Healthcare payer organizations can lower the cost of commoditized medical management functions via better and different processes, and invest the savings in member-centric care management services.
A New Payer Model for Medical Management ExecutionCognizant
To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management delivered as a service.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
Provides an overview of various ACO models existing in U.S. healthcare, their evolution and performance over last 5-6 years and provide a perspective on each of the model
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
The Need to Embrace Profit Cycle Management in Healthcare - WhitepaperGE Healthcare - IT
Executive Overview
Healthcare organizations have been operating under a fee-for-service
model for many years. As such, financial leaders have become well
versed in implementing revenue cycle management systems and
processes that primarily focus on the money that comes into an
organization. Today, a new need is emerging. Healthcare reform
and other system changes are moving the industry toward hybrid
payment models such as bundled payments, shared savings, and
capitation. To thrive in this new environment, financial leaders need
to move toward profit cycle management – an emerging model
that matches the revenues from new payment models with an
improved understanding of the true costs to deliver patient care.
The result: Positive financial performance – even in the face of
declining payments – that can be reinvested in the mission to
provide better care.
The foundation of any business or household is profit, defined as
revenue net of expenses (and applicable as such even to not-for-profit
organizations). Regardless of whether you are start-up, a Fortune 500
company, or a family of four, you need to ensure that you are bringing
in more money than you are spending. In many businesses, the
formula to determine your “profitability” is fairly straightforward.
In healthcare, however, the situation is significantly more complex,
as existing and new payment models make it difficult to determine
exactly how much revenue is going to come in the door. On the cost
side, the move to accountable care and value-based payment has
shifted the management of risk and cost onto the providers and
delivery networks, yet most providers lack the tools that would
provide a detailed understanding of the costs required to deliver
quality care, especially when that care is delivered in multiple
locations. A new model of software tools is required – representing
the next generation of revenue cycle management tools and an
emerging class of healthcare cost accounting tools. The end goal?
A solution for profit cycle management that will help organizations
generate a positive financial performance and can be reinvested
in the mission to provide better care.
This change will not happen overnight. Rather, it will be an evolution
over the next five years, as integrated delivery networks update
their revenue cycle solutions to accommodate the new payment
models, and as they deploy new activity-based costing solutions.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
A New Payer Model for Medical Management ExecutionCognizant
To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management delivered as a service.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
Provides an overview of various ACO models existing in U.S. healthcare, their evolution and performance over last 5-6 years and provide a perspective on each of the model
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
The Need to Embrace Profit Cycle Management in Healthcare - WhitepaperGE Healthcare - IT
Executive Overview
Healthcare organizations have been operating under a fee-for-service
model for many years. As such, financial leaders have become well
versed in implementing revenue cycle management systems and
processes that primarily focus on the money that comes into an
organization. Today, a new need is emerging. Healthcare reform
and other system changes are moving the industry toward hybrid
payment models such as bundled payments, shared savings, and
capitation. To thrive in this new environment, financial leaders need
to move toward profit cycle management – an emerging model
that matches the revenues from new payment models with an
improved understanding of the true costs to deliver patient care.
The result: Positive financial performance – even in the face of
declining payments – that can be reinvested in the mission to
provide better care.
The foundation of any business or household is profit, defined as
revenue net of expenses (and applicable as such even to not-for-profit
organizations). Regardless of whether you are start-up, a Fortune 500
company, or a family of four, you need to ensure that you are bringing
in more money than you are spending. In many businesses, the
formula to determine your “profitability” is fairly straightforward.
In healthcare, however, the situation is significantly more complex,
as existing and new payment models make it difficult to determine
exactly how much revenue is going to come in the door. On the cost
side, the move to accountable care and value-based payment has
shifted the management of risk and cost onto the providers and
delivery networks, yet most providers lack the tools that would
provide a detailed understanding of the costs required to deliver
quality care, especially when that care is delivered in multiple
locations. A new model of software tools is required – representing
the next generation of revenue cycle management tools and an
emerging class of healthcare cost accounting tools. The end goal?
A solution for profit cycle management that will help organizations
generate a positive financial performance and can be reinvested
in the mission to provide better care.
This change will not happen overnight. Rather, it will be an evolution
over the next five years, as integrated delivery networks update
their revenue cycle solutions to accommodate the new payment
models, and as they deploy new activity-based costing solutions.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
Webinar Deck: The Changing Face of IT Outsourcing in the Healthcare Payer Mar...Everest Group
On June 5, Everest Group will host a one-hour webinar that will answer the following questions: What are the beneath-the-surface changes taking place in the payer IT industry? What are the trends and opportunities arising out of these changes? Why should CIOs start thinking of these transformational changes now? How should service providers assess their services portfolios and sales strategies from this transformational change perspective?
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
in order to meet cost reduction targets, CMOs
* Share patient data across ecosystems
* Embed shared organizational intelligence
* Establish guidance for quality & cost within physician workflows
* Prepare physician leaders to create a culture of continual improvement
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
A 360° view of value-based healthcare: how to position your facility for successSourceMed
The shift from volume to value-based healthcare is underway and many outpatient providers are already participating. How are you preparing for this transition?
