Virtusa / Healthcare / Payers
Driving Digital Transformation for Payers

The Payer marketplace, like the overall Healthcare industry, is undergoing a transformation journey. The focus of Payers continues to be to improve the health outcomes of its members by providing accessibility to the best and most affordable care possible.

To deliver on these objectives there is signification transformation, of both business models and technology capabilities, that is occurring. Payers are focusing on the continued move from Fee for Service models to Value-Based Care models. This is happening across all segments – commercial, individual, and government business. There continues to be Payer – Provider – PBM convergence in the marketplace, to integrate capabilities, improve efficiencies and ultimately reduce overall costs. Payers are also continuing to engage in Digital Health innovations. From experimenting with new technologies to significant investments in digital health startups, they are looking to adopt technologies that can provide business value. The healthcare marketplace is also continuing to see an explosive number of solution and vendors attempting to provide solutions for the Connected Customer Experience.

Virtusa is working with the largest Payers in the nation to navigate through these challenges and to deliver on their vision for Enterprise Transformations, Digital Health Innovations, and Improving Care Delivery for its membership.

Innovative Solutions & Services

Provider Lifecycle Management

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

Provider Lifecycle Management

For Payers to manage 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 causes major data quality issues.

Virtusa’s Unified Provider Lifecycle Management solution – with capabilities supporting Prospecting, Contracting, Credentialing, System Setup, and Provider Servicing – can help Payers dramatically reduce their operational costs and improve their provider satisfaction. Using emerging technologies in Robotics and 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, providers, 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 plans 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 Management

Virtusa’s Unified Health and Wellness Management Solution

Population Health 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 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.

Healthcare Analytics

Turn healthcare data into actionable insights to improve health outcome and improve consumer experience

Healthcare Analytics

Healthcare continues to be a market where there is an abundance of data – from medical records, to wearables and sensors, to patients and their social footprints – yet the industry lacks the ability to capitalize on this data, improve customer engagement or experience, or significantly improve health outcomes for its members/patients.

Virtusa’s Healthcare Analytics practice is focused on building an ecosystem to transform raw data into actionable insights. With over 2000+ associates focused on delivering Consulting, Implementation and Data Migration services, we have over 20 years of experience in Healthcare. Our focus is to position Data Transformation for business growth and advancing competitiveness through Consulting & Co-Innovation, Enabling Agility in Data Platforms, Lowering Cost through a “Factory Model”, Driving outcomes through AI & Cognitive, and delivering Industry specific solutions for differentiated experiences. Our analytics offerings straddle across the maturity continuum from descriptive, through predictive and prescriptive to real-time, cognitive to support decisions that increase value for both company and customers.

Innovation As A Service

Accelerate ideas into MVPs faster through Design Thinking, Rapid Prototyping, and an Innovation Platform

Innovation As A Service

Latest surveys and consumer reports continue to confirm what is widely understood and accepted about the US Healthcare system… It is lagging other industries when it comes to innovation. Healthcare is burdened with the same challenges faced by other enterprises – missing innovation strategy, lack of executive-level sponsorship, legacy “IT” is stifling innovation, there is a missing “Voice of the Customer”, lack of skillsets in emerging technologies, and high cost of innovation. However, Digital Health innovation is progressing rapidly and there is a potential for emerging technologies to drastically improve Health outcomes and member/patient experience.

Virtusa Innovation-As-A-Service offering helps organizations incubate and fuel their growth through an organized Design Thinking Framework, Rapid Digital Prototyping capabilities, and an Innovation Platform that can be leveraged to accelerate solution development. Our focus is on enabling our clients deliver innovative solutions that connect payers, providers and members for a personalized customer experience. Our clients often leverage our Innovation labs which accelerate the ideation of breakthrough concepts and the creation of POC’s or MVP’s that build towards eventual deployments. Whether it is digital transformation, microservices, machine learning, blockchain or intelligent automaton our solutions and methodologies will accelerate your time to market.

Robotic Process Automation

Bring together AI, cognitive technologies and automation to automate processes and improve efficiencies

Robotic Process Automation

Manual processes and segregated, legacy systems are usually at the center of rising operation costs for healthcare organizations. From Sales & Marketing, to Provider Network Management, to Claims and Customer Service, there are an abundance of areas that would benefit signification through the application of robotic processes.

Virtusa’s Robotic Process Automation solutions align digital workers with your knowledge workers to significantly reduce costs while improving satisfaction from providers, members and third parties. Our solutions automate mundane and repetitive tasks on a 24 X 7 basis to ensure your knowledge workers have the information needed for provider onboarding, claims adjudication, and customer service eliminating bottlenecks and latency experienced by manual tasks. We architect process automation as an enterprise solution so that it fosters reuse and can handle data ingestion, lookups to legacy systems, document aggregation and other functions across the value chain. We do this through short-duration projects without disrupting existing systems and processes, to maximize your ROI.

