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 20, 2016

Continue the Transformation and Modernization Conversation during Oracle Industry Connect 2016

The impact of digital disruption is being felt across the insurance industry. For many insurers the answer lies in a progressive transformation for both the customer engagement process and the underlying systems with customer-centric processes and industrial-strength core components.

At last year’s Oracle Industry Connect, Kimberly Harris-Ferrante, Vice President and Distinguished Analyst at Gartner Research, led a panel discussion on the trends, challenges and opportunities facing insurers today. She was joined by Francine Hampleman from La Capitale and Deborah Norton from Harvard Pilgrim Health Care, who shared their recent transformation experiences.

At Oracle Industry Connect 2016, we will continue the conversation on process modernization as it affects life, annuity, P&C, and health insurers. You will not want to miss an opportunity to network with your industry peers and participate in discussions about the impact that digital disruption is having in the Insurance industry. The program will include sessions and panel discussions where industry experts and Oracle customers will review technology requirements to support product innovation and discuss how newer technologies such as Data as a Service (DaaS) can drive significant value for insurers in the future.

We look forward to seeing you in Orlando, FL.

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

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.

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

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 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:

About

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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