Your team has been using the new risk adjustment software for three months and they hate it. It doesn’t match your workflow. The screens don’t show the information they need. The reports don’t format the way you want. So you do what seems logical: you request customizations.
The vendor quotes you $50,000 for custom development. Your CFO approves it because the software isn’t delivering value in its current state. Six months later, you’ve got your customizations and a whole new set of problems.
The Maintenance Nightmare
Here’s what the vendor didn’t emphasize when they sold you on customization: every custom feature you add becomes a maintenance burden. When the vendor releases updates, they test them against the standard platform. They don’t test them against your specific customizations.
So updates break things. A new release comes out with features you want, but it conflicts with the custom workflow you paid $50,000 to build. Now you have a choice: skip the update and miss out on new capabilities, or pay for additional custom development to make your customizations compatible with the new version.
I’ve seen organizations spend $200,000 over three years maintaining customizations that initially cost $50,000 to build. That’s not a one-time investment. That’s an ongoing tax on every future improvement.
The Upgrade Trap
Customizations also make it harder to switch vendors when the time comes. Your team has learned workflows that only work with your customized version of the software. When you evaluate new vendors, you’re comparing their out-of-the-box functionality to your heavily customized current system.
The new vendor’s standard features look inadequate compared to what you’ve built. So you either commit to recreating all your customizations with the new vendor (expensive and time-consuming), or you stay with your current vendor even though you’re unhappy.
You’ve locked yourself in. The customizations you thought were empowering you are actually trapping you.
The Hidden Assumptions
Most customization requests are based on assumptions about how work should be done. “We need the system to do X because that’s how we’ve always done it.” But maybe the way you’ve always done it isn’t optimal.
Standard software embodies best practices from hundreds of implementations. When the software doesn’t match your workflow, that’s often a signal that your workflow has problems, not that the software is deficient.
I worked with an organization that spent $30,000 customizing their risk adjustment software to support a complex manual approval process for HCC codes. Every code needed supervisor review before submission. The customization added workflow stages, approval queues, and notification systems.
Six months later, they realized the manual approval process was unnecessary. Their coders were experienced enough to code correctly without supervision. They’d built elaborate software customizations to support a workflow that shouldn’t have existed.
They couldn’t easily remove the customizations because they were deeply integrated into other parts of the system. They were stuck with expensive features they no longer wanted.
When Customization Makes Sense
I’m not arguing that you should never customize risk adjustment software. Sometimes it’s the right choice. If you have unique regulatory requirements that standard software can’t handle, customization might be necessary. If you’ve built competitive advantages around specific processes that standard software doesn’t support, customization might be justified.
But these situations are rarer than most organizations think. Most customization requests are about comfort and familiarity, not actual business requirements.
Before you approve customization, ask yourself: Can we change our process to match the software instead of changing the software to match our process? Would changing our process actually improve how we work?
The Configuration Alternative
Good risk adjustment software is highly configurable without requiring custom development. You can adjust workflows, modify screens, create custom reports, and set business rules without writing code or paying for custom development.
Configuration is different from customization. Configuration uses built-in flexibility that the vendor designed and supports. When you configure the software, updates still work. You can switch vendors more easily because you haven’t built unique code that only works with one platform.
Before you request customization, explore whether configuration can solve your problem. Most modern risk adjustment software platforms are configurable enough to handle 90% of what organizations think requires custom development.
The Process Change Alternative
Sometimes the answer isn’t customizing the software or configuring it differently. It’s changing how you work.
If your risk adjustment software assumes charts move linearly through stages and your workflow is chaotic with constant exceptions, you have two options. You can customize the software to support your chaotic workflow, or you can improve your workflow to be more structured.
Improving your workflow is usually the better investment. The discipline that standard software imposes often exposes process problems you didn’t realize you had.
The Real Question
Before you commit to customizing risk adjustment software, ask this: Am I customizing because I have genuinely unique requirements, or am I customizing to avoid changing how we work?
If you’re customizing to avoid change, you’re making an expensive mistake. You’re paying tens of thousands of dollars to preserve inefficient processes, and you’re creating ongoing maintenance costs and vendor lock-in.
If you have genuinely unique requirements that deliver competitive advantage or meet regulatory needs that standard software can’t address, customization might be justified. But be honest about whether your requirements are actually unique or just familiar.
Out-of-the-box risk adjustment software works better than customized software more often than organizations expect. Give it a real chance before you start customizing. You might save yourself a lot of money and headaches.
