In response to the need for health insurance plans in the US to drive down the overall cost of care while improving quality and transparency, SunGard has launched new capabilities for health plans, including outsourcing options for end-to-end claims processing support and business intelligence (BI) dashboards for improved workflow.
With multiple competing priorities, insurance executives are seeking new ways to improve quality and transparency, reduce operating expenses, and free up valuable human and capital resources to focus on more strategic business initiatives. Delivering a complete end-to-end Business-Process-as-a-Service (BPaaS) solution for claims processing, SunGard provides mail house, scanning, data entry and secure document destruction. In addition, SunGard has launched business intelligence dashboards for its Macess workflow solution, which integrates, automates and streamlines complex processes. These dashboards help executives make more informed business decisions and act quickly on the data they have by analyzing trends in claims, enrollment and other areas.
“Insurers will win customers and reach the next level of claims-handling proficiency by making better use of their only natural resource—data. Insurers have the potential to change the key processes that determine most policyholders' views of their carriers and achieve the next level of performance for claims professionals, by turning routinely overlooked data into actionable information.” – Jamie Bisker, senior analyst, Aite Group
“Cloud computing has such potential and great interest by insurers. The move to a more affordable, variable cost model is a big win. The vendors are listening and we are seeing them pick up the pace.” – Tom Scales, research director, Celent’s Life, Health and Annuity Insurance practice
“We’ve offered BPO for claims processing for many years, but we’ve recently launched a full process service that not only helps to reduce costs overall, but also improves related downstream processes. Our latest innovations in solutions and services help health plans improve efficiency, ease regulatory reporting and drive down costs in many areas. It is part of our broader initiative to provide insurers with tools to help transform massive amounts of raw data into actionable insights. We are working closely with insurers to apply innovations which improve business process management by extending back-office productivity to mobile and cloud capabilities which meet the needs of insurers globally across life, health and property/casualty.” – Roy Massie, vice president, product management, SunGard’s insurance business
SunGard also recently launched a Health Information Exchange (HIE) Connectivity solution to help insurers improve care management, providing near real-time alerts of hospital discharges and transfers among high risk patients. In 2014, SunGard released its CMS Audit Support service to help insurers avoid and/or respond to Centers for Medicare & Medicaid Services (CMS) inquiries.