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Five Principles to Leveraging Benefit Administration Technology to Succeed During Reform

By Mike Lessila 

SKYGENUSA Powering Healthcare for the Digital Age


Well, no one said healthcare reform via the Affordable Care Act (ACA) would be easy. In fact, it’s proven to be quite painful at times as healthcare payers scramble to realign their organizations to accommodate an entirely different way of working without disrupting their current business.

One thing that has become abundantly clear since the Exchanges first launched on October 1, 2013, is that legacy systems simply are not equipped to administer the challenging new world of healthcare reform, where payers are working with large numbers of individuals rather than managing members in bulk. Because of this massive shift toward consumerization in healthcare and no shortage of other changes on the horizon, the pathway to future success for payers must include the adoption of world-class benefit management software. It is the best, most expedient way for payers to reduce the costs of delivering benefits, maximize transparency and achieve compliance.

Yet it’s no secret that moving from old legacy systems to new software platforms can be risky. Business books are filled with stories of well-intentioned technology upgrades that went bad. Very bad.

To help you avoid becoming someone else’s cautionary tale, here are five best practices that can help you leverage new benefit technology while reducing your risk. All have been proven across more than 20 years of successful implementations. 

  1. Choose a technology partner who knows your business. A technology solution that is not designed specifically for your business, such as a dental payer trying to force-fit an administrative platform designed for medical benefits, creates a tremendous amount of risk. Dental and vision payers (among others) need specific functionality – terminology, procedure codes, web portals, business rules, processes, dashboards, etc. – to operate effectively. Don’t waste time trying to educate a technology provider on the nuances of what you do. Instead, select a partner who already understands it. 
  2. Embrace technology to achieve automation. Manual processes are a huge impediment to thriving in the era of healthcare reform. The large expected influx of new members alone can have a significant impact on payer efficiency; if you gain 100,000 members, and each has just 10 transactions throughout the year, that is 1 million additional transactions that must be processed. Automating normal functions allows payers to use technology to handle the day-to-day and people to manage the exceptions only, improving accuracy and expediting processing in order to increase member satisfaction. All while reducing overhead. It’s a win all the way around.
  3. Require clear visibility of your key performance metrics. The information to determine the organization’s performance may be available in legacy systems. But if it’s difficult to find and access it has very little value. Be sure your new technology allows you to build customizable dashboards that enable executives and managers to see what’s most important to them (and the business) instantly, and have the ability to filter reports as needed. The metrics should be presented in a way that enhances understanding – and spurs action when required. 
  4. Enable users to configure software without the need to engage IT resources. This is huge, especially in the fast-moving and highly competitive world of healthcare reform. The IT department at most payers is over-burdened. It can take weeks for even a simple business user query or other request to make its way through the queue – by which time the situation may have changed completely. Giving users the ability to build queries or dashboards, or configure their software, helps the organization get to answers faster while allowing IT to focus on the high-value areas that deliver benefits across the organization. 
  5. Insist on flexible and scalable technology for seamless expansion and customization over time. Healthcare reform is anything but static right now, and given that it is as much political as it is healthcare-oriented it is likely to remain volatile for many years to come. Payers should select benefit technology that scales easily to meet demand, and provides the flexibility required to keep up with ever-changing rules, regulations, legislative amendments and organizational requirements. It’s your best protection against getting stuck with yesterday’s technology. 

That has been our experience. What is yours? What have you done to try to leverage your benefit management technology more effectively? Let us know what’s worked – and what hasn’t.


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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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