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Consulting & Solutions

Engage with our business and technology experts for strategic solutions that address the full scope of healthcare issues today, from compliance through integrated health management.
Creating a truly sustainable foundation for healthcare will require the industry to eliminate substantial costs, embrace new ways of delivering care and improve the quality of that care. Cognizant’s Healthcare Business Consulting services address the industry trends and market forces that are driving business and IT spend—from rethinking new business models to optimizing operations and enabling technology innovation.
Today's immediate challenges—cost control, regulatory compliance and improving efficiencies—demand resources and attention beyond the scope of most healthcare organizations. Cognizant’s Healthcare Business Process Services (BPS) practice engages with you at a strategic level and collaborates over the long term to implement a strategy that works.

OUR LATEST THINKING

Operationalizing Customer Centricity: A Prescription for Building Brand Loyalty and Healthy Competitive Advantage
Payers must refine processes across multiple channels to create a highly competitive brand based on consistently high-quality, member-centric experiences.
ICD-10 Advantages Require Advanced Analytics
Compliance alone will not deliver on ICD-10's potential to improve quality of care, reduce costs and elevate efficiency. Organizations need to find and apply meaning from the new code sets, which requires new IT infrastructure, partnerships and people.
Healthcare Insurance Evolution
in India: An Opportunity to
Expand Access
Leveraging emerging technology to build a robust and fast-track insurance disbursement system can spell success for private insurance firms in India.
Managing Risk: Maximizing Opportunities in the MAPD Market
The Medicare Advantage (MAPD) marketplace is growing as memberships and revenue potential increase. At the same time, it is marked by risks associated with healthcare reform, continuing cost pressures, and healthcare consumerism. To operate and compete successfully, payers will have to find new and better ways to sharpen their strategies, integrate systems, increase collaboration and optimize processes.
Leveraging Consumer-Facing Technologies to Improve
Health Outcomes
Healthcare technologies and programs are improving health outcomes and patient care, including healthcare information technology (HIT), advanced analytics, accountable care organizations (ACOs), electronic health records (EHRs), computerized physician order entry (CPOE), remote patient monitoring (RPM) and telehealth/telemedicine.
Elevating Medical Management Services to Meet Member Expectations
Healthcare payer organizations can lower the cost of commoditized medical management functions via better and different processes, and invest the savings in
member-centric care management services.
Financial Impact Analysis:
A Window into the Business Impact
of ICD-10
Health providers can determine the full financial consequences of the ICD-10 transition by using reimbursement analysis and financial sensitivity modeling.
The New Process Genome: Recoding Business Process Work to Thrive in the Modern Digital Economy
Work processes, including those in the banking, healthcare and insurance industries, are undergoing significant change -- making it hard for executives to maintain the status quo. Best practices and new research insights emphasize the new role of shared services,and how businesses can begin to re-code their business process architecutres to reduce costs, drive innovation and successfully compete in the digital economy.
A Vision for U.S. Healthcare's Radical Makeover
The healthcare industry is on the verge of a disruptive change that will significantly reshape our experiences and reorient our expectations across the provider and payer value chain.
Reducing Costs, Increasing Choice: Private Health Insurance Exchanges
Private exchanges provide payers with a competitive, value-generating solution to the challenges posed by public exchanges, employer cost controls needs and the consumerization of healthcare.

RESULTS

A Leading Blues Plan Prepares for the Healthcare Insurance Exchange

A leading blues plan was preparing for Health Insurance Exchange (HIX) participation in several states and on the federal exchange. Cognizant was engaged to assist with organization change management and contingency planning efforts.

A centralized PMO was established to manage HIX functional projects and provide ongoing advisory services including:

  • Monitoring and managing the governance controls and implementation activities associated with the different exchanges across state-based and federal HIXs
  • Establishing a risk and QA function to actively track and seek resolution of project — and program — level risk and issues
  • Established a comprehensive roadmap for exchange readiness and integration
  • Increased effectiveness in managing care for risk-based contracts reduced duplication of effort across solution, process and plan development

A Leading Health System Prepares for the ACO Marketplace

To compete in the emerging ACO marketplace, a leading health system comprised of multiple hospitals, research centers and thousands of providers had begun to make risk-based contracts, pilot population-based care delivery programs and planning for exchange products. Cognizant and the health system partnered to determine a technology and business strategy including:

  • A current state assessment to understand existing risk-based contracts and accountable care-based pilot impacts, evaluating gaps across people, process and technology.
  • Gathering business requirements to integrate and support care management needs across the enterprise.
  • Developing the business and conceptual technical architecture to support required ACO care management capabilities.
  • An integrated care management roadmap to ensure alignment of technical and business initiatives
  • Created a holistic view of accountable care impacts to business processes and IT systems
  • Established a common plan for managing ACO initiatives for IT and business leadership
  • Aligned technology issues with priority business requirements to accelerate implementation, close operational gaps and reduce duplication of effort

A Leading Payer Reduces the Costs of Medical Management

A national health insurance plan with more than 30 million members across the U.S. was under a corporate mandate to reduce medical management costs within the next fiscal year. The health plan’s clinical talent hiring and retention costs were high and it also faced considerable challenges in staffing for care management. The health plan needed a comprehensive strategy for addressing MLR regulations and compliance.

Cognizant developed a complete solution for handling the client’s commercial utilization management (UM) claims from pilot to roll-out. Our accredited and U.S. licensed clinical teams remotely accessed the client’s platform from multiple offshore operations centers and provided a full slate of UM services.

  • Reduced UM labor costs by approximately 48% and increased productivity by 18%
  • Increased accuracy of intake function from 95% to 98.7%
  • Increased turnaround compliance from less than 95% to 99.4%
  • Freed scarce internal clinical resources to mitigate care management staffing challenges

A Leading Hospital Addresses the Impacts of ICD-10

A leading hospital needed to determine the impact of ICD-10 transformation on their financial outlays; to identify any gaps in their program plan and understand potential risks that could impact overall ICD-10 transition. Cognizant was engaged to conduct an in-depth evaluation of the impact of ICD-10 on corporate finance and revenue cycle management functional areas, including:

  • ICD-10 current state assessment: to understand impact across people, partners, processes and IT; determine readiness of business partners and vendors and identify training needs
  • Financial Impact Analysis: to evaluate ICD-10 impact by LoB, payers, DRGs and MDCs
  • Financial Modeling: to identify levers that would have financial impacts due to ICD-10 and enable visibility of impact to cash flows
  • RCM / Finance-specific implementation plan and risk mitigation strategies
  • A holistic view of ICD-10 impacts to RCM and finance
  • Long-term budget planning based on financial impact analysis and sensitivity analysis
  • View of potential reimbursement losses and gains to aid proactive contract negotiations with payers
  • Detailed plan of activities, resources and dependencies required to meet the compliance deadline
  • A Leading Blues Plan Prepares for the Healthcare Insurance Exchange
  • A Leading Health System Prepares for the ACO Marketplace
  • A Leading Payer Reduces the Costs of Medical Management
  • A Leading Hospital Addresses the Impacts of ICD-10