The corporate leaders of healthcare are facing more challenges than ever before driven by a number of factors: government regulations, Medicare/Medicaid reform, social media, rapid technology advances, and cultural change as we move towards a shared risk model. Operational efficiency, accuracy, increased auto-adjudication and reduced administrative costs are all buzz words that are finding themselves on performance goals in every claims shop. The common question amongst those responsible for meeting these goals is, “With a 20-plus year old legacy system, how will it happen?”
In my prior claim operations life, I participated with and watched organizations toy with core administration replacement and enhancement under the demands of operational efficiency. While the idea of a fresh start was exciting, it was only a matter of time before everyone realized it wasn’t just the claims system that needed to change and the solution selected wasn’t going to service the immediate needs. In a flash, the program and project managers rushed in with their blank project plan to start prioritizing the initiative and looked to the business (who also just realized they now have two full-time workloads ahead of them), and said “What needs to happen first?”
The list that surfaced comprised pain points and the items that required immediate return to gain or maintain the operational department’s stability. STOP there! What happened to that list in your organization? Did the team quickly identify that a new core system or shiny add-on wasn’t going to solve those problems out of the box; so back to square one? Or, was that list seized as the holy grail of opportunity that was going to turn your team’s project into a “legacy” bringing performance-driven modernization to a locked, hard-coded legacy system? That type of power, once only thought to be housed in a magic wand, is available today. Business product management technologies that are rule-based in the language business people speak can be leveraged to transform what companies do well today into what they do exceptionally tomorrow. The ability to quickly minimize manual processes and optimize existing products, cutting out the workarounds and possibly antiquated products, empowers operations like never before and makes the goal achievable.
As with anything, the best way to learn is often through the sharing of information. Join us in Boston, October 27-28, for the 4th Annual Pega Collaborative Healthcare Summit to hear from Pega customers, partners and other healthcare experts who have already started down this transformation path.. Listen to those who have improved their billing, provider credentialing and letter generation and content management to drive huge savings and improved service. Discover where Pega technology has streamlined operations, helped organizations become more agile, and can highlight what you should target as your next modernization initiative.