look no further than your legacy system and ask yourself a few basic questions:

Can my current system:

  • Improve my member satisfaction?
  • Improve my claims adjudication rates, speed, and efficiency?
  • Help me launch new plans/benefits/services in a matter of hours?
  • Help me easily expand into new geographies?
  • Help me reduce my claims backlog?

If you answered no to any of the above questions, your first transformation opportunity may to replace your legacy system with a next-generation core administration system.

Legacy core administration systems were designed in a different era — before consumers demanded to access real-time information online, before plans realized the need to share information with providers and quickly respond to both provider and customer inquiries in real-time. While many health insurers have made significant investments to modernize and integrate these systems, their architecture prevents those organizations from benefiting from the flexibility and speed needed to be successful in today’s marketplace.

And do not underestimate the need for flexibility because in today’s market, a health plan must be agile enough from a people, process, and technology perspective to proactively embrace new regulations and reimbursement models, exceed customer expectations, and develop and introduce new plans/benefits/services fast.

If your plan is looking for a transformation opportunity, we invite you to read HealthEdge’s whitepaper entitled, Seven Ways Health Plans Reduce Costs and Achieve Operational Efficiencies.


Subscribe to The 'Edge Report Blog