Does the thought of upgrading your enterprise systems daunt you? You are not alone. According to Gartner, enterprise software upgrades can cost an average of 30 percent of the original software installation price, take months, even a year to complete, and require meticulous planning.

"Technology allows people to connect anytime, anywhere, to anyone from almost any device. This is dramatically changing the way we work, facilitating 24/7 collaboration with colleagues dispersed across time zones, countries, and continents." – Michael Dell

For the healthcare industry, it's evident that the cloud is here to stay. Managed Care Organizations (MCOs) are no longer trying to determine whether the cloud is right for them. Instead, the conversation has evolved to determine how best to leverage the cloud to meet their organization's strategic goals. The cloud has proven to be an effective tool, but there are a few avenues for MCOs to maximize this resource better and achieve their desired outcomes.

API Management is a critical component of the payer’s FHIR infrastructure. It helps in fulfilling the security requirements of the CMS mandate and business services integration requirements to orchestrate with enterprise systems and services. Further, effective management helps you comply with the security requirements for monitoring, reporting, and managing access to the FHIR resources by external stakeholders, including third-party apps and health plans. We will briefly touch upon how this API management functionality is implemented within Sagitec’s HealFHIR in this blog.

When the global Coronavirus pandemic hit the U.S. economy in early 2020, the U.S. unemployment rate spiked. New legislation complicated benefits distribution as new systems, new business rules, and new processes were stood up at a moment's notice to deal with the crisis. Of course, one objective for all Sagitec's customers was performance—we needed to serve the hundreds of thousands of people accessing our applications every day.

For Medicaid plans, there has been a shift in the way members communicate. With a clear preference for texting over calls, it’s important to align with this preference. Further, SMS is an efficient channel of communication and can help your organization serve more members while improving quality. Whether it’s being used to send informational messages and reminders to the members, the benefits are numerous.

ALM tools are the ‘source of truth’ through the software development lifecycle to update all stakeholders in real-time. These tools manage requirements, acceptance criteria, documentation, test cases, problem incident reports (PIRs) – bringing processes, and people together.

Bill Gates once said, “Business will change in the next ten years more than it has changed in the last fifty years.” Technology is changing so rapidly today that it will be even faster tomorrow.

Since the pandemic, State Workforce Agencies (SWAs) have been moving toward online solutions and call center services. However, these approaches could not meet the demand generated by the pandemic. Interactive Voice Response (IVR) systems were challenged under increased load. This led to SWA’s searching for ways to increase customer service during these unprecedented times.

CMS Interoperability compliance is a long-term journey for Payers. IT systems and processes not only have to be realigned to meet the requirements of the new mandate but also must be nimble enough to adapt quickly to changing business models as patient adoption increases. To best meet these demands, payers should focus on putting together an FHIR infrastructure that complies with the mandate and provision it to extend and scale as the mandate as patient adoption evolves.