Healthcare

Helping Healthcare Payers Modernize Operations and Improve the Member Experience.

Improve Member Experience

Digitize Services

Modernize Legacy Infrastructure

Reduce Costs

 

Personalize Care

Are You Ready?

Healthcare is changing rapidly due to advancements in technology, increasing member expectations for information and services, unparalleled access to data and shifts in both regulation and reimbursement practices.

To stay competitive and improve outcomes, healthcare payers must be able to provide products and services of greater value to their customers.

We Can Help

Our experts deliver targeted strategy, data and technology solutions so healthcare payers can gain insights about member expectations and align their products and services to deliver the best customer experience.

From IT modernization and process optimization, to data-driven business and technology planning, we can help you close efficiency gaps, create a digital member experience, ensure payment integrity and comply with ever-changing regulatory demands.

Solutions

Our team of experts can help you with:

Payer Modernization

  • Legacy System Modernization
  • Data Migration – Legacy to Cloud
  • Business Process Reengineering
  • Workflows
  • DevOps
  • Agile Transformation

Digital Member Experience

  • User Experience
  • Program Management
  • Digital Platforms
  • Mobile Application Development

Data

  • Cloud Migration
  • Big Data
  • Data Strategy & Architecture
  • Advanced Analytics – Descriptive, Predictive, Machine Learning
  • Business Intelligence & Operational Reporting
  • Data Governance

Payment Integrity

  • Fraud & Waste
  • Provider Data
  • Other Party Liability
  • Quality Assurance

NextGen Claims Processing

  • Seamless Adjudication
  • Pre- & Post-Adjudication

Audits and Compliance

  • CMS Audits
  • OIG Audits
  • Claims Audits

Product Management

  • Benefits Design
  • Benefits Administration
  • Product Development

Maturity Models

  • Agile Data Maturity Model
  • Agile Cloud Maturity Model
  • Agile Adoption Maturity Model

How Mature is Your Member Experience?

A member-centric healthcare payer requires advanced maturity across technology, data and people processes. Our experts have created three maturity models to help you assess your current state, create actionable roadmaps for improvement and implement changes to mature your organization.

Agile Data Maturity Model

Transition from data-aware to data-driven by analyzing your data maturity across six operational dimensions – Governance, Data Management, Organization, Quality Engineering, Architecture and Analytics.

Agile Adoption Maturity Model

Examine the value of Agile practices across the Team, Project, Portfolio and Enterprise levels.

Agile Cloud Maturity Model

Guide your adoption of the Cloud to leverage Managed Services and implement DevOps.

 

Federal Employee Healthcare

With more than a decade of experience supporting the business and IT initiatives of Federal Employee Healthcare, our experts understand your unique regulatory, governance and security needs and challenges.

  • We have led and supported small and large scale projects that have been driven by changes in federal laws and mandates, adoption of next generation technology, reporting and audit requirements, and strategic planning.
  • We bring deep institutional knowledge in the frameworks, processes and expertise that is required to support the plan, build and run activities found in Federal Employee Healthcare organizations.
  • We can help navigate regulatory environments and provide expertise in security, reporting and governance.

We develop strategies for federally funded programs – as well as design, build and implement applications that improve efficiencies and the member experience.

Latest Thinking

Let’s Get Started