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From understanding the impact of reform to addressing regulatory mandates, healthcare leaders choose us to help them work better and work differently.

Whether it's managing costs or finding ways to grow more profitably, Cognizant is redefining the way healthcare companies benefit from global services.

SEGMENTS WE SERVE

  • Payers

    How will your organization transform to deliver greater value? We help implement process improvements, increase innovation and prepare for the future.

  • Providers

    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.

Cognizant's consulting, IT and business process services, combined with Trizetto's world class technology products, are helping to reengineer the business of healthcare today, while reimagining it for tomorrow.

learn more ABOUT TRIZETTO,

A COGNIZANT COMPANY.

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

Cognizant Healthcare Consulting

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.

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
  • 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
  • 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 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 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.
Healthcare BPO, IT Solutions and Services | Cognizant Technology Solutions