Technology Transition Decision Tools for Insourcing Payer Business Unit

More and more organizations are using outsourcing, insourcing, mergers, and acquisitions to achieve their business objectives. But what’s the best approach to making decisions around transitioning various technologies, applications, and assets into the new arrangement? This large health plan needed to insource a business unit and we created a methodology that they can use to make repeatable decisions about what to keep, replace, or build as they take back the operations of a state-based business unit.

One of the nation’s largest health insurers had decided to insource the operations of one of its state’s Medicare and Medicaid agency line of business from its current management entity and form a new Medicaid Business Unit (MBU). As part of this transition, the software applications supporting operations will be migrated over a runout period. 

The first software application that required migration was the plan’s public facing website – their hub for sales, service, and member engagement. And, because the website did not meet the payer’s future technology standards, the site needed to be re-implemented in a new, supported technology.

SDLC Partners acted as a technology intermediary between the health plan and its service provider to enable the insourcing plan. We conducted interviews with stakeholders from both sides, performed content and technical reviews of the current website, and evaluated business, technical, and compliance needs to determine the best solution options for transitioning the website back to the client.  

We used a four-phase approach to create a reusable framework that could guide the transition of the website, but of every technology or software asset as part of the insourcing initiative:  

We created and used a comprehensive scorecard methodology to determine the most optimum solution that aligned to their business objectives. These results formed the basis for our recommendations to the client. 

Our process considered four sources of information (see Figure 1), when analyzed through the scorecard methodology, to create three options (see Figure 2). These inputs also included the voice of business stakeholders along with technical requirements, as well as their current state capabilities. 

– Option Green: Custom–build, leveraging seasoned vendor
– Option Blue: Develop on top of client’s technology stack/solution
– Option Red: Continue using outsourced vendor’s solution 

The scorecard methodology, based on the four data inputs yielded scores within eight evaluation categories (see Figure 3) that were included as part of the analysis. The final score (see Figure 4) pointed to Option Green as the best solution for the client. The client agreed with our recommendation and decided that a custom build solution would best fit their needs based on our analysis.

The recommended solution can be implemented in 10 weeks and will entail recreating all components in an Adobe Experience Manager (AEM) solution and will be hosted by the client. This solution is also attractive because it meets the client’s high technical standards, has minimal content life cycle costs, and uses a proven, “best of class” content management system for workflow management.

If your organization is planning a merger, acquisition, outsourcing, or insourcing project and need a partner who can provide repeatable and reliable guidance, methodologies, and tools to make the best IT technology transition decisions, we can help. 

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