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Health Insurance Industry Struggles to Update Legacy IT Infrastructure

Health insurance legacy IT infrastructure was designed for transactions centered around claims, not for a consumer-engaged environment, observed Beth O’Rorke, chief information officer and senior vice president at Blue Cross Blue Shield of Massachusetts.

health IT infrastructure

Source: Getty Images

By Fred Donovan

- Health insurance legacy IT infrastructure was designed for transactions centered around claims, not for a consumer-engaged environment, observed Beth O’Rorke, chief information officer and senior vice president at Blue Cross Blue Shield of Massachusetts.*

Moving to a consumer-engaged environment requires different IT systems to unlock data and make a difference to the healthcare consumer, O’Rorke told a session at the MIT Sloan CIO Symposium held in Cambridge May 22.

Understanding the patient in the middle is very different in healthcare compared to retail. Data is distributed, and there are a lot of legacy systems that are unsupported, she explained.

When O’Rorke joined BCBS in 2015, “we created an enterprise architecture and roadmap with a focus on security because our industry was on high alert due to breaches at some other companies,” she said. “We had to figure out how to boost our security, which means our applications patching, critical things like that.”

“Then we had to figure out how to streamline our business. The legacy systems were all hard-wired around transactions. We had to rethink our business model. When I started, it was all about data and analytics and digitization. That is the journey we are on now to unlock what we need to do as a business from a healthcare perspective and our broader ecosystem,” O’Rorke said.

Talk to Business Leaders about IT Needs in Their Terms

READ MORE: AHA: Medical Device Makers Falling Short on Securing Legacy Devices

Jean Kneisler, vice president and chief informational officer at medical device maker Nypro, said that her company looked at the technology enablers that drive the business outcomes in updating its IT infrastructure.

“We needed to talk in business terms about how we wanted to take the business leaders along the digital journey. We had to start thinking about core systems, factory of the future, our back office, our digital workplace, and analytics,” Kneisler told the session.

“Once we started talking to them in those terms, we were able to have conversations that allowed us to align together and helped the budget discussion go much better,” she said.

Kneisler stressed that while undertaking the digital journey is important for the future of the company, taking care of the IT basics is also vital because the business leaders expect things to stay up and running.

“When plants shut down because we have a network outage or because we have a VM farm that falls over, that’s millions of dollars because we send people home,” she said.

“Being brilliant at the basics is key because that allows us to sit at the table and have the conversions around where we are going next,” Kneisler noted.

“Four years ago, we decided to adopt cloud first … We are never going to be 100 percent in the cloud. If you think about shop floor lines, where milliseconds are at stake, we can’t handle the latency. Not yet,” she said.

“The business is understanding it and buying into it. They see the improvements in what we are doing. If we are going to talk to them about shop floor automation, IoT, and big data, we have to go back to the outcomes and that allows us to have the platform conversation,” she said.

Platform Conversation Is Critical To IT Infrastructure Update

O’Rorke said that the platform conversation at her company is also becoming crucial.

“The platform needs to be optimized and the data unlocked, but you need to have an isolation layer or an integration layer that then allows you to engage in a different way with members, giving them access to care when they need it. Without the basics, you can’t have any conversation. So if you are having production challenges, you should make sure you settle those down,” O’Rorke said.

“The conversation about where you should go is really about understanding where you want to go as a company, what you are trying to achieve, how do you create a nimble architecture,” she said.

“Right now, healthcare is behind in IT, but we can jump over a lot of things. With innovation, we are going to be part of bigger ecosystems and be able to play in many ways. We need to be able to be flexible and nimble. That is the architecture we need to put in place, but we also need to enable the core business,” she said.

O’Rorke said that once her company got the technology roadmap in place, it had to come back to the people and the behaviors that needed to change.

“What you expect out of a more flexible, agile, and nimble architecture you want that in your people as well. That is something that is new for us,” she said.

“From the standpoint of changing your culture, to meet where the business needs to go is a must. I underestimated that. It is the softer stuff that is hard to measure,” she added.

O’Rorke said that her company takes a “cloud opportunistic” approach to cloud computing. “When does it make sense to go to the cloud? What is the profile of the applications and the workload that makes sense to be on-prem or in the cloud or buy a SaaS solution? We have a pragmatic approach to the cloud,” she concluded.

* This article has been updated to correct the spelling of Beth O'Rorke's name.