Managed e-care. Where are You in the e-healthcare Continuum Today? Vijay K Cheruvu

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1 Managed e-care Where are You in the e-healthcare Continuum Today? By Vijay K Cheruvu

2 Executive Summary CONTENTS Executive Summary Overview Business Case Cognizant s e-solutions e-solutions to Your: Members Insurers Labs Physicians Brokers Cognizant s Design to an Web Based Integrated View of Business Activities e-solutions and Data Warehouse Cognizant Advantage Conclusion The Healthcare Industry faces increasing pressure to deliver low-cost, high quality care in order to keep both the patients and the insurers happy while maintaining profitability. To identify ways to enhance services and lower expenses, HMOs and Healthcare Providers must be able to easily attain a complete, exact picture of their business by consolidating and analyzing Clinical and Financial Data. To help achieve this goal, Cognizant with its immense Technical, and Healthcare Industry knowledge expertise, continuously strives to offer and provide winning solutions to its clients. Solutions that are designed to provide the critical intelligence, considered necessary to improve quality of care and reduce overall administrative and operating costs. It was the late 1990 s Internet boom, that gave easy access to information and the consumers found the new power, forever changing the way they interact with payors, healthcare companies, and pharmaceutical firms. But that was just the beginning. With more direct involvement, financial responsibility and rising demands, consumers are increasingly taking charge of their healthcare experience forcing healthcare companies to rethink their business design. Such demands of the healthcare industry require fast, efficient and automated business solutions to enhance the workflow, productivity, and profitability, while assuring compliance with the regulations of HIPAA. One such fast, efficient and automated business solution is web-based e-reporting, data access, and data analysis. Web-based data analysis, data access, and reporting are an important and widely discussed issue. If a healthcare company s goal is to increase their e-commerce business, then they will need a solid, customizable, and comprehensive web-based reporting system that provides timely information to its providers, payors, members, and to its higher management team. Healthcare Organizations looking to implement e-commerce into their business process share many key objectives. First, they want to bring the services online as soon as possible to begin to realize the economic advantages of the web. They also want to be both secure and easy to use. More than anything else, e-solutions through e-healthcare simply improve the way Managed Care Organizations work.

3 Overview The ability to conduct business, access needed information and communicate with, Labs, Physicians, Insurers, Members and its own employees is the future of all Healthcare Organizations. Technology that enables providing reports, data analysis, data access and other services over the web facilitates a key aspect of e-business. This technology in healthcare industry is what is referred to as e-healthcare; technology that automates the process of gathering and delivering reports and data regularly, reliably in the format desired. Figure 1. e-business Services Growth Projections Source: IDC Figure 2. Projected U.S e-business services spending by healthcare industry Year Services ,170 Source: IDC The main focus of this white paper is to explain the unique advantages of electronic records over paper, by implementing e-healthcare in Managed Care Organizations. It also refers to the positive side of marrying the web services with Data Warehouse. WHAT ARE WEB SERVICES? A means of integrating diverse applications and systems that are linked to an Internet protocol (IP) backbone, web services are founded on an architecture that defines ways to communicate by means of several standards.

4 Business Case In many Managed Care Organizations, if you ask the managers, what information they need to provide to Labs, Physicians, Insurers, and Members and what information do they want to retrieve back from these parties, to effectively operate the business with low-cost and high quality of care, you will certainly get a variety of detailed responses, yet most of the answers will share the same key traits. All users of healthcare information know what data they need. They want to be able analyze the information they need, without spending time on cumbersome manual work (such as printing and reading through hundreds of pages of reports). They want to be able to report easily the information they need in the format desired from different data sources. They want to be able to easily submit the information to their business partners. These user information needs are not usually addressed by an existing legacy electronic report distribution system, generally designed to simply take the report print jobs, split them and distribute them to the recipients. The answer to a wide array of end user requirements is to implement webservices that provide the intended recipients with data analysis capabilities, reporting capabilities and other host of services over the Internet. WHY NOW? Because today, Managed Care Organizations challenge a longstanding need to communicate with heterogeneous systems of trading partners, clearing houses, suppliers, hospitals, labs, and physician offices.

5 Cognizant s e-solutions to Healthcare There are several advantages to various key areas of a Managed Care Organization, when it implements web based e-reporting, data access, data analysis, and other host of web services, to its Insurers, members, labs, physicians, higher management, third party administrators etc. Electronic Records Offer Advantages Over Paper. e-solutions For Your Members/Insurers. Managed Care Organizations want long-term relationships with their members. These days employers switch plans every two or three years and dissatisfied patients always vote with them. So maintaining membership is an obvious goal, especially in an industry where 10% of members voluntarily disenroll each year. Providing access is a major element. Our Solutions Web services to your employer groups and members that give them role based secure and easy access to their information.! e-eob # Providing your members on-demand EOB reports.! e-premium # Collect both monthly premium payments and other payment electronically.! e-enrollment # Electronic enrollment of Members, Insurers.! e-check Status # Members electronically check their Referral, Claim, and Eligibility status.! e-service # Members filling in secure forms over the Internet that can be access by Customer Service for quick turnaround time. Your Benefits! These services would not only bring a great satisfaction to your members but would translate into cost savings through avoided printing and mailing of huge stacks of paper.! Comply with HIPAA requirements by using standardized data format.! Help you streamline administration.! Increased accuracy and timeliness of collecting premium payments.! Membership enrollment processing time decreased significantly.

