Government & Public Health Programs
Pharmacy Benefit Management
How will your organization transform to deliver greater value? We help implement process improvements, increase innovation and prepare for the future.
Innovative services and solutions to help your organization deliver coordinated, quality care and improved financial performance.
Government & Public Health Programs
How will you balance competing priorities and manage member volume? We help you adapt to the unexpected requirements the future may bring.
Pharmacy Benefit Management
Services include regulatory compliance solutions, clinical management programs, business intelligence systems and implementation advice.
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.
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 Health TranZform™
Deliver consumer‑centric care leveraging digital communications.
Cognizant offers solutions specific to the challenges of Healthcare organizations. Browse the pages below to learn more.
Taking Control of the MLR Review Process
For pharmaceuticals and biotech companies, medical, legal, and regulatory reviews (MLRs) are commonplace, and help ensure that product claims, promotions, and training are medically correct, and in compliance with FDA and other industry standards. This requires companies to develop an MLR process that helps assure the accuracy, relevancy, and value of the promotional material they produce and market.
The Work Ahead: How Data and Digital Mastery Will Usher In an Era of Innovation and Collaboration
In this installment of our Work Ahead series, we focus on the impact of digital transformation on the life sciences industry and what it will take to transform an industry value chain in need of drastic modernization.
Preparing for the Regulatory Challenges Wrought by Software as a Medical Device
In the rapidly evolving digital health ecosystem, software as a medical device (SaMD) plays an increasingly critical role for medical device manufacturers and other stakeholders, and understanding regulatory policies covering such software is key for determining QMS requirements.
An Analytical Approach to Provider and Intermediary Segmentation in the Pharmaceuticals Industry
In today's managed markets, pharmaceuticals companies that apply analytical approaches to market segmentation to providers and intermediaries such as health plans and pharmacy benefit managers gain competitive advantage through market-driven strategies, effective therapy launches and maximizing the value of in-line brands. We explore a number of clustering techniques to enable such analyses.
Helping Pharmas Manage Compliance Risks for Speaker Programs
To avoid stiff fees, reputation damage and the imposition of corporate integrity agreements (CIAs), pharmaceuticals companies need to monitor their speaker programs carefully for compliance to a suite of regulations. We identify those rules and outline a rigorous process based on relevant key performance indicators (KPIs) that will enable pharmas to head off these potential major hits to their bottom line.
The Internet of Things: The New Rx for Pharmaceuticals Manufacturing & Supply Chains
Product quality, regulatory compliance, and operational efficiency are chief concerns for pharmaceuticals executives, particularly in the areas of manufacturing and supply chain management. Yet the challenges of batch manufacturing have made it difficult to monitor the logistical journey of pharmaceutical products, which are subject to degradation, recalls, and strict regulatory standards. Using IoT platforms and solutions, pharmaceuticals companies can digitize and connect vital functions, achieve higher levels of quality and productivity, keep up with regulatory demands, and afford real-time visibility into virtually every area of the business.
How Decision-Support Tools Cure the Prior Authorization Time Drain
A collaboration between Cognizant, the New England Healthcare Exchange Network and Informatics In Context is demonstrating how a real-time prior authorization (PA) system for medical and administrative processes saves time and money.
The Internet of Things: An Excellent Prognosis for Medical Device Makers
By taking advantage of the Internet of Things (IoT), medical device manufacturers can focus squarely and consistently on the customer, rather than the device itself; monitor the performance and track the use of their products in real time; and operate within an automated, integrated environment that closes the gap between users, device makers, and technology providers.
m-Health: Engaging Patients at Every Touchpoint
Today, people want fast, easy and secure access to their health records, from wherever they may be and from whatever device they choose. Electronic health records (EHR) can alleviate this issue, and encourage proactive, preventive care, all within a robust, integrated, interoperable, and inclusive health system that serves the best interests of patients, physician practices, hospitals, public health, and the population at large.
The Work Ahead: Moving Healthcare Organizations into the Digital Age
For healthcare payers and providers, the digital revolution offers a powerful prescription for transforming an industry value chain in need of drastic modernization. In this installment of our Work Ahead research series, we look at the way forward to the future of work for healthcare.
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:
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 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.
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: