InfosysPublicServices - Provider Network & Performance Management | Solutions
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The document discusses the impact of healthcare reform on provider network management, emphasizing the need for health plans to redesign their networks and shift towards outcome-based reimbursement models. Infosys offers a Provider Network & Performance Management framework that provides business intelligence tools to monitor, analyze, and optimize provider performance and network management efficiently. The framework includes features such as real-time alerts, role-based dashboards, and comparative profiling to facilitate proactive performance management and adapt to changing healthcare standards.
InfosysPublicServices - Provider Network & Performance Management | Solutions
- 1. Provider Network and Performance Management ................................................................................................................................................................................................. Though the healthcare reform is aimed at improving the accessibility to care, it will have significant impacts on how the health plans design their provider networks, contract with providers and reimburse them for the services rendered as well. With the recent reforms and changes in the healthcare industry, there is also an increased pressure on the payers to reduce administrative cost to remain competitive. With Provider Network Management being a significant contributor to the administrative cost, payers are looking at ways to improve the efficiency of network management and the contracting processes to keep costs under control. Since the current provider reimbursement methods (fee-for-service & capitation) provide little impetus for providers to improve the quality of care delivered, payers are also looking at options to reimburse providers on the basis of the outcomes delivered rather than on the number of services. Infosys Provider Network & Performance Management (PNPM) framework provides a comprehensive business intelligence platform to manage provider life cycle processes including provider contracting, credentialing, provider operations, network adequacy optimization and provider performance management. PNPM enables in-depth analysis to monitor and measure performance of provider networks and network operations team against established benchmarks and offers valuable insights that can be used for planning and efficiency improvements. Offering and Features ................................................................................................................................................................................................. The framework provides a robust platform to monitor and align provider performance to the goals set. PNPM provides a suite of features to help payers implement and effectively administer Pay for Performance programs to reimburse providers based on the quality of care. The PNPM framework offers: Provider Network & Performance Management Real Time Alerting Simulation and and Notification sensitivity analysis • Real-time Alerts - Proactive alerts triggered based on features to provider triggers based tools are bundled with the solution to abnormal trends in provider performance to take corrective abnormal trends for proactive problem Operational Provider Network support decision making for Efficiency Performance Adequacy actions and minimize business risks handling and Optimization Management Optimization stakeholders. resolution. • Role-based Dashboards - Role-based, customizable and actionable dashboards to provide valuable insights into Role based Solution provides a the overall performance of providers and networks customizable actionable dashboards to provide comparative profiling of the providers at-a-glance insight into Data Analytics across specialties • Simulation and What-if Analysis - Simulation and sensitivity the overall performance Engine based on their and progress towards performance. analysis tools are bundled with the tool/framework to established Integration Layer goals. support decision making for payers • Provider Profiling and Scorecard - Comparative profiling Contracting Provider Universal Claims Provider and Member Provider CRM and Scorecards for providers based on their performance Credentialing Directory PNPM offering - Functional Landscape BENEFITS • Proactive Performance Management: Real-time alerts help proactively monitor performance and take corrective actions to minimize business risk • Flexible and Adaptive to Changing Standards: Solution is flexible and can easily accommodate new KPI’s based on standards released by CMS and other organizations • Complete Performance Management Framework: Cutting-edge holistic framework which helps leverage personalized user dashboards, performance metrics, scorecards and in-depth analytical capabilities to enhance performance www.infosyspublicservices.com
- 2. Service Offerings Infosys Member Liability Estimator Offerings Consulting & O perations Program Management Steady Support • Implementa tion and • Implementation and evel 1,2,3) Adoption Stra • Help Desk (L tegy and Adoption Strategy and ement Roadmap • Data Manag Roadmap re Hosting • Enterprise • Infrastructu Data Dictiona • Enterprise Data Dictionary Set up ry • SaaS Model Set up • Data Minin • User Training g • Data Mining • CRM oper ations • CRM operations • Ready-to-deploy solutions and products for ICD9-10 Conversion • Ready-to-deploy models for statistical Analysis • Pre-Configured Service groups for important disease conditions Solution Tool-kit • Customizable and Scalable: This solution has configurable framework across different business intelligence PROPOSITION platforms, adaptable with payer as well as CRM systems and hence can leverage existing investments. This Solution is scalable and viable for all claim platforms and is adaptable to all types of data/ communication VALUE standards • Accuracy in output due to combination of statistical as well as real-time data aggregation models, with rule based service groups configured for member’s existing health conditions • Competent Resource Pool & Delivery Excellence: Large number of data mining and statistical modeling consultants, strong CRM operations. Leveraging our engagement accelerators, governance models, process tools, and templates to deliver integration and analytical services with high quality, productivity and reliability at significantly lower cost and in reduced time About Infosys Public Services Infosys Public Services is a U.S based subsidiary of Infosys (NASDAQ:INFY), a global business consulting & technology services company. Infosys Public Services helps Healthcare & Public sector clients to transform, innovate and optimize their organizations to build tomorrow’s enterprise. We blend 30 years of commercial best practices with innovative industry solutions, best-of-breed partner content and proven execution to deliver measurable business value with predictability. For more information, contact askus@infosyspublicservices.com www.infosyspublicservices.com © 2012 Infosys Public Services, Plano, Texas, USA. Infosys Public Services believes the information in this publication is accurate as of its publication date; such information is subject to change without notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.