This presentation will explore the move to value-based care, and share ways for your facility to adapt what it is doing today to thrive under collaborative service delivery models, including: revenue cycle management, data analytics, patient engagement and system interoperability.
The Future of Healthcare in Consumerism WorldCitiusTech
The main aim of this document is to provide an overview of healthcare consumerism, its growth drivers and challenges / barriers providers and payers face while adopting it. The document provides insights on how providers and payers can tackle the rising wave of consumerism in healthcare industry. The document also provides some real-life examples on market trends which emphasize the need to brace consumerism in healthcare
Health Accounts Peer-Learning Workshop: Summary of Key Themes and DiscussionsHFG Project
In November 2016, over 60 government technicians, policymakers and technical advisors from 47 countries across the Americas, Africa, Asia and Europe participated in the first global Health Accounts Peer-Learning Workshop. During this workshop, participants shared their experiences and ideas on how to improve Health Accounts production and increase the uptake of Health Accounts results for policy.
PYA Speaks the New Language of HealthcarePYA, P.C.
PYA Principal David McMillan addressed the 2013 Florida Institute of Certified Public Accountants Health Care Industry Conference and offered a consultant-turned-linguist perspective on “Learning the New Language of Healthcare.”
Making the shift to value-based care is not easy. However, a growing number of healthcare organizations are finding success leveraging Lean process improvement and health IT to reduce waste, lower costs, and improve quality.
In fact, leading health systems like Bon Secours, Prevea Health, and North Mississippi Medical Center are using these principles to improve care management processes and achieve better patient outcomes.
We have assembled these strategies into a new whitepaper. You will learn:
- How key concepts of Lean thinking can be applied to healthcare
- Why high-performing practices are using Lean to enable care team members to provide better care
- The financial advantages of a team-based, population health management approach in a value-based reimbursement system
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
The ACA and other health reform initiatives have driven the need to use analytics to enhance the care management experience. As workflows change and new approaches are explored, patient motivation becomes the “tipping point” of success in surfacing true opportunities for reduced and avoidable costs. This session will explore how to combine analytics, using patient motivation as a cornerstone, and incorporating greater insights into the clinical workflows, resulting in successful engagements.
Moving to Value Based Care – Leveraging advanced analytics to measure physici...LexisNexis Risk Solutions
Payment reform and emphasis on value-based care is forcing payers, ACOs, and Integrated Delivery Networks to look for ways through which physician performance can be evaluated and measured over time with the goal of creating highly efficient and effective physician networks. With more pressure and risk moving to physicians – they will expect fair measurement of quality against their peers. Join this webinar to understand the implications of value-based care as it relates to physician performance analysis and why the ability to effectively monitor physicians with less than acceptable cost performance and those with high-quality performance will be non-negotiable.
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Care Management Platforms for Population Health: Seven Real-World Best PracticesCognizant
Our experience with large platforms offers important lessons and strategies that healthcare organizations can successfully replicate when deploying a population health-oriented care management system.
Webinar Deck: The Changing Face of IT Outsourcing in the Healthcare Payer Mar...Everest Group
On June 5, Everest Group will host a one-hour webinar that will answer the following questions: What are the beneath-the-surface changes taking place in the payer IT industry? What are the trends and opportunities arising out of these changes? Why should CIOs start thinking of these transformational changes now? How should service providers assess their services portfolios and sales strategies from this transformational change perspective?
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
in order to meet cost reduction targets, CMOs
* Share patient data across ecosystems
* Embed shared organizational intelligence
* Establish guidance for quality & cost within physician workflows
* Prepare physician leaders to create a culture of continual improvement
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
A 360° view of value-based healthcare: how to position your facility for successSourceMed
The shift from volume to value-based healthcare is underway and many outpatient providers are already participating. How are you preparing for this transition?
This presentation will explore the move to value-based care, and share ways for your facility to adapt what it is doing today to thrive under collaborative service delivery models, including: revenue cycle management, data analytics, patient engagement and system interoperability.
The Future of Healthcare in Consumerism WorldCitiusTech
The main aim of this document is to provide an overview of healthcare consumerism, its growth drivers and challenges / barriers providers and payers face while adopting it. The document provides insights on how providers and payers can tackle the rising wave of consumerism in healthcare industry. The document also provides some real-life examples on market trends which emphasize the need to brace consumerism in healthcare
Health Accounts Peer-Learning Workshop: Summary of Key Themes and DiscussionsHFG Project
In November 2016, over 60 government technicians, policymakers and technical advisors from 47 countries across the Americas, Africa, Asia and Europe participated in the first global Health Accounts Peer-Learning Workshop. During this workshop, participants shared their experiences and ideas on how to improve Health Accounts production and increase the uptake of Health Accounts results for policy.
