The US healthcare payer environment has been subjected to waves of changes in the form of X12/7030, VBC, Virtual Care, Member Management, Evidence-based plan of care, AI-enabled recommendations, Interoperability & Patient Access rule, etc. The latest payer business models have members at the center while defining and executing business processes.
Even though payers were among early technology adopters within the US healthcare ecosystem, they are forced to make large-scale IT systems changes due to regulatory and technology changes in their environment. They can leverage all their data to improve care quality, lower premiums, drive better consumer health and eventually, better profitability. The Covid-19 pandemic has forced payers to rethink their IT strategies and be flexible for any unseen future events.
We help achieve your business goals via the optimal use of technology. Below are a few areas we excel in. We can also bring new ideas to the table.
Integrating Claims and Clinical Data
Managing Community Health
Improving Member Engagement (MSAT)
Reporting of Quality Measures
We Can Help Accelerate Your Business
- Integrate various sources for Clinical, Financial, Administrative, Member, Provider and operations data using standards such as FHIR, HL7, EDI
- Aggregation, segregation, classification and management of data with BI, AI/ML, etc.
- Deductive and predictive analysis of data for scientific decision-making
- Meaningful presentation to enable quick business decisions using dashboards and self-service reporting
- Support existing applications (even legacy ones - AS400, Delphi, VB etc.)
- Document and reverse-engineer legacy solutions
- Build wrapper applications to provide a modern user experience while maintaining the robust, time-tested back-end
- Provide SLA-bound sunset support
- Architect, Design and Develop solutions using modern technologies
- Technology migration of solutions
- Migrate/Extend existing applications to cloud/mobile
- Perform independent validation and verification of developed solutions
- Uplift/Enhance User Experience of existing solutions
- Identify, Stratify, Classify and Positively Impact the health of high-risk members through well designed population health management solutions
- Successfully use and report Health Plan Performance measures
- Manage your provider networks and contracts to maximize quality ratings and your bottom-line
- Benchmark performance and identify instances of fraud, gaps in processes, which results in sour provider relationships
- Increase consumer health awareness by integrating better with provider system
- Ensure consumer participation in your outreach programs through professional CRM initiatives
- Enhance your reach through mobile solutions and gain more consumer eyeballs to drive preventive measures
- Listen better to your members by tracking their actions through ‘Internet of Things’ (IoT) enabled devices
Experience Payer Ecosystem
How We Stay Ahead of Competition
Healthcare Ecosystem Experience
We focus on US healthcare
Enabled by a culture of accountability and ownership
Showcased through metric-driven processes
Competent Healthcare IT Partner
Tactful health management solutions
Maximum value with risk diversification
Let's spark innovation!
A glimpse of our industry expertise