Scaling Cost Containment Without Scaling Complexity

By Serkan Kutan, CTO, Zelis

If you’ve ever tried to scale any kind of strategy across a business, you know the paradox: the more you grow, the more tangled things get.

More vendors. More tools. More workflows. More reconciliation. More abrasion.

And ironically, less clarity.

It’s a familiar story in healthcare claims operations — especially when it comes to the balancing act of accuracy, costs and throughput. As organizations expand their strategies, seek better accuracy and work to reduce friction with providers, the instinct is to layer on new solutions. But what starts as innovation in cost containment quickly morphs into fragmentation. 

And fragmentation, as we’ve seen time and again, is the enemy of efficiency.

So how do we scale smarter?

Let’s talk about what it means to grow without growing chaotic — and why modular, intelligent platforms are the key to unlocking that future.

The Scalability Trap

Scaling cost containment isn’t just about adding capacity. It’s about maintaining — and increasing — efficiency as complexity increases. But most legacy systems weren’t built for that kind of elasticity.

Instead, they rely on bolted-on modules and manual handoffs. The result is a patchwork of point solutions that don’t talk to each other, don’t share data and don’t adapt to changing needs.

This isn’t just a technical problem. It’s a strategic one. Fragmented systems slow down decision-making, obscure insights and erode trust with providers and members. And in a market where affordability and transparency are under the microscope, that’s a risk no payer can afford.

Modular Platforms: A Smarter Way to Scale

Here’s where modular platforms come in.

Unlike traditional systems, modular platforms are designed to activate only what’s needed, when it’s needed. They’re built with interoperability in mind — meaning they can plug into existing infrastructure, scale up or down based on business needs and evolve as regulations or market dynamics shift.

Think of it like building with LEGO blocks instead of pouring concrete. You get flexibility, speed, and control — without sacrificing stability.

From an operational standpoint, this means:

• Fewer vendors to manage

• Centralized data and insights

• Streamlined workflows across pricing, editing, and negotiation

• Reduced abrasion with providers and members

• Increased ROI

And from a strategic standpoint, it means you’re not locked into a one-size-fits-all model. You can tailor your cost containment strategy to your population, your networks, your policies and your goals.

What Smart Scaling Looks Like

Let’s get practical. Here are three principles we’ve seen work across high-performing health plans:

1. Start with visibility

You can’t scale what you can’t see. Begin by mapping your current claims lifecycle — from intake to payment — and identifying where fragmentation exists. Are edits happening in one system and pricing in another? Are negotiation outcomes siloed from analytics?

Unified platforms offer a single view of the claims journey, making it easier to spot inefficiencies and opportunities.

2. Design for interoperability

Avoid the temptation to rip and replace. Instead, look for platforms that integrate with your existing tools and workflows. The goal isn’t to start over — it’s to connect the dots.

This is especially important for internal teams managing multiple vendors. Consolidation doesn’t mean elimination; it means orchestration.

3. Activate intelligence, not just automation

Automation is great. But intelligence is better. Look for platforms that combine AI-powered decisioning with human oversight. A hybrid model can ensure accuracy, transparency and adaptability, especially in edge cases or complex claims.

It also builds trust with providers, who are increasingly wary of “black box” systems that deny claims without explanation.

The Payoff: Efficiency + Experience

When done right, smart scaling delivers more than just savings. It improves the experience for everyone involved.

Members get faster, clearer answers.

Providers get fewer denials, faster payments and better communication.

Health plans get actionable insights and measurable ROI and stronger relationships with their stakeholders.

And perhaps most importantly, it positions your organization to respond to whatever comes next — whether it’s regulatory shifts, market disruptions or new care models.

Final Thought

Scaling cost containment doesn’t have to mean scaling complexity. With the right platform strategy, health plans can grow their capabilities while simplifying operations, improving outcomes, and strengthening relationships. It’s not just about doing more. It’s about doing better.

And in today’s healthcare landscape, better is the new necessity.