PYA Speaks the New Language of HealthcarePYA, P.C.
PYA Principal David McMillan addressed the 2013 Florida Institute of Certified Public Accountants Health Care Industry Conference and offered a consultant-turned-linguist perspective on “Learning the New Language of Healthcare.”
Making the shift to value-based care is not easy. However, a growing number of healthcare organizations are finding success leveraging Lean process improvement and health IT to reduce waste, lower costs, and improve quality.
In fact, leading health systems like Bon Secours, Prevea Health, and North Mississippi Medical Center are using these principles to improve care management processes and achieve better patient outcomes.
We have assembled these strategies into a new whitepaper. You will learn:
- How key concepts of Lean thinking can be applied to healthcare
- Why high-performing practices are using Lean to enable care team members to provide better care
- The financial advantages of a team-based, population health management approach in a value-based reimbursement system
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
The ACA and other health reform initiatives have driven the need to use analytics to enhance the care management experience. As workflows change and new approaches are explored, patient motivation becomes the “tipping point” of success in surfacing true opportunities for reduced and avoidable costs. This session will explore how to combine analytics, using patient motivation as a cornerstone, and incorporating greater insights into the clinical workflows, resulting in successful engagements.
Moving to Value Based Care – Leveraging advanced analytics to measure physici...LexisNexis Risk Solutions
Payment reform and emphasis on value-based care is forcing payers, ACOs, and Integrated Delivery Networks to look for ways through which physician performance can be evaluated and measured over time with the goal of creating highly efficient and effective physician networks. With more pressure and risk moving to physicians – they will expect fair measurement of quality against their peers. Join this webinar to understand the implications of value-based care as it relates to physician performance analysis and why the ability to effectively monitor physicians with less than acceptable cost performance and those with high-quality performance will be non-negotiable.
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Care Management Platforms for Population Health: Seven Real-World Best PracticesCognizant
Our experience with large platforms offers important lessons and strategies that healthcare organizations can successfully replicate when deploying a population health-oriented care management system.
Provides an overview of the current revenue cycle management and its processes and offers a point-of-view on today’s RCM trends and areas of transformation.
Evolving CMS Quality Measures Move Towards More Patient-Centered Care, Less B...Health Catalyst
With today’s comprehensive Meaningful Measures initiative, CMS has refocused healthcare quality measures on improving patient needs and experiences, reducing regulatory burden on clinicians, and removing barriers to value-based payment. The evolved quality measures center on patient, clinician, and health system needs and strategic goals to truly impact improving care and lowering costs.
Meaningful Measures, according to CMS, must meet seven criteria:
Are patient-centered and meaningful to patients, clinicians, and providers.
Address high-impact measure areas that safeguard public health.
Are outcome-based where possible.
Minimize the level of burden for providers.
Create significant opportunity for improvement.
Address measure needs for population-based payment through alternative payment models.
Align across programs.
Patient Satisfaction : The Indispensable OutcomeCare Analytics
As we move into the future, the measurement of patient satisfaction is becoming less of a luxury and more of a necessity for medical groups and facilities. It is increasingly important that a patient-satisfaction program be done well, using sound protocol and methods.
Survey findings can also be used for accreditation and marketing. In this era of increasing competition and high patient demand for health care excellence, medical groups and skilled nursing facilities cannot afford to forgo the insights they can derive from patient-satisfaction surveys.
IHP 630 Final Project Guidelines and Rubric Overview MalikPinckney86
IHP 630 Final Project Guidelines and Rubric
Overview
The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.
The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize
reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare
administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement
guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front
desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes
to ensure organizational processes and internal policies are implemented.
Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement
methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along
with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare
settings.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final
submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final submission is due in Module Nine.
In this assignment, you will demonstrate your mastery of the following course outcomes:
Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning
Analyze federal, state, and third-party payer regulations and reporting guidelines for ensuring compliance with healthcare reimbursement requirements
Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement
Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer
models
Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-for-
performance incentives
Prompt
Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated
with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the
revenue cycle affect various de ...
Top Healthcare and Revenue Cycle Trends to watch for in 2019Manish Jain
2017 required healthcare organizations to respond to several new challenges – political change, growing role of technology, shift to value-based care and the increasing role of information security. While we anticipate that these issues will continue to influence through 2018, we will also see new challenges. The blurring lines between providers and payers, a refocusing on care (and more so on the patient), and a changing policy environment will occupy the center stage for 2018.
Hospitals and health systems are struggling to maximize the benefits of innovative technology to better manage uncompensated care and revenue integrity, suggests a HFMA/Navigant survey of 125 provider CFOs and revenue cycle management executives.
