Friday May 06, 2016

Exploring the Implementation of Prospective Bundling in Health Insurance

Prospective Bundling has gained much attention lately among health plans, mainly due to the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement initiative. In an effort to reduce costs for joint replacement and improve care, CMS is paying for a majority of these now as bundled cases. This means all providers who treat a patient have to share one bundled payment for that procedure. This includes any foreseeable complications and readmissions.

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Wednesday Jan 06, 2016

Webcast: Navigating the Continuum of Health Care Reform: The Role of Bundled Payments

The emergence of value-based contracting models represents an evolution in clinical and payment methodologies aimed at creating better quality and cost outcomes, greater provider accountability, and improving cost efficiency. As the Centers for Medicare & Medicaid Services (CMS) rolls out Bundled Payment pilots – for the reimbursement of healthcare providers on the basis of expected costs for clinically-defined episodes of care – health insurers are wrestling with the reality of making these arrangements work in their current environments.

In this webinar, we will examine the advantages and disadvantages of the Bundled Payments reimbursement model as well as the consideration for entering into these contracts with your providers. The discussion will also touch on how current systems have limitations on whether these programs are administered prospectively or retrospectively.

Attendees will also learn how modern component-based technology solutions, specifically designed for emerging value based payment models, can help healthcare payers make this process easier and more efficient. We’ll explore how you can move from spreadsheets to automation in this informative seminar.

For more information on Oracle Health Insurance Components, please visit oracle.com/insurance.

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Tuesday Dec 01, 2015

Reduce Medical Loss Ratio by Straight-Through-Processing

With the steady increase of healthcare costs, health insurance payers are challenged to find new ways to reduce cost. As a payer, you have three ways to achieve this: reduce reimbursement, reduce coverage or reduce the cost of running your business. The first two options shift the cost towards providers and members and are not viable in a competitive marketplace, making the third option – reducing the medical loss ratio – an attractive choice.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today's post.

Any payer strives towards a claims administration where straight-through-processing is the norm. Yet, not many payers get to boast auto-adjudication rates higher than 95%. In fact, many payers do not even come close. And given the volume of claims in health insurance, even if you achieve an auto-adjudication rate as high as 95%, that still means you have to deal with (tens of) thousands of claims that can’t be processed without some kind of intervention.

Obstacles to getting here include:

  • Inherent Complexity
  • Collaboration, Mergers and Legacy Systems
  • Evolving Benefit Plans

One alternative is to make sure that your back office is flexible and agile enough to follow the business wherever it may go. After all, isn’t the purpose of enterprise software to make business easier? There are three aspects to straight-through-processing in a componentized architecture:

  • Integration
  • Coordination
  • Auto Adjudication

The combination of these traits is the primary design principle of Oracle Health Insurance Components. They offer pre-integrated applications for the health insurance market that are configurable through fit-for-purpose, parameter-driven rules – giving you the agility you need to keep up with the constant influx of new market requirements – that can be extended with your own settings and logic to meet your specific business requirements – giving you the flexibility you require to achieve operational excellence.

  • Download the new white paper in English
  • Download the new white paper in Spanish

For more information on Oracle Health Insurance Components, please visit oracle.com/insurance.

Don’t forget to keep up with us year-round:

Wednesday Oct 21, 2015

Using IT to Keep Pace with Rapid Growth of Health Plans in Latin America

Healthcare in Latin America is undergoing significant change. Many factors are influencing these changes. Age, chronic disease and increasing wealth in some countries are creating a new demand for higher quality services. Governments are increasing spending, and local and multinational private sector players are investing heavily.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today's post.

Legacy IT systems that resist change make it difficult for health plans to capitalize on new opportunities. Custom development is a costly and cumbersome approach in a business where competitors change tactics overnight. Health plans require greater agility to address their specific business requirements and adapt in real time to ever-shifting market conditions.

Latin American health plans need flexibility as a central IT platform design component. They require applications that support core business processes where people may choose a private health plan as a supplement to, or in lieu of, public insurance – ultimately supporting business innovation and rapid growth.

Factors such as budding economies, up-and-coming middle class, and progressive policies toward managed care make it hard for public systems to keep pace. As the population becomes wealthier due to economic growth, more Latin Americans will choose to enter a private healthcare system.

The influx into the private healthcare system opens significant opportunity, and it also presents several challenges. Health plans must deal with regulatory and contractual complexities that are unique to the sector, such as waiting period requirements, co-pays, and the negotiation of in-network versus out-of-network agreements. They must also have the scalability required to process a high volume of claims.

Health Plans will be well-served in the short- and long-term by moving forward with their own game plans for success in a new era of healthcare finance and coverage. There are several strategies that health plans can put into action today that will serve them well – now and in the future – regardless of how the health plan market continues to evolve.

Plans need to consider that:

  • Cost efficiency is paramount. Most insurers are expecting to reduce the costs incurred for healthcare with technology.
  • Systems need to be agile and flexible to handle legislative changes and market demands.
  • Security and privacy of health data is an integral element of any system.
  • Data becomes critical to manage costs and outcomes. There must be access to data and the ability to analyze and manage that data.

If you are an insurer that is looking to expand into Latin America market or currently competing in the health insurance market in Latin America then you should download the new “Health Insurance in Latin America” white paper to learn some of the ways to build competitive differentiation to be successful in this market.

  • Download the new white paper in English
  • Download the new white paper in Spanish

For more information on Oracle Health Insurance, visit oracle.com/insurance.

Don’t forget to keep up with us year-round:

Wednesday Jun 24, 2015

Grow Large Group Business by Leveraging Modern Sales Tools

Profitable growth remains the key objective for many healthcare payers. However, new healthcare market reforms and increasing competition from plan sponsors and Group carriers are making it harder for payers to become more profitable. Many healthcare payers are now looking for ways to improve their profitability. One way is by increasing productivity through streamlining their sales, installation, enrollment, and renewal processes, particularly in the Large Group line of business.

For many healthcare payers, managing the Large Group sales process is challenging – from opportunity management and group management to configuring the right plan for the group and presenting the proposal to large employer. There are multiple systems throughout this sales process and too often teams must rely on spreadsheets and paper forms and email to keep track. In the current IT environment for many Large Group payers, there is no single sales tool that can help sales people increase their productivity.

What the large group payers need is a modern sales tool that can consolidate the multiple systems that sales reps use on the front end and provide a single rating engine on the back end to provide the best price for any plan combination. Essentially, the large group payers should make their complex product, pricing, and business rules available to Sales in real-time, so the sales rep always have the information they need to quickly and accurately configure, price and quote a deal.

Using a modern sales tool can help sales rep become more productive. The tool will put all of the product, pricing, and bundling rules in the system and make it easy for sales reps to manage the configuration complexity. The sales reps do not need to know the product dependencies, compliance issues and other factors because everything is built into the system. Without many of the manual processes, sales reps will have more time to do what they are supposed to do which is selling the product and closing more deals.

If you are a healthcare payer, you should consider leveraging modern sales tools to optimize your sales process and help your sales reps become more successful. We encourage you to watch this webcast on demand to learn more about Oracle solutions that can help you grow your Large Group business.

For more information on Oracle Insurance Insbridge Enterprise Rating and Oracle CPQ Cloud (Configure, Price, Quote), visit oracle.com/insurance.

Don’t forget to keep up with us year-round:

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Oracle’s solutions provide the modern, rules-driven flexibility insurers need to support Digital Insurance transformation, simplify their IT environments, and innovate to keep pace with changing demands.

For more information, visit oracle.com/insurance.

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