Health Plans Move Platforms to Ensure Seamless Connection

Health Plans operating on legacy platforms have started to migrate to new platforms and technologies, which can adapt to ongoing changes in regulations, and take advantage of technology advancements to improve outcomes and reduce costs. This trend calls for a collaborative effort of technology and business services to ensure a successful transition.

Transitioning to a new platform affects all aspects of a health plan’s business processes — from provider and network management, benefit plan creation and underwriting/enrollment to claims adjudication, benefits management, and financial recovery. Needless to say, it impacts the key stakeholders of the health plans, both employees, and providers. Transitioning also poses operational challenges, including managing staffing requirements, improving the learning curve of team members, and managing the decrease in auto-adjudication rates. All of these activities can increase grievances from providers and member customers, impacting the call volume and correspondence.

Most important, the data accuracy during migration from one platform to the other poses a Big Data challenge. While processes migrate, databases also need to migrate, providing a unique challenge regarding maintaining continuity in operations.

With rising costs and the advent of healthcare reform, healthcare administration is more complex and costly than ever. Dell Services can help you stay ahead of these challenges. We have in-depth experience implementing and managing large-scale health plan administration platforms, planning and streamlining workflows, and using leading knowledge management tools. Our health plan BPO services can streamline your processes, reduce costs, process claims faster and set you apart from the competition.

Our new whitepaper, Ensuring a Near-Seamless Transition to a New Health Plan Platform emphasizes a holistic assessment of the impact of platform migration on the overall organization. Many healthcare CTOs have found that it may be wise to engage outside counsel to help create a change management program and a clear understanding of the impact on different processes, as well as the re-skilling needs of the organization.

Cover of whitepaperAbout the whitepaper

Health plans need core administrative platforms that can keep up with changing regulations and technology. It is important to understand the key challenges of migrating an existing process to a new platform. Dell can help you stay ahead of these challenges.

About the whitepaper authors

Manish Jain

Solution Architect Director – Healthcare and Life Sciences BPO

Manish Jain leads the market development strategies, practice efforts to build new solutions and deal intake processes to maximize the growth of the business in the healthcare payer and provider markets. He holds an MBA from the Institute of Management Technology, Ghaziabad, one of the premier business schools in India.

Prasad Sampath

Director of Process Delivery and Transition

Prasad is responsible for offshore payer operations and leads multi-site delivery for payer clients across the globe. He has 22 years of experience in healthcare across various roles — including operations, business excellence, solutions, and business transformation and transition. Prasad holds an MBA from SP Jain Institute of Management and Research, one of the premier business schools in India.

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About the Author: Rajesh Antony