iworks healthcare Administrative Systems Integration

iworks healthcare Administrative Systems Integration

Helping You Capitalize on Change Healthcare reform is prompting insurers to take aggressive steps today to prepare for tomorrow s uncertainty. By deploying SunGard s award winning solutions, insurers are able to streamline operations with a proven partner that knows Servicing, Care Management, Medical Loss Ratios and understands the broader industry. iworks Healthcare enables payers to achieve the vision of integrated healthcare management. This award-winning platform wraps around existing business systems to improve organizational agility, increase productivity and ensure regulatory compliance.

iworks HOST SYSTEM INTEGRATION: A Single system wrapper Bridge operational gaps, creating a unified workflow. Healthcare plans make significant investments in the core administration (or host) systems used every day to support key functions across different areas of the organization. Each host system is the operational centerpiece for the unique line of business, location or division it serves, and each brings its own set of user procedures. Many plans, over time, have acquired multiple host systems through mergers, acquisitions and new system purchases. With multiple hosts come complexity and management challenges to the broader organization. Consistency in reports, user training and efficiency levels can vary widely from one host environment to the next, making it difficult to manage the overall operation. SunGard s iworks Healthcare s integration solution helps bridge these operational gaps, linking users, content, processes and systems by creating a unified workflow with a single system wrapper. This wrapper interacts with multiple core systems to help:» Improve operational efficiencies, eliminating manual steps» Standardize production reports» Reduce reliance on additional software and interfaces» create more streamlined business processes» Simplify the user experience with a common access interface to multiple hosts Augments, rather than replaces, existing systems Unifies and normalizes information across disparate platforms and operating systems Provides a consistent production environment for users accessing disparate applications Securely manages data flow from multiple platforms Provides access to structured and unstructured data in standard formats A common user experience for host system interactions also makes user training more consistent and increases the opportunities to cross-train users for different host environments. Additionally, content is maintained in a common repository with granular security, reducing the need for paper and increasing security and privacy compliance. SunGard s iworks Healthcare s system integration helps healthcare payers save interface development and staffing costs, manage and enhance applications without significant IT resources, improve client relationships through timely delivery of information and reinforce compliance initiatives.

Host-User Workflow Patterns While many possible variations exist, two general usage patterns, as seen below in Diagram 1, represent most processing environments: userdependent and localized workflow. In the user-dependent pattern (Host System A below), the user, not the software, determines the work to be completed and the priority, often without reference to conditions in the host system. In many cases, the user-dependent pattern is paper intensive. If electronic imaging is available (e.g. claims images), the user must type in key values to retrieve the image most appropriate to the work. In the user localized workflow pattern (Host System B below), software determines the most appropriate work for the user. The work selection may come from within the host system itself, or alternatively, the selection may occur in a thirdparty workflow system integrated to sequence user work according to conditions within the host. Often, the workflow applications are limited to only one host system even if the hosts are the same kind. As in the user-dependent pattern, imaging is optional, though it is more likely if a third-party workflow is integrated. In either scenario, it is difficult to achieve consistency in production reports, claims inventory and prioritization of work at an organizational level. Diagram 1: Two prevalent host-user workflow patterns Two operations separated within a common organization Host System A (Workflow depends on user) Paper Host System B (Host or other workflow) Image & Paper HOST PATTERN A HOST PATTERN B

Wrapping Multiple Hosts In Diagram 2 below, the organization s host systems are integrated, or wrapped, with a single instance of content, process and rule capabilities. Each host system retains its distinctive abilities within a unified framework; the wrapper does not attempt to merge or blend the host platforms. Rather, the wrapper provides a common production environment for users who interact with the host systems. This helps reduce training and increase user productivity. Images and supporting documentation are maintained in a common repository with granular security. This greatly reduces, or even eliminates, the need for paper, thereby increasing security and privacy compliance. Content is sequenced for users according to conditions determined by the respective host system. Each host is incorporated according to its capabilities and overall business model. Analysts or managers provide rules and process designs to enforce best business practices practices which can include both organization wide and local standards for each host area. Some of the benefits from wrapping multiple hosts include:» Automated Work Distribution» consistent Reporting» Image & Data Synchronization» compliance Support» consistent Security Enforcement» Reduced Training Cost» Consistent User Interface Diagram 2: Wrapping multiple hosts Host System A Host System B Graphical Process Business Rules IF Pending-Code = Adjustment AND High-Dollar = TRUE THEN Priority = HIGH HOST WRAPPER BUSINESS ANALYST/MANAGER Image & Paper HOST USERS COMMUNITY Host User Interface

iworks Healthcare Partnering for Success Working as a team with both customers and other technology providers pays dividends. Customers obtain more elegant solutions truly tailored to their organization. Technology partners can leverage their particular expertise more effectively. SunGard works with customers of all sizes, including some of the world s largest insurers, all of whom appreciate how technology can power their success. We are also proud to work closely with leading technology providers like Microsoft and HP. Support Services Each of our customers is assigned a dedicated Technical Support Representative that understands the insurance market and your unique system configuration. Management Team Each of our customers is assigned a dedicated Sales Executive who is responsible for managing their relationship with SunGard. They are a resource that is always available to assist you with business related questions and provide a broad depth of SunGard s technology and best practices across industries. Your Sales Executive is accountable for your satisfaction and is driven to ensure your success. Implementation We have a proven implementation strategy that is built on a staged delivery methodology and formalized implementation plan which has been successful in more than 250 implementations in the healthcare payer market. About SunGard SunGard is one of the world s leading software and technology services companies. SunGard has more than 20,000 employees and serves 25,000 customers in 70 countries. SunGard provides software and processing solutions for financial services, higher education and the public sector. SunGard also provides disaster recovery services, managed IT services, information availability consulting services and business continuity management software. With annual revenue of about $5 billion, SunGard is ranked 434 on the Fortune 500 and is the largest privately held business software and IT services company. Look for us wherever the mission is critical. For more information, visit www.sungard.com. About SunGard s iworks Healthcare SunGard has been helping healthcare payers succeed for more than twenty years. Our award winning Macess and FormWorks solutions are trusted in a wide range of operational areas including claims, / service, Enrollment, Appeals, Authorizations, ing, Marketing, Legal and many others. Healthcare payers also depend on SunGard s Financials solutions for comprehensive accounting and reporting to meet the stringent demands of regulators and stakeholders. Our healthcare payer clients cover the spectrum of size and specialty from indemnity to managed care, individual and group products, from fully funded to TPA financial models. With hundreds of implementations in this range of healthcare payers, SunGard compliments core platforms from other vendors and enhances many in-house applications The iworks solution suite is used by more than 2,500 customer sites in more than 50 counties. The iworks suite provides business-focused technology solutions for the insurance industry in each of the following major business lines: life/ health/annuities/pensions, property and casualty and reinsurance. For additional information on SunGard s iworks Healthcare Solutions, please go to www.sungard.com/iworkshealthcare or contact us at iworks.info@sungard.com.

www.sungard.com/iworkshealthcare For additional information on SunGard s iworks Healthcare Solutions, please go to www.sungard.com/iworkshealthcare or contact us at iworks.info@sungard.com. SunGard 104 Inverness Center Place Birmingham, AL 35242 Tel: 205-437-7500 iworks.info@sungard.com 2011 SunGard. Trademark information: SunGard, the SunGard logo and iworks are trademarks or registered trademarks of SunGard Data Systems Inc. or its subsidiaries in the U.S. and other countries. All other trade names are trademarks or registered trademarks of their respective holders.