6 e-solutions For Your Labs. The Value of Laboratory Test Results Data Managed Care Organizations are continuing to shift away from traditional Medical Management Programs to focus on interventions designed to improve the health of an insured population. This strategy emphasizes the importance of sophisticated data integration to identify target populations and track clinical outcomes. Laboratory data are becoming increasingly valuable for health care organizations seeking to promote health improved to their members. Our Solutions Web service to your laboratories, that brings the lab test results straight into your organization and integrates with the patient data. Such patient integrated data in a Managed Care Organization can improve the clinical outcomes and translate into cost savings through avoided hospital admissions.! e-clinical Data # Labs submit the test results data electronically in a timely fashion. Your Benefits! Outpatient laboratory data have the potential to transform population health improvement and outcomes research.! Laboratory claims data reflect process oriented outcomes related to appropriate laboratory services.! Increasing burden and Cost of data collection for HEDIS reporting is significantly decreased.! Integration of laboratory data into claims data provides an enhanced method to profile practitioners.! Lab test results data serve as performance yardsticks. Answers any questions such as Do we have a lot of Asthma? HMOs will need to organize information so that consumers will be able to make choices that meet their needs.

7 e-solutions For Your Physicians/Provider Organizations. Provider Organizations are being challenged to reduce the administrative costs, improve healthcare delivery, and provide patient information at all points on the healthcare continuum. Over the past one-year, many factors have band together to the growth of e-healthcare. These include, an increase in consumer demand, a shift in the physician-patient relationship, and the cost-efficient delivery of technology. Our Solutions Web Services to you Provider Organizations and Physicians, less paperwork and more time for Patients.! e-patient Record # Internet based services to affiliated physicians and practices to help better meet patient needs. Connecting patients to physicians by offering services such as online appointment scheduling. Physicians reporting on patients disease management data, lab tests results.! e-refer to Specialist # Electronic primary care-to-specialist referral program.! Physician Portal (Web Site) # Ensures that patients are getting quality information. Your physicians can become the information portal to the patients. Your Benefits! Access information faster and speed up the process.! Comply with HIPAA requirements by using standardized data format.! Less paper work and more time for patients.! Improved Physician profiling.! Reduce the cost of paper storage and retrieval.! e-solutions for your Provider Organizations translate into cost savings through the advantages of electronic records over paper.! Improved Provider-Patient relationship. e-solutions For Your Brokers. With traditional paper systems, payors take several days to update the information and respond to brokers. Our Solutions! e-broker # Web Application that can display the enrollment and insurance information needed by your brokers to provide price quotes to prospective customers.

8 Your Benefits! Brokers will be able to find data online and distribute the information via standard mailings.! Speed up process and less paper work.! Improved business process. Cognizant has various e-solutions designed for reporting with-in Managed Care Organization, to improve the productivity of its managers, by providing quick, easy, and timely access to clinical and financial data. Figure 3. Web based integrated view of business activities. Source: Cognizant Technology Solutions

9 e-solutions and Data Warehouse Maximize e-healthcare profitability with the power of data warehousing Over the last ten years, given the speed of change in healthcare industry, information can be a strategic advantage. Information also provides the foundation for the planning required to be successful. Gathering information to support timely decisions has always been a challenge in the healthcare industry. Data warehousing found its way into healthcare and has been a valuable tool in the decision support process. Expanding on the data warehouse solution, the e-solutions provide the infrastructure to get the information to the consumers who need it in the form in which they need it and when they need it. e-solutions and data warehousing match bring useful data management advances. Without the web-enabled architecture, the cost of deploying data warehouse tool to hundreds of desktops, the licensing fee, the implementation and support time is too high. e-solutions through web architecture continue to minimize the cost and the effort to provide the information at consumers fingertips. Potential benefits of data warehousing with web-enabled architecture are:! It provides demonstrable data in one version for all reporting and analytical needs.! Online analytical processing systems will open new decision support perspectives for executives through a dynamic and easy to use interface.! Using data marts for analysis would allow business experts to locate answers quicker and solve problems sooner.! Better understanding of populations and providers will improve care management programs.! Confidence in data quality will increase.! Benchmarks will be established.! Labs, Provider Organizations, Brokers, Members, and other consumers will be able to develop of an information-based culture. More and more healthcare organizations are equipping themselves with webenabled Data warehousing systems and looking at their own data in a benchmarking manner, to decrease costs while improving quality of care.

10 The Cognizant Advantage Strong focus on Healthcare With more than person years expertise in developing Healthcare applications, Cognizant possesses extensive domain knowledge of industry business processes. 24x7 onsite/offshore operational model This operational model allows Cognizant to reduce turnaround time of solutions while offering substantial cost savings. Component-based development Cognizant has a well-developed component culture that facilitates the development of e-health solutions using pre-built components. The component repository contains a number of Healthcare business components that substantially reduces the time and effort to develop e-health solutions. HIPAA expertise Cognizant has setup a HIPAA competency center to assess the impact of HIPAA on MCO systems. It has also developed powerful tools to aid in the process of making IT systems HIPAA compliant. Based on this research, Cognizant has developed a comprehensive solution set to achieve HIPAA compliance. Best-of-breed solution Cognizant has forged strategic partnerships with leading e-business infrastructure providers and service providers ensuring that clients get solutions incorporating the best technology, developed at web speed. Emphasis on quality Cognizant's software engineering processes are certified at optimizing level of the SEI-CMM model, which few companies worldwide have been able to emulate. The optimizing level means that Cognizant collects metrics for all projects executes and uses these to make improvements to the processes. Conclusion As you stand at the doorway to e-healthcare and envision a world of opportunity, these e-solutions will help you unlock the door and realize your vision