Managed care organizations face significant challenges as spending grows disproportionately with misaligned allocations—in an environment of increased utilization and consumer demand for greater choice. Consider:
- Are you providing the tools your members need to access healthcare services proactively?
- How are you tracking the quality of provider services in order to ensure positive outcomes?
- What have you done to lower costs without jeopardizing quality?
- Do you have a forum for trusted, transparent information that both satisfies regulators and educates constituents?
Meet the challenges head onMarket dynamics have forced tradeoffs between cost of care, quality of care and access to services. Efficient organizations typically achieve success in one or two of these areas, but usually not without compromising the other(s).
Proactive managed care organizations have an opportunity to achieve balance across cost, quality and access by optimizing operational processes through better information management.
Business and IT process alignmentBusiness and IT architectures have a limited capacity for integration and interoperability. At the same time, process and technology applications continue to evolve due to growing regulatory requirements and constituent desires for customization and scalability. Addressing consumer-centric requirements requires better ways to standardize and integrate systems and data.
Customized products and servicesData-driven insights enable the creation of acceptable products and services that meet members’ service expectations—often set by their experiences with other industries (financial services, hospitality, retail). For example, managed care organizations can design products customized for a disease state with variable premiums.
Is your managed care organization effectively balancing cost, quality of care and access to services?
IT-driven cost managementAggregating operational and financial information at granular levels can help identify opportunities for tactical cost-cutting initiatives, such as determining the cost of a potentially redundant claims management system on a $PMPM basis.
Our services and solutions include:
- Project and program management
- IT management and due diligence
- System integration and implementation support
- Process optimization
- Customer relationship management
- Business intelligence
- ICD-10 conversion accelerator
- Disease management analytics accelerators
That’s business in the right direction.