Claims Systems - Build vs. Finance?

As Advalent’s new CEO, former CTO of one of the largest telehealth companies, and Founder and CEO of one of the early EMR companies, I have had many conversations with health plans about the pressure to build and/or finance claims administration systems. I then see some of these same plans experiencing compliance issues, MLR challenges and problems meeting enrollment and retention expectations. These plans, if not building systems themselves, are actually financing solutions that are not built with the latest technology, nor are they complete end-to-end solutions. They still require add-on portals for enrollment, billing, risk, quality and submissions, as well as costly UM/CM/DM solutions.

As an experienced technologist, it is mind-boggling to hear about plans who finance implementations of a purported next generation or “future proofed” claims system, yet still have to bolt on other supporting systems for Medicare Enrollment, Risk Adjustment, HEDIS or Submissions, etc. Today’s technology should not require financing 9 to 12 month implementations in the era of cloud and open source architecture, then offer little more than iPhone® like icons. Transformative administrative solutions are nimble, highly cost-effective and should address all your lines of business without question–whether the reimbursement model is value-based or traditional fee for service. Additionally, they should have built-in experience views, not bolt on “portals”. I am deeply concerned that in our industry “transformative” still equates to requiring portals and bolt on solutions focused on a single line of business and “next generation” requires creative financing, or as in a few plans’ viewpoint spending 100s of millions to build their next generation. I am challenging our industry to do better.

Future proof technologies embrace open source, cloud architecture and nurtures an ecosystem that includes the integration of technology across many spectrums like in-home services, telehealth, EMRs omni-channel digital communications all driven by real-time experience views which can be tailored to that member or provider or group administrator. Future proofing should eliminate the need for 4 of 5 vendors, create a best of breed integrated administrative and clinical ecosystem and reduce your total cost of ownership. At Advalent, we are committed to bringing health plans affordable and long-lasting technology that adapts with you and your changing business needs, without large incremental costs. Our solution delivers real software as a service and includes all of the above and more. In fact, we can enable true provider transparency into new value-based and ACO payment models supported by administrative systems, medical management and risk and quality solutions.

Advalent is a single, unified data model, which enables transparency to all plan stakeholders and networked providers, so everyone sees the same data and the same views in real time, if required. Our solution is cost effective, modular, self-service, innovative and the true next generation. Keep in mind, industry analysts and consultants usually only present “future proof” from their perspective and mainly from vendors who can afford to contract with them. So, most payers don’t see what the real future looks like until it’s probably too late.  Don’t wait until it’s too late for your plan.

- Brian Lichtlin, Advalent CEO