Modernize Payer Core Systems


Ensuring the Best Technology Decisions in Today’s Evolving Healthcare Environment.

Whitepaper | David V. Gallegos
Senior Vice President Consulting Services Change Healthcare

David Gallegos is Senior Vice President of Change Healthcare Consulting Services. He is responsible for leading efforts to engage clients for consulting services, and has over 20 years’ experience in healthcare-related operations.

Healthcare delivery and reimbursement have changed dramatically since the 1990s, yet many organizations remain shackled to outdated information systems and technology. Because these legacy platforms were designed for a different era, they’re increasingly unable to meet the ever-expanding automation, interoperability, and data demands of today’s healthcare ecosystem. Widespread adoption of 21st century technology is therefore essential to support critical elements of the emerging healthcare environment, from value-based care and price-and-quality transparency to improved collaboration, optimized patient experience, and advanced cybersecurity.

Many organizations, however, are reluctant to embrace new technologies and continue to rely — sometimes precariously — on their legacy installed base. This caution is understandable, given the cost, complexity, and risk typically associated with implementing new software. Moreover, a growing recognition exists across healthcare that technology alone cannot transform an organization. More than a few executives have learned the hard way that deploying new systems often requires organizations to fundamentally re-think business models, processes, and job descriptions originally designed around legacy platforms. Leaders consequently worry that even the best-designed solutions may cause major disruptions and fall short of an organization’s original business objectives and budget targets.

Because changing technology solutions is rarely easy and not without risk, aligning with an experienced, unbiased third-party to help guide your transition can be enormously beneficial.

Compounding this uncertainty are dramatic changes in the vendor community. Recently, several software vendors have determined that their product roadmaps have hit a dead end. They realize their underlying technology is out-of-date and cannot meet the current and future needs of their customers. Some of these vendors are rearchitecting their platforms and encouraging clients to move to their new systems. Others are selling their client base to vendors with more modern capabilities in the hope that their clients will migrate to the new vendor’s system. In all cases, clients are being pushed to new platforms and technology whether they like it or not. Unfortunately for these clients, change has caught up with them before they are ready. Now what should they do?

If this situation sounds familiar, my recommendation is to push back against the vendor and adopt instead a thoughtful, proactive approach to taking charge of your IT future. At its core, this process involves embracing change as a means of driving your organization’s evolution towards success in the new healthcare environment.

Here Are Some Key Factors to Consider at the Outset of Your Journey

Don’t let your system vendor force you onto their new platform without considering all alternatives.

Document your current and future requirements and evaluate various software applications before finalizing your selection. Your vendor’s new platform may ultimately be the right choice. But don’t default to that conclusion without carefully weighing your needs against alternative solutions.

Evaluate multiple software vendors carefully.

Several options generally exist in a given software systems market and each product will have its strengths and weaknesses. The right system for your organization, therefore, will depend on aligning the application’s capabilities with your organization’s specific requirements and objectives.

Product demos are not enough.

Many vendors are great at presentations and demonstrations, but be diligent in your evaluation beyond “the pitch.” Assess your requirements against each vendor’s capabilities and require proof-of-concept demonstrations based on your business scenarios.

Software capability has no value without a solid implementation strategy.

Investigate the processes and methodologies vendors have in place to migrate your business to their platform. Understand what roles your organization will be responsible for and what that means to your business. Equally important, explore the vendor’s implementation track record.

Make sure the vendor’s product roadmap and culture align with your organization’s strategic trajectory.

Think carefully about future needs. Here’s an example: If you’re not serving a Medicare population currently but plan to do so in the future, ensure that your vendor of choice can perform all the tasks necessary to accommodate this complex line of business (or that they at least offer the required functionality in their product roadmap).

Confirm that the vendor is viable for the long term.

Many innovative start-up companies have grand ideas and cutting-edge technology. But their early-stage costs can be high and the competition strong. The last thing you want is to find yourself in situation where you’ve implemented a solution only to find the vendor is shuttering the product or selling it to another company.

Because changing technology solutions is rarely easy and not without risk, aligning with an experienced, unbiased third-party to help guide your transition can be enormously beneficial. Change Healthcare Consulting has been working with a wide range of healthcare organizations to evaluate vendors and implement solutions for over a decade. During this period, we’ve assisted hundreds of clients in the successful deployment of core claim systems, electronic health records, provider credentialing systems, care and disease management systems, and consumer-facing web portals. And because each of our consulting team members has a minimum of 15 years’ experience, we’ve developed the leadership, insight, and management skills necessary to support the best decisions at each step in the process.

At Change Healthcare, we can help you see around unknown corners to chart a clear path forward. We’ll help you avoid pitfalls and steer toward the enterprise system that is right for your organization. We can also assist with implementation once you’ve selected a new solution to reduce the risks associated with transitioning complex systems.

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