Is Core System replacement really the best option? What Healthcare Payers need to know before they take the leap.

The only constant in healthcare is change. The landscape is constantly evolving, and all the players are feeling the heat to improve care delivery while making healthcare more affordable. There are many factors at play here; new payment methods, regulatory changes, and the need for better engagement and management of the health of members can all disrupt traditional operating models.

Small to mid-sized payers face enormous challenges in managing their operations. These organizations are often working with limited budgets and facing significant staffing shortages. They’re faced with the same regulatory challenges as larger plans, but may not have the resources to make major changes less painful. One of the biggest challenges these payers face is managing their core systems.

The Core Claims System Challenge

Many small to mid-sized healthcare payers may be using legacy claims platforms, which may struggle to keep up with the evolving needs of the organization, and often rely on workarounds or quick fixes to get through their day-to-day operations. This can lead to inefficient processes and workflows and may even put the organization at risk.

Another challenge is the significant turnover within these organizations. Most of the people who were around for the original implementation of the core system are likely gone, often leaving inconsistent training and nonexistent documentation. This can make it difficult for new employees to understand how the system works and how to use it effectively. A simple workaround may never be corrected because the new employees are taught “how it’s always been done”.

To address these challenges, small to mid-sized healthcare payers may consider replacing their core systems with newer, more advanced technologies. This is not a silver bullet. It’s not as simple as unplugging one system and plugging them back into a new one.

Understanding Your Core System

When your organization is growing or considering expanding into new business lines, it’s natural to think about updating your IT systems to keep up with the changes. But is that really the best option?

Before making any decisions about replacing your core system, it’s important to take a step back and evaluate what you already have in place. This means understanding your legacy system and how it works, as well as the applications it interacts with. You want to be sure you’re confident about its capabilities and how it may be able to scale with your organization to meet your current and future business needs.

It’s also a good idea to check if your employees have the necessary training or expertise to use the core system properly. They may be able to uncover hidden capabilities that you weren’t aware of. Plus, by ensuring that your systems are up to date with the latest releases, you may find additional functionality that could facilitate your growth and expansion plans.

Overall, understanding your core system is a critical part of making informed decisions for your organization. Take the time to evaluate what you already have in place, and you’ll be well on your way to finding the right solution that meets your needs and supports your goals.

Lack of Confidence

Sometimes it can be tough to keep up with all the latest technological developments, and that’s especially true when it comes to legacy core systems. Many businesses are now considering upgrading to newer, more sophisticated systems to keep pace with the demands of growth and expansion.

However, it’s important to remember that newer systems are not always the best fit for every organization. While they may have the advantage of more recent technology, they may not have the same depth of expertise in handling certain scenarios that the legacy software has mastered over time.

To make sure you choose the right system for your business, it’s important to evaluate your specific operational needs and business requirements. Don’t just go for the newest and shiniest option without considering whether it will truly meet your needs in the long run.

To avoid being swayed by the allure of the latest technology, take the time to engage with trusted business partners and have detailed conversations about how systems can address your specific business scenarios. This will help you gauge capabilities and ensure that you have the support you need both now and in the future.

There is hope!

Core systems are the backbone of your organization, supporting your operations. To keep things running smoothly, it’s essential to regularly evaluate your system’s capabilities and make necessary updates to keep up with industry changes.

Before making any big decisions, take a step back and assess the situation. You don’t need to replace your entire system just for one new feature. Sometimes, a targeted solution can do the trick. Upgrading your core system can be a significant investment, so it’s worth taking the time to thoroughly evaluate your needs and determine what gaps need to be addressed.

Remember, replacing your core system is a big step that can be costly and risky. With the right evaluation and planning, you can maximize the value of your current assets and ensure that your organization is ready to face whatever challenges the future may hold.

Finding the right partner is important and HCIM is here to help. Our healthcare veterans can help provide support and insight into your operations to ensure you’re getting the most from your claim platform. Our payer operations team has extensive experience and can help with configuration support, reporting, and even automation technology application that can eliminate or reduce manual processes. If you are certain that you are ready for a change, we also provide system selection support and have a team of experts with in-depth knowledge of the leading technology and can help guide you through the process. Contact us today to learn more about our services and how we can help you get the most from your core system.