Case study

The challenge

A major health plan decided to redesign its physician contracting process to reduce cost and improve pricing accuracy. The plan faced several contract execution challenges in its new markets. Configuration staff spent weeks—and at times months—trying to interpret complex legal contract language and determine the intent of pricing agreements after negotiations were completed. Limited communication between configuration staff and contract staff, who negotiate the contracts, resulted in inordinate delays. Contract staff had to reconstruct conversations with providers for pricing term details, which frustrated providers. The health plan approached Cognizant for help improving provider relations.

Our approach

Cognizant reimagined the traditional workflow and configuration methodology, implementing an innovative solution that improves communication between contract and configuration experts. We worked closely with the client to revamp contracting processes and generate contract language from configuration text, leveraging the flexibility of TriZetto® NetworX Modeler®. The new process brings together contract staff and configuration staff, creating a single “contract team” that uses the NetworX Modeler software during negotiations to configure and generate the actual contract language for pricing—before the contract is signed. The software exports the configuration into plain English that is then incorporated into the contract, so the contract language is derived from the configuration. 

The new governance process leverages a set of standard template rate sheets with default expected pricing terms. This creates a uniform starting point for the contract team and eliminates ambiguity in pricing language. Cognizant’s team of product specialists and business and change management consultants built and tested templates, designed new process flows, recommended plans and methods to change the plan’s organizational structure, integrated NetworX Modeler software with an existing enterprise contracting system and created operational documents to guide staff.

Innovative solution improves configuration accuracy

Our solution saves costs by eliminating manual pricing and downstream errors while improving the health plan’s provider relationships. Initial training and feedback revealed a 100% success rate in training non-IT staff to complete limited configuration tasks in NetworX Modeler. We helped the client achieve an estimated cost savings of 35% by eliminating manual pricing. We also helped streamline the contracting process using a standardized pricing structure. An estimated 75% improvement in configuration accuracy helped reduce rework.

100%

success rate in training non-IT staff to complete limited configuration tasks

~75%

improvement in configuration accuracy

Streamlined contracting

through a standardized pricing structure