Health plan executive leadership recognizes the need to invest in technology to remain viable in 2023 and beyond. Composability allows you to adapt to shifting industry needs and maintain market shares.
Issuers continue to move toward composable, modular solutions while simultaneously reinventing preexisting, monolithic platforms. Composable solutions enable enterprise data center operators to leverage the many cost and availability benefits of cloud computing solutions using on-premises networking equipment.
Composable disaggregated infrastructure (CDI), sometimes stylized composable/disaggregated infrastructure, is a business mindset that allows organizations to innovate and adapt to changing business needs quickly. When the health insurance industry utilizes the term composable, it encompasses a mindset, technology, and processes that encourage change-on-the-fly capabilities in response to the evolving requirements within their environments.
Hardcoded technology proves to be unadaptable and difficult, if not unfeasible, to modify. When expanding platform offerings, the right solution should have the ability to integrate with legacy, new, and future systems alike.
Advantages for Switching to Composable Solutions – Business Agility, Cost Reductions, AI-Powered Automation, Effectuation Rates, and Member Retention
Composability directly correlates with relative performance according to Gartner, Inc. The CIO Agenda: Create an Action Plan to Master Business Composability surveyed 2,387 CIOs and technology executives and found that companies with high composability experienced superior business performance compared to those with a low level of composability.
Improved business performance can be attributed to a multitude of factors, including an increase in business agility, reduced costs, further automation, and improved effectuation and retention rates.
Business Agility Allows Health Plans to Adapt to Shifting Regulations and Reduce Costs
Building a platform with interchangeable building blocks allows health plans to modify infrastructure and business capabilities quickly and efficiently.
Increased flexibility allows health plans to capitalize on changes within the market and adjust to meet shifting regulations. Avoiding frequent infrastructure overhauls reduces administrative and technology overhead, freeing resources to pursue new opportunities and markets with relative ease. Cost-effective private cloud techniques eliminate the need for costly system overhauls and modifications.
Automation Encourages Data Transfer and Cross-Platform Communication
The composable architecture approach breaks down the traditional silos of computing, storage, and networking. Automation of communication allows composable solutions to seamlessly work together while conveying member information. For example, integrated reporting grant greater insight into the member journey, including enrollment, financial management, and retention efforts. Once a collection of disconnected processes, an interconnected web of composable solutions provides a holistic view of the complete member journey through automatic data exchange and cataloging.
The need for seamless member data transfer continues to grow for health plan issuers. Alongside other advancements such as edge computing, the Internet of Things (IoT), artificial intelligence (AI), and machine learning (ML), composable solutions provide a reduction in operating expenses.
Effectuation and Retention Rates Improve Alongside Composability Efforts
Inherent flexibility and scalability allow for rapid membership growth. Composability, and the automation that naturally follows suit, allows for the quick implementation of customer facing solutions. Rapidly responding to the demands of members and effortlessly adapting to shifting market trends benefits both effectuation and retention rates.
Know what Your (In)Composable Problems Are — And Prioritize Composability When Shopping Solutions
Assessing current system limitations and collaborating with technology partners leads to a personalized composability solution.
Requests for information (RFIs) allow health plans to gain a deeper understanding of the steps required to fix current issues while investigating potential partners. Start the process by identifying internal pain points that arose due current system restraints.
Common struggles health plans aim to solve with the composable solutions model include the:
- Inability to scale operations to raising enrollment rates.
- Resources spent trying to rapidly meet changing regulations.
- Lack of communication and data transfer between different solutions.
- Failure to capitalize on expanding markets due to limited flexibility.
Lean on the support and suggestions of trusted advisors who have a clear understanding of the goal of this transition from internally devised pain points. An effective composability plans often arises from the collaboration between internal stakeholders, industry experts, and technology vendors. Be open to alternative but proven solutions that better rectify current issues.
Pay Special Attention to Master Data Management as You Grow and Expand; Increasing Composability Requires It
Businesses’ composability efforts lie on a spectrum. Those further along in the process see more significant performance improvements.
Those just beginning their journey to composability should identify pre-existing integration points that would result and the highest return on investment. Constructing and executing a master data management strategy based on composability would be an effective first step.
Health plans often report struggling with the intake in management of various member information, especially during the open-enrollment period. With various IDs correlated to different aspects of a member’s policy, health plans can struggle with managing them all. And if your plan expands into multiple states, make sure you avoid this issue: The same Exchange-provided IDs can get assigned to different members in different states. If a health plan provides plans to multiple states, two members from different states may possess the same ID. Health plans must identify and have a strategy in place to effectively mitigate confusing overlaps beyond relying on a single ID for member identification.
Composability can resolve potential member identification issues by integrating all member records and basing identification on a variety of factors, including a unique claims system ID. Universal member matching rules would eliminate data discrepancies and prevent reconciliation issues.
Identify how your health plan has already invested in a composable mindset and current needs to determine the next step towards composability.
Learn more about how to select an accredited technology partner by downloading Softheon’s Marketplace Shopping, Enrollment, and Billing RFP Guide for Health Plans.