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Disruptive Benefit Management Software: Red Flags That Show It’s Time for a Change

By Mike Lessila 

SKYGENUSA Powering Healthcare for the Digital Age


I think we can all agree that most people don’t like change. Change is hard. It gets us out of our comfort zones. It introduces uncertainty and risk.

Yet it’s often necessary, especially in business. Solutions designed for the marketplace of 30 years ago don’t always translate to the realities of today.

This is a dilemma many healthcare payers are now facing with their benefit management systems – especially for ancillary benefits such as dental and vision. Software developed for large mainframes or AS400 systems have served their owners well for many years. But it may no longer meet the requirements of today’s business users –and customers.

Making the decision to disrupt the business and replace an aging but reliable benefit management system with a more modern one doesn’t come easily. There are a lot of sunk costs in the old system, not to mention careers on the line. It’s analogous to a heart transplant: most organizations will look for any justification not to do it, and even when they know they should, they will do everything they can to try and put it off until it’s absolutely necessary.

So how do you know it’s time? Here are a few red flags:


  1. Your benefit management software is not set up for individual purchasers. One of the biggest changes on the payer landscape has been the Affordable Care Act (ACA). When the old mainframes were implemented, most payers worked almost exclusively with groups, i.e., one invoice would cover the premium payments for dozens, hundreds or thousands of employees. Thanks to the ACA, millions of individuals are now purchasing health insurance directly through a multitude of Exchanges. This means payers must now manage the benefits of those individuals one at a time. Since the group market is essentially static, the growth opportunity for insurers is largely being driven by the ACA. If your benefits management software can’t handle individuals, it’s time for a change.  
  2. IT can’t deliver what sales needs. The health insurance market has become far more dynamic, with consumers demanding configurations that change on a daily basis. Sales needs to react quickly to remain competitive. But before they can sell a new product, the organization has to ensure it can administer the benefits. You can no longer afford to wait four to six months for IT to work through the issues to bring a new product to market. You need to give business users the ability to configure new products so they can be tested and introduced within a couple weeks or in some instances days of the request.
  3. Your systems are not designed for the purpose. It is not uncommon for payers looking to offer ancillary benefits such as dental and vision to try to adapt software designed for medical benefits to these areas. The result is rarely sufficient.  You want software that is specifically designed for the purpose, with the right codes and terminology already available – and without paying for a lot of extra features that don’t apply.
  4. Your systems are not consumer-friendly. When we go to conferences, a good 75% of the discussion is around the importance of payers making their systems more consumer-friendly. This is an expectation driven by our customers’ daily encounters with retailers, banks, consumer technology companies and every other business they access online. Client, provider, and member portals with intuitive interfaces and navigation are a must. So is presenting information in a way that is easy to consume, especially when approaching individuals who may not have much insurance literacy. That can be tough to accomplish if your systems are based on green screen command lines.  
  5. You can’t get good reports. It can be difficult for business users to gather valuable data and reporting from old mainframe systems – especially if they are hard-coded. Users don’t have time to wait months for IT to write new reports. They need immediate access to dynamic information they can parse and change themselves by pointing and clicking to help them make decisions on a daily basis. 
  6. Users have to schedule training. With old mainframe systems, internal training is generally a separate, formal activity that needs to be scheduled one or two weeks in advance. Disruptive benefit management software can incorporate training dynamically, offering direct access to self-training documents and videos that help users get answers fast in order to remain more productive.
  7. You’re struggling to find people to work on them. The Baby Boomers who built those systems are retiring in large numbers, and only a handful of colleges are still training students in mainframe technology. It’s a tide that won’t turn back. Best to make the move before there’s no one left who knows those systems.

Making the change


If any of those red flags sound like your organization, it’s time for a change. But to what? After all, this is a career decision that potentially could affect the organization for the next 30-40 years. Not to mention your own employment.

The first thing you want to look for is a company that has extensive experience in the areas you’re looking to improve. Sure you could try building it yourself again.  

But why would you when there are proven benefits administration software and outsourcing options that can take you from the back of the line in technology to the front in just a few weeks. We should know, because we offer some. We’ve already faced (and solved) the issues you’re starting to look into. Instead of spending time developing systems that already exist, you can redeploy your resources to focus on other areas of your business - such as product development.

While price is important, it shouldn’t be the primary driver. You’re looking for quality and effectiveness first, then price to deliver value. Think of it this way: if you need to select a heart surgeon, will you want one who has been successful first and foremost, or the cheapest one? You always want to keep the long term in mind.

Finally, you’ll want to work a partner who understands the value of good communication throughout the process. They should be able to show you a core strategy that has proven successful while having the ability to tailor it to your unique needs. Change management should be an integral part of that plan. You don’t want to just throw new technology out there. You want to be sure the transition is seamless for your employees as well as your providers and members.

Now it’s your turn. Did I miss any red flags? What has your experience been in trying to teach old technologies new tricks? How have you minimized the disruption of disruptive technologies?

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Mike Lessila


As Director of Credentialing Services, Mike Lessila is responsible for all of SKYGEN USA’s credentialing-related services and operations. This includes leading the internal credentialing function, working on growth strategies to increase the Credentialing Services provided to clients and managing SKYGEN USA’s Credentialing Service Hub and its rapid growth in the industry.

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