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Advance to Achieve: How Can Healthcare Payers Thrive In The New Reality


Advance to Achieve: How Can Healthcare Payers Thrive In The New Reality

Healthcare payers can thrive in the new reality with legacy systems modernization.

With these  payers now preparing to operate in the post-pandemic era, the industry as they know it has witnessed a fundamental overhaul – customer expectations have evolved, products have changed, operating models have been re-designed, compliance and regulations are becoming increasingly more challenging. Yet despite the altered landscape, different does not necessarily mean worse, and recent events have also yielded positive outcomes. Scalability and agility are the key takeaways. Both now rank as topmost priorities on every healthcare payer strategic agenda – and modernizing IT systems represents the first step towards capturing the benefits associated with scalability and agility.

Beforehand, though, they must overcome an initial dilemma, one that is accompanied by several risks. Changing legacy core systems is an overarching requirement – and this is a task that has always entailed big budgets and lengthy processes. In addition, slow decision-making and low to non-existing budgets make it even more difficult for technology teams to implement changes. However, modern technologies offer a more sustainable route. Rather than traditional methods of replacing core systems with new ones, modern technologies enable a smooth, incremental change.

If planned and executed correctly, customer experience gains will be attained, as will positive financial outcomes and operational efficiency.

Achieving legacy systems modernization

As healthcare payers look ahead, successful legacy systems modernization hinges on two powerful components. Both are vital for seamless, straightforward integration between legacy systems and new systems – and both provide the platform plasticity required to swiftly adapt to evolving demands and deliver new functionalities:

Microservice architecture

Driven through a rapid, frequent, and reliable delivery of applications, microservice architecture enables payers to evolve their respective technology stacks and accommodate changing business demands. Moreover, the architecture breaks an application down into core functions – each of which are services that can be developed and deployed independently. Organized around business capabilities, the services are also tested independently, have the capabilities to function without compromising others in any capacity, and communicate via APIs.

API economy

APIs enable different applications to interact quickly and seamlessly. The technology has witnessed an evolution in its own right, becoming a primary influencer in facilitating easy and efficient services development. Irrespective of their platforms, data structures, and underlying technologies, APIs introduce multiple applications to a new level of connectivity and data sharing. The innovative power they provide has resulted in APIs now being identified as a critical enterprise solutions component that influences operational bottom lines and drives efficiencies, growth, and innovation. This has created the API economy, which is loosely defined as the way APIs can positively affect an organization’s profitability.

A future of enablement and empowerment

As healthcare payers prepare to navigate the latter stages of the ongoing crisis and enter the post-pandemic era, microservice architecture and API economy present a smooth, incremental, and viable path to efficiently achieve legacy systems’ modernization for scalability and agility. A winning combination proven to deliver sustainability, the possibilities and potential that accompany the two are invaluable.

Besides creating avenues for healthcare payers to quickly adjust to evolving environments, microservice architecture and API economy streamline partner and provider engagement, deliver new generations of applications that equip members with more services, and embrace emerging technologies such as machine learning and IoT. Hosted along with legacy business-critical systems, this modern architecture represents a new window of opportunity for healthcare payers to replenish business models, promote innovation, achieve customer centricity, and elevate operational excellence.

This article was published in Khaleej Times on Feb 23, 2021

Expert Opinion

Kassem Darwish
Kassem Darwish

Solutions Architect

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CME’s on-going contributions for a tech-forward insurance future perfectly aligns with the digital landscape’s ever-evolving intricacies. Our comprehensive insurance suite enables insurers to seamlessly interact with market dynamics and purse innovation with ease.

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