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A Playbook for Managing at the Crossroads

OUR LATEST THINKING

Innovation Beyond The Four Walls

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FEATURED NEWS

December, 04, 2014

Cognizant to Present at the CLSA Americas Innovation Summit

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The Cognizant Difference

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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.
Solution Spotlight
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.
Cognizant offers solutions specific to the challenges of Healthcare organizations. Browse the pages below to
learn more.

OUR LATEST THINKING

How Pharma Can Fully Digitize Interactions with Healthcare Professionals
By building end-to-end IT ecosystems and understanding preferred communications channels, pharmaceuticals companies can create more engaging and fruitful digital relationships with healthcare professionals.
Employee Wellness: Two Parts Perspiration, One Part Persistence
With employee health affecting bottom lines, organizations need to support preemptive initiatives that encourage both personal wellness and quantifiable results. Here's how we are addressing this major challenge.
Medication Adherence in the Real World
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
HIX 2.0: New Alternatives for State Participation in Health Insurance Exchanges
By examining the pluses and minuses of emerging forms of health insurance exchanges, states can make informed decisions on cost and performance trade-offs and arrive at an optimal HIX model that suits their operational needs and those of their constituents.
Turning the Vision of Connected Health into a Reality
To fulfill the goals of the healthcare industry's Triple Aim framework and the new patient-centric paradigm, stakeholders across the healthcare and life sciences sectors must combine high-tech with high-touch.
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.

RESULTS

  • Blues Plan Prepares for Healthcare Insurance Exchange
  • Health System Prepares for ACO Marketplace
  • A Leading Payer Reduces the Costs of Medical Management
  • A Leading Hospital Addresses the Impacts of ICD-10

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 MDC.
  • 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

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