This is the fourth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
POV Healthcare Payer Medical Informatics and AnalyticsFrank Wang
Health Insurance / Payer Analytics
Medical Informatics
Fraud Detection
Care Management
Utilization Management
Business Performance Management
Clinical Outcome Measures
The Foundations of Success in Population Health ManagementHealth Catalyst
From hospital systems to large employers, organizations are increasingly taking on financial risk for the health of populations. Drivers of this trend include the update to the MSSP model, the recent CMS Primary Cares Initiative announcement, the increasing prevalence of the Medicare Advantage model, innovative partnerships in the self-insured employer space, and the proliferation of Medicaid ACOs. Yet while market pressures push organizations toward population risk, they don't necessarily help them succeed: most organizations are struggling to attain or sustain the dual imperatives of high-quality care and cost containment. A primary reason? Short-sighted and tactical approaches that don't provide the flexible data infrastructure and tools to adapt to emerging trends in population health—or to support short-term contractual requirements while building toward long-term success.
View this launch webinar to learn about Health Catalyst’s Population Health Foundations solution, a data and analytics-first starter set aimed at optimizing performance in value-based risk arrangements and providing the data ecosystem that will flex and adapt to complex needs of risk-bearing organizations. Solution services ensure that the strategic value of data is maximized to improve performance in risk contracts—and provide side-by-side subject matter expert partnership for establishing short- and long-term goals for population health management (PHM).
Built on Health Catalyst’s foundational technology and supported by the nationwide experience and perspective of its experts, the Population Health Foundations solution helps organizations leverage multiple data sources to understand their patient populations and create meaningful views of financial and clinical quality performance. As a starter set that organizations can build on based on their needs, the solution is designed to compensate for the known limitations of “black box” population health applications that fail to reveal the “why” of analytic insights and exacerbate the challenges of transforming quality, cost, and care. The Population Health Foundations solution delivers the essential analytic tools needed for success under value-based risk arrangements.
In these slides you can expect to:
- Review recent changes to the field of value-based care, and reactions and insights from the market
- Discover how the Population Health Foundations solution can act as a comprehensive, data-first analytics solution to support your population stratification and monitoring needs
- Understand how this solution functions as a foundational starter set for value-based care success, enabling clients to leverage all their data and other relevant population health tools
Using Adaptive Scrum to Tame Process Reverse Engineering in Data Analytics Pr...Cognizant
Organizations rely on analytics to make intelligent decisions and improve business performance, which sometimes requires reproducing business processes from a legacy application to a digital-native state to reduce the functional, technical and operational debts. Adaptive Scrum can reduce the complexity of the reproduction process iteratively as well as provide transparency in data analytics porojects.
It Takes an Ecosystem: How Technology Companies Deliver Exceptional ExperiencesCognizant
Experience is evolving into a strategy that reaches across technology companies. We offer guidance on the rise of experience and its role in business modernization, with details on how orgnizations can build the ecosystem to support it.
The Work Ahead: Transportation and Logistics Delivering on the Digital-Physic...Cognizant
The T&L industry appears poised to accelerate its long-overdue modernization drive, as the pandemic spurs an increased need for agility and resilience, according to our study.
Enhancing Desirability: Five Considerations for Winning Digital InitiativesCognizant
To be a modern digital business in the post-COVID era, organizations must be fanatical about the experiences they deliver to an increasingly savvy and expectant user community. Getting there requires a mastery of human-design thinking, compelling user interface and interaction design, and a focus on functional and nonfunctional capabilities that drive business differentiation and results.
The Work Ahead in Manufacturing: Fulfilling the Agility MandateCognizant
According to our research, manufacturers are well ahead of other industries in their IoT deployments but need to marshal the investment required to meet today’s intensified demands for business resilience.
The Work Ahead in Higher Education: Repaving the Road for the Employees of To...Cognizant
Higher-ed institutions expect pandemic-driven disruption to continue, especially as hyperconnectivity, analytics and AI drive personalized education models over the lifetime of the learner, according to our recent research.
Engineering the Next-Gen Digital Claims Organisation for Australian General I...Cognizant
In recent years, insurers have invested in technology platforms and process improvements to improve
claims outcomes. Leaders will build on this foundation across the claims landscape, spanning experience,
operations, customer service and the overall supply chain with market-differentiating capabilities to
achieve sustainable results.
Profitability in the Direct-to-Consumer Marketplace: A Playbook for Media and...Cognizant
Amid constant change, industry leaders need an upgraded IT infrastructure capable of adapting to audience expectations while proactively anticipating ever-evolving business requirements.
Green Rush: The Economic Imperative for SustainabilityCognizant
Green business is good business, according to our recent research, whether for companies monetizing tech tools used for sustainability or for those that see the impact of these initiatives on business goals.
Policy Administration Modernization: Four Paths for InsurersCognizant
The pivot to digital is fraught with numerous obstacles but with proper planning and execution, legacy carriers can update their core systems and keep pace with the competition, while proactively addressing customer needs.
The Work Ahead in Utilities: Powering a Sustainable Future with DigitalCognizant
Utilities are starting to adopt digital technologies to eliminate slow processes, elevate customer experience and boost sustainability, according to our recent study.
