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Gain Insights into Current Technology Trends and Challenges Impacting Insurers and Healthcare Payers

Introducing Oracle Insurance Cloud Solutions for Healthcare Payers

The market dynamics of the healthcare industry have changed significantly with the growing impact of consumerism, digitalization, preventative healthcare and regulations. Given these rapid paces of changes in healthcare, health insurers must be equipped with flexible, adaptive IT systems. They need technology to effectively transform with the times. More than ever, payers need to move with lightning speed and accuracy. They must be able to create new products, modify plans, execute new reimbursement models, and much more.

Oracle Insurance Cloud Services

Flexibility is the name of the game and the new gold standard in health IT systems, yet many payers remain ill-equipped with rigid legacy systems. A majority of health insurers reported that they would have to replace some or all of their legacy systems, and most didn’t have effective processes in place to replace them. Evidently, many health insurers are struggling with rigid, antiquated systems incapable of supporting quick change.

To effectively address these issues, health insurers should consider cloud computing. Cloud services offer scalability and the ability to adjust to demand rapidly. Cloud services can also provide faster deployments and higher customer satisfaction as well as improved collaboration and productivity. Additionally, the economic benefits of cloud computing can be significant since cloud computing provides cost flexibility and the potential for reduced costs. So, the question now is: Is there reliable vendor that provides core systems functionality in the cloud?

Oracle is pleased to announce the new release of Oracle Insurance Cloud Services solutions. Unlike some vendors that “cloud enable” their existing software products by putting the old software in the cloud, Oracle Insurance Cloud Services solutions were built from the ground up to work optimally in the cloud. Oracle is the only large-scale cloud provider that builds the entire stack in-house: hardware, firmware, software-defined networks, and business software. Healthcare payers have the option to deploy Oracle’s HIPAA-compliant components independently alongside their legacy systems or as a comprehensive suite. Because the Oracle solution is SOA-based, users can easily integrate with existing applications, scale up and consolidate systems.

The new Oracle Cloud Services products that are available for healthcare payers are:

Oracle Insurance Policy Administration Cloud Service

The Oracle Insurance Policy Administration Cloud Service is designed specifically for the healthcare insurance market and is built to support a large volume of plans and members. The product also includes a flexible configuration rules engine that is designed to enable health insurers to respond to regulatory changes. With Oracle Insurance Policy Administration Cloud Service, healthcare payers can effectively manage more members, meet changing regulatory requirements and improve patient and provider experiences.

Policy Administration

Oracle Insurance Policy Administration Cloud Service Highlights:

  • Policy Administration – Allows customers to administer their group and individual membership and to calculate plan premiums in a flexible, agile, and scalable way. Key Features: book of record for member enrollment and policy administration, premium calculation and premium financial transactions generation.
  • Commissions – Calculates commission based on written premium and is highly configurable to account for changing rates, brokers and agents over time. Key Features: Rules-based setup to define commission rule details and commission calculations as well as automatic generation of financial transactions for calculation and recalculation.
  • Cafeteria-Style Benefits Tracks members’ products, liabilities and optional benefits independently: there is no restriction to predefined choice combinations. The premium rate automatically recalculates based on the member’s choices. This feature also includes an enrollment information integration point that can parameterize the claims engine to automatically take into account the member’s choices, in real-time when processing a claim, and determine the applicable coverage and liability.

Oracle Insurance Claims Administration Cloud Service

The Oracle Insurance Claims Administration Cloud Service is designed to manage the entire claims process including authorizations, notifications, referrals, eligibility, straight-forward and/or complex benefit plan configuration and management of numerous provider pricing methodologies. With Oracle Insurance Claims Administration Cloud Service, healthcare payers can manage the claims cost and, in turn, increase revenue.

Claims Administration

Oracle Insurance Claims Administration Cloud Service Highlights:

  • Claims Adjudication – Provides automated claims benefit adjudication
  • Product Definition – Enables payers to efficiently manage benefit plan data and setup benefit plan configuration.
  • Claims Pricing Enables payers to efficiently manage healthcare provider data, setup provider contract configuration, and automate claims pricing.
  • Authorizations – Administer Authorization requests and determines whether Authorizations should be Approved or Denied, based on configurable business rules and manual medical review steps.
  • Analytics – Provides payers with pre-built dashboards and reports to allow for efficient management of the day-to-day claims operations. 

Transform to Digital Health

There is no longer a debate on whether the cloud is the best option for enterprise organizations. Multiple studies show resounding agreement among analyst firms, research organizations, and IT experts: the future is in the cloud. For healthcare payers facing uncertainty, Oracle Insurance Cloud Services provide the flexibility they need to transform their operations. Oracle Cloud solutions enable health insurers to adapt to changing circumstances in the market, regulatory agencies, and competitive landscape and help build competitive advantage in the market.

Learn more about Oracle Insurance Cloud Services by visiting cloud.oracle.com.

You may also be interested in reading our new white paper, Six Ways Adaptive IT Systems Are Driving Healthcare Transformation. Download and read the paper today.

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