CHALLENGE: The Payer Systems Mess
Running a payer business is getting more complex with everything from payment models to measuring quality rapidly changing; all intra-company functions are increasingly interrelated and time sensitive; tight and speedy integration with external partners and patients has become an imperative.
Point solutions, home-grown tools and desperately trying to acquire and move data to where it is needed (an exercise in futility) have been the only way to tackle any problem. Conventional wisdom points us to ‘innovation’ and analytics to solve point problems. But the problems persist while inadvertently and inevitably driving up IT complexity with increasing operations and IT costs. It is not for a lack of ideas or lack of trying, however. It is about execution.
The reality is that it doesn’t matter how innovative or fast a tool or technology is if it doesn’t do two things at the same time:
- It solves the problem it aims to address AND
- It does not add to overall complexity and cost
What needs to be resolved is the COMPLEXITY PARADOX: payer software needs to get radically simpler AND much more capable to support a business that is growing increasingly demanding and complex.
In healthcare today, we hear a lot about amazing innovations, from AI to drug andgene therapies to software solutions. These innovations are pushing the boundaries of the possible. In other words, they are raising the ceiling. However, that ceiling is typically only raised for the very few who have an elevated platform, be it financially or operationally. For the vast majority of patients, but also for providers and payer organizations, we need to operate on the floor. The ground level of what is available and affordable. And therefore, profound and lasting impact only happens when we raise the floor.
Applied to healthcare IT, this means that core functionality and data availability is reliable, instant, accurate, secure, scalable and automated wherever possible. It doesn’t matter that some capabilities (e.g. analytics) are bleeding edge (the ‘ceiling’). If one or more of these functions cannot operate as needed, the entire operation often gets dragged down to that lowest common denominator: the floor.
Only when we raise the floor far enough can the entire organization perform the way the business demands and the stakeholders deserve. In the health insurance industry, raising the floor means running ALL company functions on ONE software platform – thus resolving the COMPLEXITY PARADOX
THE PLATFORM: Technology has Potential – a Platform Realizes it
Everyone in the healthcare insurance industry understands that the many functions a payer organization needs to manage today are highly interrelated – and painfully aware just how disconnected information and systems are, and the frustrating limitations that brings with it.
The ONLY solution to this mess is an integrated, mature software platform that not only integrates data but also allows everyone on the organization to collaborate and execute their roles efficiently.
We are building exactly that platform. It meets the core requirements to be able to raise the floor:
- has a module for each function/department
- incorporates complete feature sets and best practices in each module
- ensures all modules work together seamlessly
- Works seamlessly off one shared data set that leverages interoperability with external stakeholders
So that platform defines where we want to take payer system. We know where we want to end up. But how do we get there from where we are in today?
The X-Factor: HOW to get there
Of course, transitioning to that platform can’t be a ‘out with the old, in with the new’ approach – it needs to gradual, diligent and smooth while the result needs to be revolutionary. It is perhaps the most difficult and hardest to get right.
We know how to get that platform to market with a unique approach. It’s not a straight line. We have already mapped out the path.
THE FOUNDING TEAM:
Experience, Vision and Execution
The four co-founders are among the most senior and experienced leaders in healthcare IT today. They understand the payer business extremely well and have been in senior executive roles including CEO, CRO, CPO, CTO, CSO with a deep understanding of payer and IT/SaaS operations and how to scale them, legislation, regulations and standards; technology and software product development, M&A and working with Venture Capital and Private Equity firms – a unique combination of skills and experience in one cohesive team that is needed to make the Rebus platform a reality.
In addition to the executive team, RHS has established a large group of top industry advisors who will guide the company on an ongoing basis.
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