AI in Media & Entertainment: Starting the Journey to ValueCognizant
Up to now, the global media & entertainment industry (M&E) has been lagging most other sectors in its adoption of artificial intelligence (AI). But our research shows that M&E companies are set to close the gap over the coming three years, as they ramp up their investments in AI and reap rising returns. The first steps? Getting a firm grip on data – the foundation of any successful AI strategy – and balancing technology spend with investments in AI skills.
Operations Workforce Management: A Data-Informed, Digital-First ApproachCognizant
As #WorkFromAnywhere becomes the rule rather than the exception, organizations face an important question: How can they increase their digital quotient to engage and enable a remote operations workforce to work collaboratively to deliver onclient requirements and contractual commitments?
Five Priorities for Quality Engineering When Taking Banking to the CloudCognizant
As banks move to cloud-based banking platforms for lower costs and greater agility, they must seamlessly integrate technologies and workflows while ensuring security, performance and an enhanced user experience. Here are five ways cloud-focused quality assurance helps banks maximize the benefits.
Getting Ahead With AI: How APAC Companies Replicate Success by Remaining FocusedCognizant
Changing market dynamics are propelling Asia-Pacific businesses to take a highly disciplined and focused approach to ensuring that their AI initiatives rapidly scale and quickly generate heightened business impact.
The Work Ahead in Intelligent Automation: Coping with Complexity in a Post-Pa...Cognizant
Intelligent automation continues to be a top driver of the future of work, according to our recent study. To reap the full advantages, businesses need to move from isolated to widespread deployment.
The Evolution of Non-Banking Financial Companies (NBFCs) in India: Challenges...beulahfernandes8
Role in Financial System
NBFCs are critical in bridging the financial inclusion gap.
They provide specialized financial services that cater to segments often neglected by traditional banks.
Economic Impact
NBFCs contribute significantly to India's GDP.
They support sectors like micro, small, and medium enterprises (MSMEs), housing finance, and personal loans.
how can I sell pi coins after successfully completing KYCDOT TECH
Pi coins is not launched yet in any exchange 💱 this means it's not swappable, the current pi displaying on coin market cap is the iou version of pi. And you can learn all about that on my previous post.
RIGHT NOW THE ONLY WAY you can sell pi coins is through verified pi merchants. A pi merchant is someone who buys pi coins and resell them to exchanges and crypto whales. Looking forward to hold massive quantities of pi coins before the mainnet launch.
This is because pi network is not doing any pre-sale or ico offerings, the only way to get my coins is from buying from miners. So a merchant facilitates the transactions between the miners and these exchanges holding pi.
I and my friends has sold more than 6000 pi coins successfully with this method. I will be happy to share the contact of my personal pi merchant. The one i trade with, if you have your own merchant you can trade with them. For those who are new.
Message: @Pi_vendor_247 on telegram.
I wouldn't advise you selling all percentage of the pi coins. Leave at least a before so its a win win during open mainnet. Have a nice day pioneers ♥️
#kyc #mainnet #picoins #pi #sellpi #piwallet
#pinetwork
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
BYD SWOT Analysis and In-Depth Insights 2024.pptxmikemetalprod
Indepth analysis of the BYD 2024
BYD (Build Your Dreams) is a Chinese automaker and battery manufacturer that has snowballed over the past two decades to become a significant player in electric vehicles and global clean energy technology.
This SWOT analysis examines BYD's strengths, weaknesses, opportunities, and threats as it competes in the fast-changing automotive and energy storage industries.
Founded in 1995 and headquartered in Shenzhen, BYD started as a battery company before expanding into automobiles in the early 2000s.
Initially manufacturing gasoline-powered vehicles, BYD focused on plug-in hybrid and fully electric vehicles, leveraging its expertise in battery technology.
Today, BYD is the world’s largest electric vehicle manufacturer, delivering over 1.2 million electric cars globally. The company also produces electric buses, trucks, forklifts, and rail transit.
On the energy side, BYD is a major supplier of rechargeable batteries for cell phones, laptops, electric vehicles, and energy storage systems.
where can I find a legit pi merchant onlineDOT TECH
Yes. This is very easy what you need is a recommendation from someone who has successfully traded pi coins before with a merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi network coins and resell them to Investors looking forward to hold thousands of pi coins before the open mainnet.
I will leave the telegram contact of my personal pi merchant to trade with
@Pi_vendor_247
What website can I sell pi coins securely.DOT TECH
Currently there are no website or exchange that allow buying or selling of pi coins..
But you can still easily sell pi coins, by reselling it to exchanges/crypto whales interested in holding thousands of pi coins before the mainnet launch.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and resell to these crypto whales and holders of pi..
This is because pi network is not doing any pre-sale. The only way exchanges can get pi is by buying from miners and pi merchants stands in between the miners and the exchanges.
How can I sell my pi coins?
Selling pi coins is really easy, but first you need to migrate to mainnet wallet before you can do that. I will leave the telegram contact of my personal pi merchant to trade with.
Tele-gram.
