Some of the mid-size companies are okay at this; but the low-end guys are very, very unsophisticated (there are a lot of local / state plans as mandated by various state laws) and the super-big guys just have so much stuff they have no idea how to integrate it all. Think 15-20 different, incompatible claims systems with overlapping numbering schemes, different versions of schema, different versions of underlying DB required, etc. Then do the same with provider management systems, contracting systems, etc. You get the point.
By the time you get halfway through scoping out a project, the architecture will be obsolete. Oh and also the federal government keeps changing the rules about ICD-10, ACA, Medicare reimbursement, and a whole bunch of other stuff, so make sure you add in that capability to all existing systems and don't get sanctioned. A lot of companies are having a hard time keeping their heads above water.
The big guys are going to eat the data-hungry guys. Or rather, the big guys will buy the best of the new data-first health plans (Clover, Oscar, etc.) for their platforms and migrate everything onto them.
Some of the mid-size companies are okay at this; but the low-end guys are very, very unsophisticated (there are a lot of local / state plans as mandated by various state laws) and the super-big guys just have so much stuff they have no idea how to integrate it all. Think 15-20 different, incompatible claims systems with overlapping numbering schemes, different versions of schema, different versions of underlying DB required, etc. Then do the same with provider management systems, contracting systems, etc. You get the point.
By the time you get halfway through scoping out a project, the architecture will be obsolete. Oh and also the federal government keeps changing the rules about ICD-10, ACA, Medicare reimbursement, and a whole bunch of other stuff, so make sure you add in that capability to all existing systems and don't get sanctioned. A lot of companies are having a hard time keeping their heads above water.
The big guys are going to eat the data-hungry guys. Or rather, the big guys will buy the best of the new data-first health plans (Clover, Oscar, etc.) for their platforms and migrate everything onto them.