With the state of healthcare, an understanding of healthcare finance and risk management is crucial to creating a flexible software as a service (SaaS) platform, one that TPAs can actually use to improve outcomes—and afford in the first place.
When you look at risk management, you’re trying to identify things that may drive costs or members that may drive high utilization in the future. To identify those components, you need data—the critical component for risk management to work in this space. Most TPAs work with data from multiple sources, from providers to patients, meaning there’s a lot of data to unpack. Without the support of that, you may as well be wandering around blind.
And you don’t just need data. Outdated data is not only ineffective, but it can give you an inaccurate picture of claims if it’s far enough out of date. Real time data is crucial for reliable, actionable insights. Sharing that real-time data with third parties who specialize in care coordination, member management, disease management, and more is just as important as having any data in the first place. Timeliness is key.
Another key component? Scalability, which you need to support growth. Another advantage of SaaS is that cost scales up and down, in synch with the business and TPA. This allows you to avoid high costs associated with a low number of lives. Additionally, IPS can implement features and updates across all clients, rather than just a client-by-client basis. This not only saves you time, but also money, as this allows the cost of features and updates to be spread across the entire client base, instead of each TPA paying for those features themselves.
This brings us to the technology itself. New technology is being introduced to the market constantly, especially when it comes to AI. It makes sense to want the best tech for your platform, but tech comes at a price. Having the best tech if it isn’t affordable isn’t a solution—it’s another problem. For TPAs competing in a low margin marketplace, tech like AI needs to be within a reasonable price range.
Regardless of where you stand on new technology, the reality is that modern TPAs are in the tech business, whether they like it or not. The question is, how do you move forward with that?
At IPS, we’ve made an effort to serve as one solution. IPS started from the ground and went up, using Salesforce and cloud computing as a kind of cornerstone. This allowed me to incorporate my own understanding of healthcare finance and risk management, resulting in the creation of a flexible SaaS platform that allows TPAs to keep up with tech while still keeping costs under control.
It's not an all-around solution, and it doesn’t exactly fix the broken healthcare system, but in my experience, that’s an impossible goal in and of itself. Instead, we need to focus on one or two pieces at a time, making the healthcare system incrementally better instead of promising the revolutionize the entire system at once. We’re not tilting at windmills here like a modern-day Don Quixote—we’re improving things one step at a time. And today, that’s building a SaaS platform that withstands the future.