@Pi_vendor_247
Empowering the Unbanked: The Vital Role of NBFCs in Promoting Financial Inclu...Vighnesh Shashtri
In India, financial inclusion remains a critical challenge, with a significant portion of the population still unbanked. Non-Banking Financial Companies (NBFCs) have emerged as key players in bridging this gap by providing financial services to those often overlooked by traditional banking institutions. This article delves into how NBFCs are fostering financial inclusion and empowering the unbanked.
how to sell pi coins in South Korea profitably.DOT TECH
Yes. You can sell your pi network coins in South Korea or any other country, by finding a verified pi merchant
What is a verified pi merchant?
Since pi network is not launched yet on any exchange, the only way you can sell pi coins is by selling to a verified pi merchant, and this is because pi network is not launched yet on any exchange and no pre-sale or ico offerings Is done on pi.
Since there is no pre-sale, the only way exchanges can get pi is by buying from miners. So a pi merchant facilitates these transactions by acting as a bridge for both transactions.
How can i find a pi vendor/merchant?
Well for those who haven't traded with a pi merchant or who don't already have one. I will leave the telegram id of my personal pi merchant who i trade pi with.
Tele gram: @Pi_vendor_247
#pi #sell #nigeria #pinetwork #picoins #sellpi #Nigerian #tradepi #pinetworkcoins #sellmypi
when will pi network coin be available on crypto exchange.DOT TECH
There is no set date for when Pi coins will enter the market.
However, the developers are working hard to get them released as soon as possible.
Once they are available, users will be able to exchange other cryptocurrencies for Pi coins on designated exchanges.
But for now the only way to sell your pi coins is through verified pi vendor.
Here is the telegram contact of my personal pi vendor
@Pi_vendor_247
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
Elevating Medical Management Services to Meet Member Expectations
1. • Cognizant 20-20 Insights
Elevating Medical Management Services
to Meet Member Expectations
Healthcare payer organizations can lower the cost of commoditized
medical management functions via better and different processes, and
invest the savings in member-centric care management services.
Executive Summary
With the launch of healthcare exchanges and
intensified competition among payers, healthcare consumers are rapidly taking their place at
the center of healthcare transactions. Payers that
deliver rich, member-centric experiences that go
beyond mere claims processing will be positioned
to win — and sustain — market share.
Results from our recent Medical Management
Survey indicate that chief medical officers and
other medical management executives understand this new value proposition (see Figure 1,
next page). (See page 7 for a full description of
the survey.) These decision-makers identified care
management as the component of medical management that delivers the highest satisfaction to
members and consumers. Yet they continue to
invest one-third or more of their medical management budgets in utilization management (UM), a
service that is at best invisible to consumers and,
at worst, seen as a barrier to care.
This white paper examines how payers can
address the gap between the medical management services they know members want and
where their resources are being invested. We
review key survey findings and how these illustrate
where payer organizations must challenge their
traditional thinking about medical management
cognizant 20-20 insights | january 2014
priorities. Finally, we discuss better processes and
different approaches that payers are evaluating
to control costs and avoid unnecessary care while
delivering member-facing programs that achieve
and grow their competitive value.
Aligning Satisfaction Drivers with
Financial and Clinical Resources
Like most businesses, healthcare payer organizations must balance cost reduction mandates with
the need to offer more individualized services and
products delivered via current technologies. Our
survey results indicate that payers could achieve
the financial flexibility necessary to carry out
this dual mandate by rethinking how they apply
medical management resources.
Key Finding #1: Payer CMOs and clinical
directors say care management is a critical
driver of member satisfaction.
Of the chief medical officers and clinical directors
surveyed, 42% cited care management programs
as the leading factor in delivering satisfying
benefits, while 35% named disease management for the top spot. Taken together, 77% of
respondents agreed that member-facing case
and disease management programs deliver the
highest level of member satisfaction (see Figure
2, next page).
2. Survey at a Glance
Execs may need
to re-allocate
budget to member
satisfaction…
…however…
77%
34%
Many respondents believe
care management delivers
member satisfaction…
70%
…over one-third of the
budget continues to be
allocated to utilization
management.
Nearly
50%
Reforms
…as multiple industry
reforms continue to
be a challenge for
payers.
…as a majority of respondents
are not completely satisfied
with existing process
performance.
> 66%
…with almost half of
respondents evaluating
partners for medical
management.
Most plan to streamline
and automate
processes and use
analytics.
Global delivery models
are also
coming into play…
Respondents
are also keeping
an eye on legislation…
Source: Cognizant 2013 Medical Management Survey
Figure 1
Member satisfaction and “quality of outcomes”
are the two leading metrics by which decisionmakers evaluate the success of medical management efforts. Meanwhile, less than one-quarter of
respondents ranked utilization management as a
key member benefit.
Critical Satisfaction Drivers
Q: What provides the most benefit
to your members?
