Helping you stay ahead of the curve on your digital healthcare journey.

NTT DATA Healthcare Payer Services

NTT DATA’s Standard Operating Procedures deliver 99.5% accurate configuration of healthcare payer systems, compared to the low 90% range for payers’ full-time staff and the low 80s for part-time staff. The benefits: Higher auto-adjudication rates, lower costs, and improved customer satisfaction.

Did You Know?

As a healthcare payer you’re under intense pressure to reduce costs, provide more patient-centered services, and continuously improve operations. At the same time, you’re ramping up new business models, processes, and systems to adapt to sweeping, complex laws such as the Affordable Care Act and delivery models such as Patient Centered Medical Homes (PCMH) and Alternative Quality Contracts (AQC).

NTT DATA helps you meet these challenges and thrive in the new IT landscape. We combine the scale and skills of a global IT and business services provider with disciplined, industrialized healthcare operational processes and tools. All these ensure you receive measurable business benefits at a predictable cost. Meanwhile, our continuous improvement initiatives free staff and budget for innovative products and services that make you a leader in a changing healthcare payer market.

The NTT DATA DifferenceWe have worked with healthcare payers, providers, and technology firms for nearly five decades. With our deep operational experience and core IT and business consulting capabilities, we deliver solutions customized to your business, strategic requirements, and corporate culture. We help you speed decision-making, increase accuracy and quality, and enhance your productivity.

Predictable, Repeatable ResultsWith NTT DATA, your projects won’t sit on hold while we find and train the right staff to meet your needs. Nor will we recommend generic “best practices” that are too vague to implement, much less measure. We instead focus on delivering results that matter to your business, without surprises. We start each engagement with a focused consulting project that:

» Captures and reviews detailed processes, standard operating procedures (SOPs), and the performance of your staff. This approach enables a realistic understanding of productivity and what activities will drive the greatest revenue or cost benefits to your business.

» Documents and analyzes current practices for capturing and reporting performance. This enables you to define success at the program and individual level by aligning metrics such as overall configuration costs to corporate objectives such as per-member/ per-month administrative costs.

» Recommends specific projects across prioritized functional areas with accurate pricing and the assured, quantifiable results they will deliver.

For example, our payer configuration service begins with a detailed Configuration Process Audit that aligns operational processes with configuration rules and definitions. As a result, you develop an understanding of defect rates and how well your staff is adhering to processes, as well as the ability to improve through SOP maturation and process re-engineering. NTT DATA averages 99.5% configuration accuracy and can show you how to achieve similar results.

Sustainable Improvement in Business PerformanceOur goal is to ensure that your staff, in areas ranging from project management to data modeling, operates at or above the level of your peers in the industry and is equipped for success. In every area from software configuration to business process reengineering to testing, we continually examine the full business process, not just the isolated technical feature, to ensure we deliver business benefits. Our work is built on deep knowledge of the systems your business relies on every day, leveraging a blend of industry-certified professionals and our own custom-developed training.

We have provided sustainable increases in efficiency and effectiveness in healthcare payer functions such as enrollment and claims efficiency, financial management and billing, and the setup and reporting of risk-sharing models, including Accountable Care.

Providing Ensured Results, Predictable Costs, and Continual Improvement for Healthcare Payers

NTT and Toray Industries have developed a “smart shirt” that can record and transmit an electrocardiogram of the wearer to a smartphone. As lines blur between healthcare payers and providers, such wearable, consumer-oriented solutions should be treated as competitive differentiators, delivering premium preventive healthcare to members while reducing healthcare costs.

Smart Solutions

Outcome-based RelationshipsYour shareholders, regulators, and customers demand results they can measure in dollars and cents and in time saved. You should expect no less of your service provider. Through our up-front assessment of your needs and continual measurement of our work, we give you more assured results at a more predictable cost. This makes everything from planning to budgeting to ROI calculation easier.

We also know that business change involves more than tweaking code. It means changing how people work, which requires an understanding of business processes as well as ongoing communication and education. That’s why our services include not only technical functions such as system integration, data migration, and data interchange but also business process reengineering, technology and business alignment, and organizational change management. Again, at every step we rigorously define the costs, the outcomes, and the associated financial benefits you will receive.

