Technology debt is the cost of maintaining legacy software systems over time, often built in hard code. Updates and workarounds are expensive and the process for implementation is slow, but there's also the opportunity cost, business goals and timelines to consider. In order to adapt to the fast-paced landscape of today's health plan operations, plans need to be nimble and adaptable to change to stay competitive.

There are tool sets in the cloud that allow for innovation of processes, software products, and the ability to scale which wasn't previously available. There are many different ways to leverage the cloud and a spectrum of what it means to be cloud-native. Infrastructure as a Service (IaaS) takes all the same servers, infrastructure, and architecture that's in place today, keeps it in-tact and runs it virtually in the cloud. For many this has a lot of benefits, scales, and can be optimized. The next step in the evolution on the spectrum is Platform as a Service (PaaS). This gets rid of the limitation of having the infrastructure and architecture lifted into the cloud and it builds an infrastructure through code by leveraging the cloud-native storage, tools, and technology as the platform itself for software services, products and applications—allowing for greater innovation capacity. PaaS allows for quick scaling, up or down,  enhanced automation and connectivity between development pipelines, heightened security, API management, governance and toolsets. Beyond the cloud's abundant flexibility, speed and configurability, it's a more cost-effective environment.

Host: Welcome to Episode 8, The Technology Debt Dilemma—Why Cloud Operations Are Essential. We’re joined today by Larry Moncol, who leads Advantasure’s product software and technology platforms. Welcome, Larry. It’s great to talk with you today.  

Larry: Hey, yeah, it’s great to be here.

Host: Larry, when we talk about the operating infrastructure of health plans and its reliance on technology to expedite processes, scale, and react quickly to regulatory changes or changes in the market. What are some of the challenges plans with legacy systems are facing now?

Larry: You know, not too long ago, the cloud was a scary thing for the healthcare industry. To think about hosting their data, their processing, their services, and servers—they wanted to keep it within their private data centers or managed data centers to maintain ownership of it. But as the cloud has matured over the past decade, there’s been a lot of progress that’s enabled plans and their vendors to release that burden of responsibility. The maintenance of in-house expertise and the management and execution of those data centers. Legacy systems require a lot of capital expenditures and forecasting for computing capacity—you know, in the cloud, there’s monitoring and alerting built in. For example, if we knew we needed to expand capacity for processing computing power, maybe a health plan has new members or users or needs product enhancement. If I’m in a data center, I’ll need to go out and procure additional new servers, new drives, storage arrays, and network gear. At this point, you’d have to procure and incur the expense of new equipment. You’d have to account for the timelines of purchasing, shipping, implementation, configuration, and testing. You know, in the best-case scenario, that’s a few weeks before you can actually do what you need to do to expand. In the cloud, the additional storage and computing power can be turned on within minutes. So now, a several-week process can be collapsed into several minutes through some dashboard configuration changes within your cloud environment. This translates into a quicker change for the health plan and ultimately transfers into less overhead and cost, which trickles down from the vendor to the health plan. But there’s also the opportunity cost to consider; delays put the business goals and timelines at risk. A lot of the legacy systems are built in hard code, so there are a lot of workarounds, and it’s a slow process for that, too.  

Host: That sounds cumbersome. So, how’s the cloud more flexible? You know, what enables things to move so much faster in the cloud?  

Larry: Toolsets in the cloud allow for process innovation, software products, and the ability to scale, which wasn’t previously available. With legacy, an actual data team had to go in there to make adjustments.  

As it relates to the journey of the cloud, there are many different ways to leverage the cloud. There’s a spectrum of what it means to be cloud-native. Essentially, on the front part of that spectrum is Infrastructure as a Service—taking all of the same servers, infrastructure, and architecture that’s in place today, keeping it intact, and then having it run virtually in the cloud. For many, this has a lot of benefits: it scales well, and it can be optimized. The next step in the evolution of this spectrum is a Platform as a Service. This gets rid of the limitation of having the infrastructure and architecture lifted and shifted into the cloud, and it leverages cloud-native storage, tools, and technology, and leverages the cloud itself as a platform for software services, products, and applications. Now, this allows for innovation capabilities and tools that are not possible with Infrastructure as a Service. One of the things PaaS allows for is to scale more quickly—up or down. For example, with the services that Azure offers as PaaS, you’ll be able to scale processing and compute power for different applications or certain processes based on the number of users, the schedule of the processes, and alerting for things like data constraints. You know, it’ll say something like, you’re at 75, 80% of your data c monitor and get alerts on—things that you might not have in an IaaS or Infrastructure or data center provision. This also allows for enhanced automation and connectivity between your development pipelines, software products, and applications. You’ll be able to open up access methods and connectivity to free you up so you don’t have to jump through hoops like in a server-to-server situation or a traditional IaaS networking paradigm.