Case
M
anagement
Disease
M
anagement
Utilization
M
anagement
Source: Cognizant 2013 Medical Management Survey
Figure 2
cognizant 20-20 insights
Key Finding #2: Payers expect little change
in budget allocation for care management
and utilization.
Decision-makers surveyed predicted that more
than one-third of their medical management
budget will be allocated to utilization management in the next two to three years (see Figure
3, next page). Respondents do not expect any significant shifts in budget allocation to care management in this timeframe.
Clearly, payers’ budget priorities are not aligned
with what they say are key member satisfaction
drivers, i.e., care management programs. Utilization management is a commodity. It must be
done quickly and accurately, but those qualities
will not be an advantage for payers competing
for employer or healthcare consumer business.
Meanwhile, shifting budget resources away from
utilization management to care management
offers payers clear opportunities for creating
member-centric programs that create competitive differentiation.
Collecting more meaningful quality of outcome
metrics is a distinct area of differentiation that
2
3. Little Change in Budget Allocation
Q: In the next 2-3 years, what percentage of your medical management
budget do you foresee being allocated to support these programs?
30.8%
Utilization
M
anagement
36.1%
Case
M
anagement
31.9%
Utilization
M
anagement
35.5%
Disease
M
anagement
33.9%
Disease
M
anagement
32.6%
Case
M
anagement
Source: Cognizant 2013 Medical Management Survey
Figure 3
payers could achieve by shifting utilization management spend. Such metrics must go beyond
simple gaps in care, such as overdue procedures
or exams, and measure results in a timeframe
that is longer than the one-year period that satisfies most pricing actuaries. More comprehensive
metrics should be gathered on well-defined treatment groups and the cost and quality of the care
that members receive from specific physicians
and providers. These views can be achieved with
advanced analytics that can discover and analyze
patterns across a wide range of data sources.
“Member satisfaction” data also needs to go
beyond measuring plan member longevity. A more
telling measure is “likelihood to recommend.”
Reallocating administrative spending on utilization management must be done carefully.
Savings realized from utilization management
are more easily and quickly quantified than those
gained from care management programs. Utilization management also helps identify and prevent
unnecessary procedures, contributing to cost
reduction and control.
By adopting different processes and better
approaches, payers can spend less on utilization
management without sacrificing its efficacy. For
instance:
• Global
clinical resources can be used for
the vast majority of utilization requests and
reviews, enabling the reallocation of highly
trained, locally-based registered nurses and
other clinicians to more satisfying work.
• Analytics
programs can be used with large,
disparate data sources — such as financial
and clinical outcomes databases — to probe
for patterns, causes and effects that can help
payers quantify the savings gained from care
management programs, as well as new and
different utilization management processes.
Such data can help justify additional process
improvements and greater financial support
of care management and other member-facing
initiatives.
Building Better and Different
Member-Facing Programs
About 70% of survey respondents said they
were not completely satisfied with their current
medical management processes (see Figure 4,
next page). They intend to adopt a variety of
approaches that could streamline processes and
support more member-facing initiatives (see
Figure 5, next page).
Q: In the next 2-3 years, what percentage of your
medical management budget insights foresee being
do you
cognizant 20-20
3
allocated to support these programs?
4. Room for Improvement with Medical Management
Q: How satisfied are you with your organization’s current medical
management practices?
Not
Satisfied
Not
Satisfied
Slightly
Satisfied
Slightly
Satisfied
Completely
Satisfied
Completely
Satisfied
Not
Satisfied
Slightly
Satisfied
Completely
Satisfied
Source: Cognizant 2013 Medical Management Survey
Figure 4
Key Finding #3: Payers focus on process
improvement to reduce costs.
Almost all survey respondents expect to streamline and optimize existing processes in the next
two to three years to provide better cost manage-
ment. Nearly 75% expect to introduce more automation and new technologies, including social and
mobile, suggesting that payers want to alleviate
any inefficiencies experienced with their current
processes and systems.
An Array of Planned Improvements
Q: Which initiatives for cost reduction in clinical operations do you
expect your organization will implement in the next 2-3 years?
Process improvement
i
nitiatives
Technology and
p
rocess automation
(
social and mobile)
Global delivery
options (sourcing)
Analytics to create
better processes
90%
73%
69%
65%
Pay-as-you-go model
(
subscription-based)
61%
Source: Cognizant 2013 Medical Management Survey
Figure 5
cognizant 20-20 insights
4
5. Additionally, payers want to utilize more data
to make better decisions about members and
business through the use of analytics. Analytics
was cited by 65% of respondents as a means to
drive better processes.
survey results indicate that payers are examining a variety of medical management processes,
including routine discharge follow-up tasks, to
determine whether they are true core activities
or “commodity” processes.
Key Finding #4: Use of external partners and
creative sourcing for medical management is
likely to grow.
Streamlining commodity processes, such as
intake, pre-certification reviews and concurrent
reviews in utilization management, should give
payers the flexibility to focus on delivering services that build member loyalty and satisfaction.
These include case management and health and
wellness programs.