Finally, we reduce your day-to-day operating costs, freeing funds for new data-driven services to reduce healthcare costs while improving outcomes as the market shifts to a more consumer-driven model.

For example, the savings from our managed application outsourcing services allowed one payer to create a provider-tiering model, including everything from the application and algorithm to the data model and reporting of results that rewarded providers for improving their quality of care.

Our Services for Healthcare PayersWe focus on the business and technology services our healthcare clients have told us are most critical to their success. Contact us to learn more about how we can put our skills to work for you in each of these areas:

» Project Management and Business Analysis built on deep knowledge of healthcare payer operations such as enrollment, adjudication, and payment. We benchmark requirements and deployment activity to continuously improve your ability to scale, perform, and deliver measurable business results.

» Configuration Services that assure best-in-class results from the leading payer administrative systems. Configuration Process Audits, Member Touchpoint Measurement improvement, and Enrollment and HIX Servicing drawing on standardized operating procedures and industry-certified staff are just a few of our services that meet your needs for scalability, accuracy, or process improvement.

» Quality Assurance and Test Programs that use healthcare payer-specific libraries mapped to and built around business processes, not individual applications, to produce higher-quality business outcomes. We validate your most critical business functions with a mix of functional automation, performance, and data quality testing performed by industry-certified healthcare specialists.

» BI and Data Services focused on specific healthcare business needs such as medical loss ratio reporting, HIPAA / EDI transmission, and healthcare-focused data architecture and warehouse layers for Accountable Care and Medical Home integration. We help you build the foundation for risk analysis, information sharing, predictive modeling, and the consumer-oriented shift in healthcare.

NTT DATA’s industrialized approach to IT services drives efficiency and innovation through an outcome-based model focused on your greatest business challenges.

NTT DATA Services for Healthcare Payers

Application Development & Management

Quality Assurance & Testing (QAT)

Project Management & Business Analysis

Cloud & Infrastructure Services

Business Intelligence & Data

Configuration, Claims& Business Process Services (BPS)

Accurate deployment and migration supported by predefined SOPs and platform-specific templates

Architectural and operational discovery drives 95%+ accuracy in estimated costs and benefits

Portfolio modernization based on optimized payer reference model ensures payers are as efficient as their peers

Configuration Services: 99.5% accuracy reduces costs while improving quality and service

HIX/enrollment servicing based on federal/state standards

MTM improvement: 20 points in 120 days

BPR and OCM accelerates decision-making across payer ecosystem through facilitated process summits

MLR reporting accelerates compliance requirements

Agile ETL development that reduces enrollment cycles and fraud

ACO and PCMH strategy and modeling, based on CMS standards

EMR hosting in secure, private cloud environment for lower cost, greater agility

Clinical and hospital system support center

Healthcare IT app/hardware servicing center

Business Analysis as a Service delivers ROI through quantitative improvement in data analysis

Project and program management links operational risk to portfolio

Performance improvement based on custom training in your business challenges, processes, and culture

Functional test strategy linked to business process ensures critical business functions are tested

Asset-driven approach minimizes UAT cost and effort

50,000+ test case asset library for pharmacy and payer systems accelerates scenario-based testing by 70%

Find out how NTT DATA can help you flex your business faster. For more information, contact:

HealthPayer@nttdata.com

THINK SMART. ACT FAST. FLEX YOUR BUSINESS.

© 2015 NTT DATA, Inc.www.nttdata.com/americas

About NTT DATANTT DATA is a leading IT services provider and global innovation partner with 75,000 professionals based in more than 40 countries. NTT DATA emphasizes long-term commitment and combines global reach and local intimacy to provide premier professional services, including consulting, application services, business process and IT outsourcing, and cloud-based solutions. We’re part of NTT Group, one of the world’s largest technology services companies, generating more than $112 billion in annual revenues and partner to 80% of the Fortune Global 100. Visit www.nttdata.com/americas to learn how our consultants, projects, managed services, and outsourcing engagements deliver value for a wide range of businesses and government agencies.