The digital transformation in healthcare insurance requires a revised business and operating model with a planned program for a legacy systems modernization. Implementing an incremental strategy will protect budgets and business continuity.
Digitization, particularly AI, IoT and advanced insurtech solutions, has introduced a new paradigm in customer service. While digital insurance products are becoming mainstream in a handful of markets, many areas of the world have been slow to catch up. At the same time, digital customers’ expectations are growing, and insurers are facing increased market competition.
On the other hand, healthcare payers’ business and operating models have to become more agile to respond to the continuously changing environment and regulatory requirements, while operating within the industry’s shrinking profit margins. Although this cannot be done without addressing legacy IT systems, a company can still achieve a digital transition for healthcare payers that doesn’t blow the budget.
CME asked its insurtech engineers for advice to TPAs and healthcare payers’ technology decision-makers. Changing core IT systems can be a long and expensive process. The key to successfully modernize IT legacy systems is an incremental approach. Well-planned steps to the digitization goal will ensure the budget is not exceeded and there is no business continuity risk. Careful planning will bring about change to the customer experience and the company’s financial outcomes, and operational efficiency. One of the most effective ways to achieve this is to keep legacy systems, like the Core Management System, and use containerization to add complementary services like members or partners portals, business intelligence module, gamification app, and more.
Containerisation allows legacy core systems to be retained with additional services wrapped into new containers and plugged in next to existing ones for a seamless transition. This allows the healthcare payer to test the waters and is the best way to see how things improve; and allows companies to adjust and adapt services, adding or removing, as necessary.
APIs deliver a fast and smooth integration between different containers. The healthcare payer can easily add elements, like submitting claims through a mobile app or chatbots to automate call centers. Another benefit is that APIs are vendor-independent, offering the healthcare payer further flexibility. 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.
This represents an exciting shift from a single, monolithic architecture to a microservices one. Containerisation technology facilitates a step-by-step transformation of the legacy systems, integrating new services for a bespoke one that will directly enhance a company’s business, and the payer benefits immediately from the transition.
Containerisation is not only agile, but it’s also affordable. Microservices can be deployed onto small, cost-efficient commodity hardware rather than older, ‘clunkier’ systems using massive servers with their associated initial investments. It also means that resources can be drawn only when required, as specific services are added, as containerization scales up to meet demand. Organized around business capabilities, the services are also tested independently, and have the capabilities to function without compromising others in any capacity.
A healthcare payer’s transformation can be adapted on-the-go, meeting changing business goals and priorities and keeping pace with the company’s capabilities and growth rate.
Many healthcare payers adopt a hybrid approach, mixing existing hardware and software with new cloud or remotely installed software solutions. The hybrid containerization model is also flexible and cost-efficient. The cloud provides scope for a ‘pay-as-you-go’ approach, and healthcare payers can scale up their digital services in any order they wish.
CME has implemented containerization for multiple organizations to progress towards their digital transformation, often in reduced timeframes. Successful digital transformations have included hosting a company’s legacy system, introducing innovative service modules powered by Robot Process Automation, Artificial Intelligence, Natural Language Processing, Optical Characters Recognition, and the Internet of Things, coupled with powerful business intelligence and data management tools.
Without exception, every company has to undergo a digital transformation to maintain a competitive edge, retain customers and benefit from the efficiency savings and insights that data and analytics provide. Adopting an incremental approach and containerized technology solutions is not only the future for digital services, but it is also the easiest and most affordable way for a healthcare payer to future-proof their business.
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