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.

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Tuesday Jun 23, 2015

Watch Now: The Changing World of Value Based Payments

The emergence of value-based contracting models represents an evolution in clinical and payment methodologies aimed at creating better quality outcomes, greater provider accountability, and improving cost efficiency.

As a quick introduction to the topic, we’ve created a short video that examines the background and emerging payment models.

In a recent Webcast with FierceHealthPayer, Richard Lieberman, Chief Data Scientist at Mile High Healthcare Analytics and Oracle’s Kathy McCarthy, Director of Sales Consulting, discuss the shift from fee-for-service to value-based payments. Some of the topics discussed are:

  • How the transitions to value-based payments are being accomplished
  • Where are the success stories
  • How the new models of capitation are different from capitation of old
  • Integrating accountability into value-based payment models

Richard and Kathy examine the technology needed to accomplish these payments, what types of systems/models are suited to this new paradigm and how this technology can be delivered to your organization. They also discuss where and how cloud technology can fit into your transition.

For more information on Oracle’s solutions for healthcare payers, visit oracle.com/insurance.

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Thursday May 07, 2015

Webcast with FierceHealthPayer: The Changing World of Value Based Payments

The emergence of value-based contracting models represent an evolution in clinical and payment methodologies aimed at creating better quality outcomes, greater provider accountability, and improving cost efficiency. In this webcast we will examine the shift from fee for service to value based payments. Some of the issues being discussed are:

  • How the transitions to value based payments are being accomplished
  • Where are the success stories
  • How the new models of capitation are different from capitation of old
  • Integrating accountability into value-based payment models

We will also examine the technology needed to accomplish these payments, what types of systems/models are suited to this new paradigm and how can this technology be delivered to your organization. We will also discuss where and how cloud technology can fit into your transition.

Join us for the webcast:

  • Tuesday, May 19, 2015
  • 1:00 pm EDT / 10:00 am PDT
  • Register now

Thursday Jan 08, 2015

Core Technology Platform for Health System of the Future

With healthcare costs rising annually over last decade, health reform is at the forefront of many developed and emerging market countries. In many developing nations, the focus of reform is around business models that have more involvement from private sector, while the focus of the reform in the United States is on business models that incent providers to cut costs while improving quality.

However health reform is in its infancy globally, and there is constant change expected over next several years as governments experiment with various business models. Under those circumstances, there is need for a new genre of technology options to cater to the health system of the future. Current inflexible platforms, and even the newer flexible platforms that require health plans to rip-and-replace entire core operational systems, aren’t going to work for emerging health plan needs. Health insurers need to consider “progressive transformation” approach where there is a phased approach to overall end-to-end core systems transformation.  Additionally, insures need to look at options that provide value-based payment support and that work in parallel with their current core processing systems.

Oracle Health Insurance (OHI) business unit within Oracle is dedicated to address the needs of the global health insurance market. The OHI Claims solution was first introduced in 1994 in the Netherlands to cater to the needs of the Dutch market. Today, over 50% of the health insurers in Netherlands run their core operations on Oracle Health Insurance solutions, with many achieving over 98% auto adjudication on claims processing. Furthermore, OHI applications have now been successfully deployed in the United States and other international markets.

The OHI team has spent the last couple of years on developing a technology platform for the newer and emerging health insurance business models.  As a team, we are working with governmental institutions and private companies to understand and help these organizations with their transformation projects. Given our origin in Netherlands, we routinely host health officials and delegations from the emerging market countries considering health transformation to study the Dutch system.

Based on those leanings, we are starting blog series to explore different aspects of the health reform as it impacts health insurance organizations.  We will present business transformation imperatives one at a time and explore technology options to support this. We encourage you to start by downloading our new white paper Building the Healthcare System of the Future. It lays the groundwork for some of the topics we’ll be discussing in the blog series, such as:

  • Driving Transparency with Benefit Adjudication
  • End of Fee for Service? Gaining Popularity of Shared Saving Plans
  • Engaging with Health Providers in Future
  • Real-time Claims Adjudication to Enhance Member and Provider Service
  • Technology Platform for Health Insurance Exchanges
  • Administering Government Programs in a Cost-effective Way

At the end of the series, we will summarize all of the imperatives ahnd present a holistic platform for the health system of future.

