How We Help Health Insurers
- Soup to nuts process design, system development, software and TPA selection, and systems integration for a brand new health plan
- eBusiness applications for brokers, providers, employers and members, enabling self-service web and mobile applications integrated with enterprise transaction processing systems
- Population health management solutions including the acquisition and integration of social, behavioral, and physical health data from organizations across the community
- Utilization management and care management systems implementations, including the selection and integration of vendor software and carve-out service providers
- Design and delivery of custom small group and individual product systems, including quoting, enrollment, renewals, broker commissions, integration with legacy systems
- Systems to estimate the cost of care episodes for providers and patients based on benefit plans and contracted rates
- Health Care Economics consulting, including predictive modeling, cost of care analysis, and enterprise reporting
- Requirements definition, planning and testing of systems that support the processing for 20+ state health reinsurance pools
- Design, delivery and hosting of a physician and facility credentialing system for a national insurer, enabling our client to resell credentialing data to third parties
- Enterprise data warehouse and analytics assessment, development, and ongoing support
- Selection and implementation of carve-out and disease management vendor solutions
- Design, development and PMO support for hospital and physician pay-for-performance programs
- Post-acquisition integration including sales and marketing integration, claims re-pricing, network and contract rationalization
