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Reduce Costs, Generate Growth
REIMAGINE MEMBER ENGAGEMENT AND DELIVER EXCEPTIONAL SERVICE
Cognizant Digital Healthcare Payer empowers consumers with the latest self-service tools. It enables payers to create competitive products and focus on customer experiences at the lowest possible cost.
Consumers have increasing control over how they spend for healthcare. That simple fact puts tough demands on healthcare payers and their ability to compete in today’s market. What’s more, expectations for service and engagement have changed. Shaped by digitally native companies, consumers now expect payers to provide digital self-service tools and deliver personalized experiences while keeping costs low.
Cognizant Digital Healthcare Payer helps organizations thrive on the challenges of becoming a consumer-driven, value-based, on-demand provider. We combine automation, human-centered insights, and best-in-class industry processes and platforms to enable you to create new products, focus on customer experiences and develop strong competitive differentiation.
Our proven Business Process as a Service (BPaaS) offering spans the policy administration value chain. It allows payers to achieve operational excellence and to:
- Reduce administrative costs with streamlined processes incorporating robotic process automation, machine learning and AI.
- Stimulate business growth with better insights for your members and their changing needs.
- Enhance regulatory compliance with more efficient reporting processes and faster identification of potential issues.
- Improve member satisfaction and Net Promoter Scores by providing efficient, intelligent and personalized services using tools ranging from AI-driven chatbots to care managers and coaches.
VIEW PDF
25–50%
reduction in total cost of ownership resulting from BPaaS.
LEARN MOREOUR PERSPECTIVES
Automation is making inroads into U.S. health plans to improve...
BPaaS goes beyond cost-cutting to ensure that health...
By using modern customer engagement techniques such as...
With BPaaS, health plans can focus on more strategic work...
New automation technologies are rapidly changing the industry...
Healthcare-on-demand platforms may render current industry...
Process automation could enable healthcare organizations to...
HEALTHCARE
BPaaS Solution Improves Health Plan’s Financial Wellness
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The Challenge
A major U.S. healthcare organization with more than one million members in its government programs had difficulty modernizing the systems and capabilities required to comply with the emerging regulatory requirements of the Centers for Medicare and Medicaid Services. Its systems were outdated and expensive. Low automation rates, extensive manual processes and non-standardized data structures resulted in inadequate claims processing turnaround times and claims pricing inaccuracies. Antiquated customer service tools and minimal interactive voice response capabilities resulted in poor user experiences that hurt the brand and its standing with CMS.
The payer turned to Cognizant's healthcare technology experts for a comprehensive yet cost-effective solution that would solve its immediate need for a modern, end-to-end solution and provide a foundation for thriving under value-based care.
Our Approach
We deployed our Business Process-as-a-Service (BPaaS) solution for government programs, delivering a comprehensive TriZetto Facets core administration platform as a hosted service operated by Cognizant and overseen by the client. To begin with, Cognizant addressed the root causes of claims and encounter issues by collaborating with the payer’s senior operations executives and drawing on their extensive experience in government health plan administration. Facets enabled streamlined maintenance, standardized processes and improved system capabilities to reduce claims backlog. The solution also enhanced provider-matching rates by 3% to 4%, eliminating the chances of authorization rejection by plans due to invalid procedure codes.
A separate project introduced the Encounter Data Management module of Facets. It not only improved encounter utilization monitoring acceptance rates from 83% to 92% in just a month but also enabled the submission of more than $450 million in backlogged encounters, improving the payer’s revenue stream. Automating HIPAA authentication and self-service claims helped reduce call volume by 15% and call time by 30 seconds for remaining 51% of the call volume.
Facets Core Administration Solution Boosts Revenue Streams
Cognizant helped the healthcare payer meet regulatory compliance levels and position itself for success under a value-based care model and emerging mandated interoperability requirements by improving processing speed and data accuracy. Integrating Facets features like NetworX Pricer helped the client achieve over 99% pricing accuracy through automation. We not only helped the payer enhance member and provider experiences but also boost its revenue.
25%
reduction in plan administration TCO
15%
reduction in call volume
99%
claims pricing accuracy