Learn More at Oracle Industry Connect in Washington, DC, March 25-26, 2015

Oracle Industry Connect is a premier conference designed to promote innovation and transformation through open and provocative discussion within the Financial Services and Insurance communities. The event brings together top business and IT executives from leading financial institutions including healthcare payers, insurers and banks. Join your industry peers for in-depth discussions on trends, challenges and opportunities facing healthcare payers and insurers today.

Check Back for New Posts

We hope to create a lively discussion throughout this blog series.  Please participate with your comments and thoughts as it will enrich the experience as we embark on this transformational journey of Healthcare Reform.

Please check back soon for our next post. In the meantime, you can keep up with Oracle Insurance year-round via social media.

Wednesday Sep 17, 2014

The Need to Shift to Oracle Health Insurance Alternative Reimbursement

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

The healthcare system is dramatically changing within the United States – both out of necessity and want.  In the current economy, the US spending on healthcare is more than any other nation, more even than this country can sustain.  With the fastest rate of growth compared to any other nation on gross domestic product, the US does not have the best action plan to solving this dilemma. Consumers are left with higher costs and decreased attention to their care, when the focus should be primarily on their well-being. 

The Affordable Care Act (ACA) is putting consumers back in charge of their health by requiring the government to ensure that payers improve outcomes, lower cost and increase access to care.  This application of value-based reimbursement will have four plans that will be implemented by 2015.

  • Physicians in group practices of 100 or more who participate in Fee-for-Service Medicare will be subject to the value modifier in 2015, based on their performance in calendar year 2013.
  • Physicians in group practices of 10 or more provider who participate in Fee-for-Service Medicare will be subject to the value modifier in 2016, based on their performance in calendar year 2014
  • For 2015 and 2016, the value modifier does not apply to groups of physicians in which any of the group practice’s physicians participate in the Medicare Shared Savings Program, Pioneer ACOs, or the Comprehensive Primary Care Initiative.
  • The value modifier starting in 2017 will affect all physicians who participate in Fee-for-Service Medicare.

The value-based payment models are aligned with better outcomes for the consumers and the healthcare providers are forced to work more closely with their patients.

  • Capitation payment is managed by care organizations to control the cost of healthcare.  The fixed amount of money per time period is determined on age, how many individuals and services provided in the geographical area. 
  • Shared Savings Program is services established for Medicare and Medicaid (CMS). This program simplifies communication among providers to improve and ensure optimal healthcare for those using CMS. 
  • Pay for Performance is an incentive payment used to improve the quality of healthcare through a collaboration of measuring the overall care of the patient, resources used and other factors.
  • Bundle Payment is a single payment made to providers or healthcare facilities based on treatments and conditions given.  This method was designed to focus on improved care that providers have clear metric to follow in order to maximize their payments.
  • Fee-for-Service is a specific reimbursement for an individual service done to a patient. Payment is based on formula and funding levels by what the consumer wants to pay, the cost of service and type of service provided.

As a result, healthcare payers need to have better access to data, tools, efforts and a significant increase in time to carry out the implemented models. Therefore, there will be an emerging need for payers to have agile and open systems to meet the new market demand.  Data will need to be merged by payers, in order to provide crucial information that will accurately determine payment.

As the models change so will the need for flexibility and delivery methods.  Cloud-based solutions that have insight, agility and operational efficiency will be the game changers. The Oracle Health Insurance Alternative Reimbursement solution supports a wide range of models that formalizes and automates data. Oracle Health Insurance holds accountable details for contracts, products, providers and members to create financial messages.

To learn more, download and read the white paper, Emerging Healthcare Value-based Payment Models for Improving Patient Outcomes and Cost Efficiency.

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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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