Prasanna Ganesan

Technical debt—the idea that IT systems are owed updates because teams “borrowed” against long-term quality in service of short-term workability—is on the rise. A 2024 report from Forrester found that 79% of IT decision leaders in the U.S. face at least moderate levels of technical debt, which makes sense, given the speed at which technological change is accelerating. However, it also makes the need to respond to technical debt even more urgent.

Addressing technical debt early is crucial because the debt compounds at a very high interest rate. The first few band-aids that provide a quick solution to a deeper problem may look like they are helping, but when a system accrues 2,000 band-aids, it slows innovation to a crawl. It’s nearly impossible to improve or change a module when it’s unclear what the repercussions will be as a result. When a new tool is added on, as a fix for one problem, it results in additional technical debt in another area, band-aid 2,001.
Technical debt in healthcare
While technical debt is something that all industries deal with to varying degrees, healthcare experiences it differently, and perhaps more intensely, because such a large proportion of the tech stack is past its use-by date, resulting in the stack itself feeling like technical debt.

Many subsectors of healthcare are strapped by technical debt, but few demonstrate the long-term problems created by short-term fixes better than payment integrity solutions. These solutions, which are designed to enforce specific policies and guidelines to help health plans pay claims properly, are riddled with arcane, inflexible technology.

The payment integrity architecture of today emerged from a series of tactical fixes made to patch the process one band-aid at a time. The result is an extraordinarily complex chain of cobbled-together elements and processes, each of which partially duplicates many others, and has their own imperfect understanding of the same policies they are intended to enforce. While each of these historical decisions may have been well-justified at the time, the resulting system is one that’s fundamentally unfit to solve pain points for health plans.

Because health plans continued to put band-aids over problems in old technologies, rather than start the process of adopting new ones, technical debt continued to build. The resulting system is now ill-suited to fix root problems holistically from the ground up. Many of these systems need to be reimagined to review claims with new technologies, largely because health plans have let technical debt build up to the point where current solutions are no longer efficient.

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