The IT systems of the statutory health insurance funds not only support staff in managing statutory and compulsory benefits. Insured persons also interact with these systems via the Internet. They should therefore combine security, efficiency and flexibility with an appealing user experience.
To achieve this, the presentation of the range of services on the website or in apps must follow a representative customer journey rather than following the structure of the Social Code. In addition, the offering must keep pace with changes in the legal framework, industry standards and demand.
But how can all these requirements be met when numerous external IT providers are involved in providing the service? How do health insurers keep track of the capacity, quality, costs and security of their IT services? Which health insurance service incurs which costs? How can the total costs of a service be allocated fairly and correctly to its internal and external sources? And what tools can the health insurance funds use to integrate their IT partners into the range of services without compromising on flexibility?
Allocate and reduce costs
The answer to such questions is professional IT service management (ITSM). It enables the constantly growing complexity of managing internal and external IT contributions to fund services to be mastered. And because external resources are increasingly coming from the cloud, i.e. from distributed systems, a clear division of responsibility between the health insurance fund and the providers is more important than ever. ITSM provides health insurance companies with a complete overview of the internal and external IT resources of the core business, supports their integration and management, including the search for alternatives and the reallocation of tasks. Consileon offers an industry-specific approach to the introduction of ITSM that has been tried and tested over many years. This is also suitable for healthcare organisations such as hospitals or laboratories. Our approach is divided into four phases.
1. Business process analysis and structuring in business services
First of all, the health insurance company’s complex and diverse business processes are professionally analysed, structured and combined into so-called business services. In this early step, care must be taken to ensure that the business processes assigned to a business service place similar demands on the IT infrastructure. To achieve this, a meta perspective must be adopted in order to identify processes with similar requirements across departmental boundaries and assign them to the business services. Care must be taken to ensure that the structure can continue to evolve. An overview of clearly defined business services reduces the complexity of business process requirements.
2. Alignment of IT with business services
After the processes, the technology is put to the test. As the technical counterpart to the business services from phase 1, we network internal and external infrastructure elements such as platforms, apps and services to create overlap-free IT services. Ideally, each IT service should consist of resources from a single provider so that they can be cancelled separately.
3. Allocation of IT resources to cash register services
In the third step, we map the IT services to the business services in a bidirectional matrix. The matrix shows which business service requests which IT service and vice versa: Which service flows into which service? Depending on the IT history, this overview can be quite complex. However, the hard work is worth it because the health insurance company regains control over its IT, becomes less dependent on individual service providers and can better allocate IT costs to the functional areas based on the overview. The transparency of the services and their sources also strengthens the position of the health insurance fund when negotiating, applying and adapting framework agreements (service level agreements, SLAs) with external IT providers.
4. Automation and optimisation
Once IT service management is established in day-to-day business, it makes sense to automate the procurement of services from external and internal sources. Relevant tools make it easier to comply with legal regulations, global standards and internal IT governance requirements.
At your side
Professional ITSM helps health insurance companies to allocate their IT costs to internal and external sources, avoid bottlenecks and redundancies and reduce expenditure. We provide you with advice and support in the planning, introduction, automation, optimisation and further development of this area of activity. This also extends to the selection and procurement of software that optimally supports the change in tasks and fits in with the corporate culture.