Respondents see utilization management intake
and review (60%) and case management (50%)
as two key areas for partnering with an external
service provider. Respondents said discharge
follow-up and managing readmission rates were
additional sourcing candidates, with nearly 40%
indicating these would be appropriate areas for
partnerships.
Almost two-thirds of payers said they are evaluating and are likely to turn to global service delivery
options and sourcing to reduce their clinical operations costs.
In our experience, payers that address dissatisfaction with existing medical management processes can open doors to greater automation
and other, better ways of delivering utilization,
disease and care management. These initiatives
are most likely to succeed if payers re-evaluate
their core competencies and processes to identify
which are commodities vs. competitive differentiators and allocate resources accordingly. Our
At least one leading health plan with which we
work realized savings of up to 60% per utilization management transaction by combining
more automation with less expensive yet highly
qualified global clinical resources delivering
routine reviews.
Furthermore, applying analytics to abundant
aggregated member data will improve a variety of
payer processes and deliver richer member experiences. Better and earlier risk stratification, personalization of case management programs and
behavioral economics-based member engagement models can be driven through the use
of member and core business analytics. These
analytics-derived insights enable payers to move
from process-centric to member-centric business
models.
Vast Majority Planning New Technology Platforms
Q: Has your organization implemented technology platforms
that help support care and medical management?
In place
20%
In preliminary stages
of evaluation
34%
Under active
consideration
92% under
various stages of
implementation
24%
Decided on
platform, but not
implemented yet
14%
Currently
not in plans
4%
Figure 6
cognizant 20-20 insights
5
6. Adopting technology that digitally savvy younger
consumers now rely on in their daily lives also
will enable payers to deliver richer experiences to
members, such as self-service mobile portals and
on-demand data delivery. Healthcare consumers
have said e-mail, text and voicemail can be as
helpful as in-person provider visits or phone
calls.1 Millennial consumers in particular already
use social technology regularly for healthcare
purposes.2 Savings that are achieved by streamlining noncore processes, including utilization
management, should be invested into digital
transformation.
Challenging Assumptions about
Utilization Management Efficiencies
Our research indicates that few payers are completely satisfied with their utilization management processes, with about 70% indicating room
for improvement. Payers working through the
following checklist can identify where utilization
management may be more expensive and less
efficient than it appears.
1. Evaluate your current spend on utilization
management. Are expenses high because of
an inefficient process? Are expenses too low,
indicating a potential loss of opportunity for
cost savings?
2. Create models that show ROI for all utilization reviews. Account for the “sentinel
effect,” i.e., treatments that are not requested
or ordered because they are unlikely to pass
a utilization request. This ROI model should
be adjusted at least once a year based on unit
costs and cost per utilization management
(UM) review.
3. Determine cost per UM review. This review
should also calculate the cost of appeals,
including the expense of sending cases to
independent review organizations and the
percentage of cases found in favor of providers
and/or members. Another cost to consider is
the impact of such reviews on provider and
member relations.
4. Evaluate utilization management automation
levels. Automation that can significantly
reduce utilization management costs while
improving its performance includes provider
self-service portals with decision support;
automated queues and workflows; automated
processing of routine requests; and auto-generated routine correspondence.
5. Evaluate “up to license” use of clinicians.
Using highly trained, locally-based registered
cognizant 20-20 insights
nurses to assemble records or conduct routine
reviews is an inefficient use of expensive
resources. More member satisfaction can be
gained by realigning these clinicians with highvalue, member-facing programs.
Our internal calculations reveal that many payers
are spending $1.50 to $2.30 per member per
month for utilization management. These costs
may be reduced to $1.00 per member per month
via global delivery models. Utilization management cost reductions vary depending on payer
automation levels (such as the availability of
physician self-serve Web portals) and the rate
of global service delivery adoption. In general,
cost saving are achieved by using offshore skilled
nurses to do routine utilization management
work. The more work a payer sends offshore,
the greater the savings. If a payer also has Web
portals, physicians and/or members can use it to
check pre-authorizations (vs. phone calls, letters,
etc.), which leads to additional cost savings.
Accepting the Challenge to Transform
Medical Management
Payers seeking to boost their competitiveness in
an evolving healthcare market must answer these
questions:
• How well does the organization’s clinical budget
align with member and consumer priorities?
• How will the organization create a differentiated experience for members?
• How
will process transformation and new
technology initiatives be funded?
It is a challenge to balance the dual requirements
of cost reduction and member satisfaction. That
said, many payers already have the resources to
achieve both goals locked within their traditional
approaches to medical management.
By challenging conventional wisdom about how to
derive value from utilization management, payer
organizations can transform a wide range of utilization review processes. The savings they gain
can be shifted to care management programs
that enable them to build more personal, customized relationships with their members. Such
relationships will build on payers providing tools
and information that members can use to better
manage their health as their life circumstances
change. These member-centric services deliver a
competitive advantage today and a firm foundation for additional future growth.
6