Moving to PaaS provides DevOps, automation, and deployment. You know, you can automate. Not just your software builds and products, but you can actually start to build your infrastructure through code. Essentially, you can code the scaling of your infrastructure and the automation of that, based on code, instead of having to configure and implement additional servers and other aspects of IaaS. That’s a huge benefit when you talk about continuous integration and development pipelines and your ability to get that software through your environment to a production environment in a much quicker and easier way. It also helps out with quality controls, your QA, and your testing activities so you can load, distribute, and publish to these environments while bringing down overhead. Ultimately, it allows you to have more time and not be constrained by the overhead, builds and deploys. Now, one other thing: Azure offers frameworks that you can plug into for things like API management, API governance, and toolsets. Same as it relates to data platform capabilities, data movement, and data processing as well. There’s a lot of goodness that comes along with the PaaS instead of having to build it ourselves or having to buy, procure, and manage. We can curate from the cloud so we can focus on developing software.

For us, our risk adjustment and quality products and applications are on an API-based framework; we’re able to automate our deployment pipelines using our cloud DevOps and even move into the database as a service. All of this culminates in lower overhead, greater cost efficiency, enhanced monitoring and alerting, and greater insight and understanding of the pieces and parts that need continuous scaling or our at-risk areas for activity saturation.  

Host: That makes sense—you know, to use the available tools instead of reinventing the wheel. That way, you can stay on mission and maximize efficiency. Of course, from a health plan’s point of view, being flexible to changes in the business environment and being able to respond quickly is essential. Let’s talk about the posture of security in the industry and how the cloud supports that.  

Larry: Yeah, so the pivot is really the enhanced security and toolsets that come with the cloud in the form of multi-layered frameworks. We’ve been able to leverage this with additional capabilities that we’ve provided around firewall and WAF that protect from hacking and malicious attempts. Things like Denial of Service—essentially hackers attempt to flood your access points, your IPs with traffic, millions of transactions, or request messages to bring down your site. So, how would that play out? Well, the internet site might show an error message. In some of those cases, they’re under attack. There are configurations and tools in place to identify those so services stay up and running.  

There’s features like geoblocking to restrict people’s ability to access the internet from our end or vice versa. There are certain areas of the world that are notorious for hacking. So we can make sure our associates aren’t able to get to, let’s say, North Korea domains and IPs. Likewise, we can also ensure and enforce we don’t have our network accessed by certain geographical areas like Russia or North Korea. This tamps down security risks from bad actors.  

The next point of control is being precise in access permissions. There’s IDS, intrusion detection toolsets, anti-bot defenses, or cloud-provided levels of encryption that are relatively easy to configure and implement. The cloud provides the ability to get granular with role-based permissions. You know, so each person has the least amount of access necessary to do their jobs. For example, you wouldn’t give a customer service person access to claims applications.

Host: We’ve been talking a lot about the technical benefits of the cloud. If we were to summarize the benefits of the cloud in non-tech terms, you know, what would be the benefits for health plans to adopt an ecosystem of cloud-native solutions?  

Larry: So, there’s the scalability, you know, we can scale up or down very quickly; the cloud is certainly the most cost-effective environment, and there’s heightened security, as we just discussed. And from an innovation perspective, it’s easier to bring more technology enablers into play in a way that increases performance. Something we haven’t talked about as a benefit is disaster recovery for business continuity in the case of an adverse event. Then, there’s enhanced monitoring. Because the cloud environment allows for an increased level of proactive management, which translates into less risk of downtime, less risk of delayed transactions, less risk of delayed data processing, and impacts to SLAs.

You know, the cloud is just abundantly flexible, so you’re going to see speed…with time to market, time to production on things like enhancements and implementations.

Let me give you an example, for risk adjustment, if we want to implement NLP for medical chart reading, or we want to implement machine learning into the gap and chase programs. Those are innovations that can be turned on much easier through libraries or tool sets that can be leveraged as part of the cloud. I mentioned the security that comes along with an API gateway, a health plan can interface with a vendor in a much quicker way than having to go configure those within a data center infrastructure. Then, from a business perspective, these new capabilities expedite timelines. And the same thing from an overall data integration perspective, the cloud has developed a marketplace so the vendors of a health plan can interact with each other in a quicker, more efficient way. An example of that is a vendor that is working in a Platform as a Service mode and has a predefined cloud-ready API data interface so integrations can be spun up very quickly and data exchange can occur in real-time. All of these benefits really add up to the end goal of better service at a lower cost.  

Host: You know, you see these different tech solutions, and some are saying they’re in the cloud, and some aren’t; now we know…why it matters. I read a book called Exponential Organizations, and the take-home message was: if your organization doesn’t like change, it’ll like irrelevance even less. And I think that resonates here as the healthcare industry is gaining traction with the adoption of its technology.  

Larry: This is so true.  

Host: Larry, thanks so much for joining the podcast.  

Larry: Great, it’s great to be here. Thanks for having me.

Host: To all our listeners, thank you for listening in. Don’t forget to follow the podcast on Apple or Spotify, rate it, and share it with your colleagues. See you next time.