I recently shared some advice with Health Plan Week about how to drive improvements in payers’ claims processing and core administrative processes

“A decade or so ago when you talked to a potential customer, it was about your functional requirements or the functionality that your system brought to bear. That’s still important but it seems the conversation nowadays is more on, ‘Tell me about your technology and your architecture. Tell me about how I can extend your platform to communicate with a care coordination system to coordinate with this much longer ecosystem of solutions.’” –Keith Vargo, Vice-President of Sales, Marketing, and Strategic Relationships

Value-based care, regulatory drivers, and user experience (UX)

I recently spoke to Health Plan Week about PLEXIS’ experience driving cost-saving improvements for payers by monitoring user experience (UX) and enhancing the automation of our industry-leading technology stack.

The June 13, 2016, article, “Increased Automation, Communication Drive Improvements in Back-Office Results,” describes several important industry trends. First, as the healthcare industry continues its transition to value-based care it is increasingly leveraging big data and data analytics to improve claims processing and other core administrative processes.

Secondly, regulatory requirements are increasingly driving payers toward technology transformations. The article reports that new regulations “are pressuring insurers to improve their data systems, but at the same time giving them the opportunity to increase quality.” At PLEXIS we like to emphasize the potential ROI and cost-savings behind this golden opportunity. The cost of compliance is replacing the enterprise core administrative platform. However, when a payer adopts the open architecture of the PLEXIS platform there is also the assurance that this technology was built to grow with them. The improved quality translates into everyday savings on the cost of operating business much more efficiently.

Finally, I talk about UX and the modern imperative for technology vendors to build user-friendly interfaces. Thanks to the era of social media, users expect to be able to operate a claims platform with a user experience that’s comparable to what they’re seeing in other aspects of their lives. The article discusses how Capital BlueCross utilizes a “feedback loop” to stay abreast of the needs of front-line staff. PLEXIS, too, significantly improves UX by maintaining a consistent dialogue about what end users need to get their job done more accurately and efficiently. As a result, we see payers reducing costs and improving the quality of their service offerings.

To read the entire article, please visit our resource, Increased Automation, Communication Drive Improvements in Back-Office Results