Create an Ecosystem That Connects Payers, Providers, and Patients

Even in this digital era, Healthcare remains one of the few industries where information and experiences for customers are fragmented, unconnected, and often frustrating. Healthcare customers are beginning to expect Amazon-like customer service and care and are usually disappointed.

Virtusa brings digital solutions to the marketplace that enables healthcare organizations to help engage with their customers and employees in a meaningful manner. Customers are looking for digital solutions that provides superior experiences and connects their journeys from when they purchase their healthcare to when they require medical services to proactively help them manage their health and wellness. We’re helping –payers, providers and major healthcare enterprises build digital platforms that can scale to the needs of their customers.

Digital Solutions & Services

Provider Lifecycle Management (PLM)

A disruptive platform that modernizes all aspects of a Payer's complex provider network management capabilities

Provider Lifecycle Management (PLM)

For payers, managing their vast provide network effectively is not only critical, but a strategic differentiation in today’s competitive environment. However, Payers today have limited provider management capabilities. They’ve stitched together legacy applications, manual processes, and error-prone point-solutions that create long provider onboarding times and cause major data quality issues.

Virtusa’s unified Provider Lifecycle Management solution – with capabilities supporting Prospecting, Contracting, Credentialing, System Setup, and Provider Servicing – can help Payer’s dramatically reduce their operational costs and improve their provider satisfaction. Using emerging technologies in Robotics Process Automation (RPA) and Artificial Intelligence (AI), the PLM platform reduces a plan’s overall Provider onboarding time by 50%. All business-critical components are integrated together on an intelligent business process management platform, significantly cross team efficiencies. Our industry leading Smart Credentialing functionality leverages robotics to gather and validate data from Primary Sources, reducing manual efforts by >80%. The platform automates over 90% of the manual steps related to the intake and processing of hundreds of roster files received daily/monthly from Hospitals.

Customer Contact Center

A Customer-Centric platform that enables a superior customer experience for its Members, Provider, and key stakeholders

Customer Contact Center

Payers are continuing to witness an influx of digitally savvy stakeholders (members, providers, brokers), who are demanding quality services and transparency of information. Members can freely switch plans, and inquire about their coverage, enrollment and pre-existing conditions. However, Payers face several challenges in providing an exceptional and consistent customer experience due to the prevalence of inflexible legacy systems that are rigid and not integrated. Also, members expect information across multiple channels and expect it to be consistent.

Virtusa’s Contact Center Solution is a Customer-Centric Engagement Platform that provides a 360-degree customer view. Utilizing the latest emerging capabilities around chat bots and robotics, information is easily accessible to CRSs looking to serve Member, Providers, and other key stakeholders. Guided flows enable CSRs to quickly generate accurate benefit details or answer complex questions related to claims. This innovative platform helps organizations reduce average call handle times, reduce CSR training times, increase first call resolution, and improve call wrap-up times.

Complaints, Appeals & Grievances

A platform to manage all Complaints, Appeals & Grievances and meet 100% CMS-enforced SLAs

Complaints, Appeals & Grievances

Payers need to continue to strengthen their relationships with members and ensure that complaints are managed effectively. Specifically, for non-commercial members, handling complaints efficiently is not just a competitive advantage, but mandated by CMS. However, many Payers continue to struggle to meet CMS’ standards around complaints, appeals, and grievances because they have large volumes of complaints to manage, there is generally a lack of visibility across multiple groups involved, and manual processes slow down the resolution process.

Virtusa’s Complaints, Appeals & Grievances Management Solution provides a flexible platform which is cost-effective, easy to maintain and can be rapidly deployed by Payers. Its ability to perform Auto-case creation and assignment, Intelligent case routing, Stringent quality checks, and Continuous quality improvement sets it apart in the industry. Enterprises see an increase in member satisfaction and retention due to hassle free complaints resolution, increase in CSR productivity due to simpler, unified platform, decrease in hefty CMS fines and penalties due to timely complaints resolution, and increase in proactive escalation methods due to availability of historic information.

Population Health & Care Management

Virtusa’s Unified Health and Wellness Management Solution

Population Health & Care Management

Healthcare organizations continue to lag in their adoption of advanced analytics and turning valuable member and patient data into insights and improving their experiences and outcomes. In this digital age, Payers must invest in the systems that will allow them to better understand their member’s preferences, clinical data, claims information, and financials and use that as a guide for targeted and personalized prevention plans, interventions, and overall care management tools and services.

Virtusa’s innovative and Unified Health and Wellness solution does just that. It integrates member data with a robust patient analytics and decisioning platform that creates the right action plans for members and patients. Key features of the solution include Rules Engine for Care Gaps w/ Guidelines, Evidence-Based Interventions, Care Plan & Workflow Support, Identification & Stratification, Network Utilization Analytics (Predictive, Realtime Retrospective), Outcomes/ Quality/ PI Analytic, Portal-Based Transparency, Provider Profiles, and 360 Member Profiles.

HOPE

Driving a Connected Health Experience between Patient, Provider, and Payers

HOPE

The Healthcare industry is experiencing a steep technology adoption curve as consumers are quickly embracing the opportunities that digital offers. From social media to mobile apps, wearables, and smart devices, customers have several choices available. At the same time, providers, payers, and life sciences companies are digitally transforming themselves to provide a seamless customer experience. Still, the overall customer journey remains fragmented.

Virtusa has built HOPE to answer these challenges. Leveraging its digital innovation capabilities and coupling them with the features of the IBM Watson Cognitive Platform, Virtusa built HOPE, as an intuitive, integrated, and connected platform powered by artificial intelligence (AI). HOPE provides seamless collaboration among patients, providers, and payers, while fostering self-service and addressing gaps in the patient journey. HOPE also provides an easy-to-use, guided experience that helps users navigate the patient lifecycle from enrollment to recovery and beyond. With Hope, patients can track their health, receive prompt medical advice and recommendations, get medicines replenished, and be provided with insights about their lifestyle patterns by their respective health centers and payers.

Digital Asset Management

Anytime, anywhere, any device availability of your digital assets

Digital Asset Management

404 Page Error? File not found? Content Syndication Error? Not everyone has cracked the digital asset management code. Yet, healthcare enterprises, being the primary sources of vast amounts of information available from medical records, wearables and sensors, patients and their social footprints, are publishing content at a mind-numbing pace. With the sheer quantum of digital assets to be managed, it is easy to lose sight of the big picture and get lost in the chaos. Managing these digital assets is more than just creating storage repositories.

Virtusa, in collaboration with leading enterprise content management partners, strengthens your brand by accelerating adoption of AEM Assets. We bring the power of AI to assets with the Adobe Sensei’s smart tagging, which augments search capabilities of AEM by automatically adding relevant tags to assets. We are global. No matter your time zone or continent, you’ll have access to our Adobe experts worldwide.

Healthcare AnalyticsToAction
Virtusa has partnered with IBM® Watson Health to lead digital transformation in Healthcare.

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