Health Plans spanning the entire United States from Rhode Island to Hawaii will at one point face the challenge of replacing their core administration systems. These systems are the backbone of these health plans and manage key processes like Member Enrollment, Premium Billing and Claims Processing. The reason why health plans look to replace these systems is because they no longer can easily support the continuous changing rules of the business, such as changes in plan design. As Federal Healthcare Reform continues on and Payment Reform continues to evolve, these administration systems must be able to support payment changes too, like bundled payments. Health plans in their search for a new solution, consider solutions not limited to TriZetto QXNT, TriZetto Facets, Perot Diamond and DST AMISYS.
The initiative to replace a core administration system is no easy task. It takes a lot of brainpower, years and money. It is such a hard task in fact, that many health plans have even scrapped the initiative after spending years on the project.
As health plans continue with replacing their core administration systems, here are some key points to consider:
Appoint Exceptional Leadership. It really does matter who is leading the initiative. The project team will become so large, that it’s important to make sure that the overall project leader and the leaders below can understand how the whole project ties together and what objectives their teams must meet to make the overall solution work. All leaders must understand how to implement a replacement system, understand the importance of their team’s contribution to the solution and be able to direct the team to stay focused on the business goal. It is important for the leaders to be able to recognize when the project has gone off course and to redirect efforts. An exceptional leader that really understands both systems and business process is essential.
Put your Best Team on it. The core system replacement will no doubt be one of the health plan’s most difficult tasks ever. It will take the brightest and most committed team to give it the best chance for success. There will be many challenges along the way that will require only the best problem solvers. Commitment is also important because the project will go on for a long time. There will be up’s and down’s and the team must be able to brave the storm.
Break it up into Phases. This means not to try to do everything all at once. The Health plan is replacing the core systems that cover almost every process; it seems impossible to do it all at once. Instead, break it up into phases either by grouping the customer accounts into phases or by separating business functions into phases.
Pick the Right Solution. Make sure to understand what the business and technical requirements are for an ideal core administration system replacement before choosing the solution. Remember to consider future needs too. Take time to research which solution meets the needs of your requirements.
Learn the Product. Even after choosing a solution, take time to learn in-depth how the product works before configuring it. An understanding of how the product works will allow you to visualize how to configure it best to work in the business environment. After visualizing the overall configuration strategy, the detailed configurations can be filled in.
