Healthcare is now the world’s largest industry. Most healthcare leaders understand that spending increases cannot continue indefinitely and are looking for ways to increase efficiencies. Change is constant in today’s health insurance environment from responding to healthcare reform and increasing costs, to rethinking the core business and making better use of IT.
Healthcare Payors need to get ahead of change by optimizing every aspect of the business, whether it is exploring new business models to remain viable or diversifying with new products and services for emerging customer segments. In addition, health plans are focused on finding better ways to manage administrative processes that significantly reduce costs and help eliminate waste, fraud and abuse. Meeting these demands means using knowledge in new ways to drive more effective, efficient and affordable healthcare with analytics and systems. The industry is focused on the following:
Customer Centricity - Fierce competition and evolving markets have paved the way for customer-centric business models, with an increased demand for personalized products and services as well as increased product and pricing transparency. Going patient-centric will require greater IT integration to enable seamless communication and interaction between patients and providers.
Regulatory compliance – HIPAA 5010, ICD-10 and the Meaningful Use mandate will create enterprise-wide impact to people, processes and technology. With solutions and strategies that accelerate the transition, enterprises can make their journey smoother, while also reducing risk, cost and effort.
IT Solutions that are Payor Aligned – The emergence of digital health is opening new doors from electronic medical records to connected health approaches and hospital-at-home programs.
Increased costs: The industry is faced with addressing rising medical and operational costs, while also enhancing efficiency and quality. With the right systems, enterprises improve healthcare delivery through patient data analytics, evidence-based medication and paperless transactions.
The Health insurance business is undergoing dramatic changes to address healthcare reforms and regulatory mandates to emerge as more matured, agile and standardized industry. The payers are increasingly considering business transformation and new technology adoption to improve health outcome, sustain business growth and remain competitive: Many of the current initiatives payers are implementing are not new, but there is a greater sense of urgency.
Fulcrum worked with a national insurer to support ICD transition. The scope of this effort covered 15,000 systems that could be impacted by these changes. Fulcrum’s team analyzed systems to determine issues and then mapped data elements upstream and downstream to uncover impacts and develop technical specifications.
Fulcrum provided Project Managers services to assist with efforts to enhance the client’s claims system. The project managers were responsible for creating the project plans, facilitating user meetings, identifying and mitigating risks to the project and communicating the project stats to the sponsor and technical teams to deliver an on time project.
Helped a nonprofit organization develop a comprehensive health IT strategy and secure funding for its implementation, with the primary goal of increasing the adoption of electronic health records by organizations throughout the United States