DevOps and Microservices

Increase the effectiveness of your agile and modernization journeys by 50-70% for business agility and cost savings

DevOps and Microservices

Healthcare organizations are beginning to embrace DevOps, Microservices and Cloud adoption. Digital healthcare players operate at a much different pace than heritage brands. As they embark upon business-led designs & heavy technology focus, they require pluggable business components (private, public, etc.) that provide ala-carte functions instead of a channel buffet. They require new architecture styles and domain-driven designs, that has open API ecosystems and automation embedded at its heart.

Virtusa’s award-winning tools and methodologies can customize your journey to becoming an agile organization and reducing your technical debt. Our microservices capability model goes beyond just services, into supporting capabilities, core capabilities, process & governance capabilities as well as infrastructure capabilities.  We have perfected our blueprint related to the key aspects of API technology through multiple customer engagements. Our API Lifecycle Management & Registry enables enterprises ensure standardization & conformance to their overall microservices strategy.


Enterprise Product Solution

A Digital Product Platform that reduces redundant products and effectively manages the Product Management Lifecycle

Enterprise Product Solution

Healthcare regulations are dramatically changing the health insurance landscape, mandated retail exchanges are nurturing intense competition and there is a greater demand for consumer-centric products at lower prices. In this environment, payers need to invest in product platforms that can support flexible product designs and service all segments – groups, individuals, and government business. A single source of truth for product repository is required.

Virtusa has a proven methodology and an innovative platform that guides Payers through a successful product / benefits implementation, accelerated by customized assets and solution. The transformation has the potential to create significant benefits for Payers.

  • 30% DECREASE in product time to market
  • 4x INCREASE in speed & accuracy of benefit load
  • 25% DECREASE in incorrect claims payments & overturned appeals
  • 20% INCREASE in accuracy of Member and Provider benefit inquiries
  • Significant cost savings through improved deployment flexibility

Sales Automation Platform

A platform that drives engagement and accelerates customer acquisition with digital convenience

Sales Automation Platform

The healthcare industry is witnessing an unprecedented increase in individual and family enrollment, in the current ACA market. There is also a growing demand for customer-centricity in healthcare and one of its major impacts are on the ability of Payers to effectively sell their new products and services to groups and individuals. Changing rules, new marketplaces, tighter sales periods and heightened consumer involvement strain what are already high-stakes decisions. New sales models call for tailored sales navigation, streamlined processing and rapid market response that traditional sales tools do not deliver.

Virtusa’s Sales Automation Platform, is a scalable, easy to manage enterprise administration platform designed to integrate real-time with health plan management systems. A broker-friendly system that increases sales, transparency and accuracy of standard products for small group/ individual sales. Key features of the Sales Automation Platform are Lead management, Opportunity management, Opportunity finalization, and Renewal automation. The platform increases transparency and accuracy of standard products for small group/ individual sales.

Automated Billing & Payments

A retail billing & payments solution that supports a Payer's complex financials related to the individual market segment

Automated Billing & Payments

As an industry that had been dominated by B2B business from employers, the large shifts to B2C marketplace brought upon by ACA have forced the healthcare industry to engage in technologies and digital strategies that enable Insurers to engage a direct consumer. Dramatic increases in direct-to-consumer retail plans purchased on health exchanges and increasing patient responsibility make it more important than ever for healthcare organizations to give customers convenient, easy-to-use, and secure payment options.

Virtusa’s Enterprise Automated Billing & Payments Platform for Payers allows for Automated Billing that provides positive impact across finance, organizational revenue management, operations and customer service. Financial and Compliance Reporting customized for regulatory requirements and support the ability to effectively manage open receivables and payables. Portal Payment capabilities that reduce administrative overhead, drive out process redundancies, reduce payment delays, and enable organizations to handle subsidized payments or credits, and manage dual payment processing online. Claim Payment solution that provides end to end payment capabilities that include paper and electronic payments, positive pay, encashment, and payment reporting.

Testing Automation

Move away from low-ROI, rules-based Test Automation

Testing Automation

Traditional test automation continues to struggle to replace human workers, despite being around for over a decade. Many high-volume healthcare use-cases, though ideal for being automation-tested, cannot be test-automated due to the many critical limitations of rules-based test automation: lack of intelligence to look/think ahead and make real-time decisions, inability to read unstructured formats and lack of situational awareness, inability to use context to fill-in missing information, lack of workflow management, business rules, and next-best case management.

Virtusa’s Test Automation Factory enables healthcare enterprises to move away from traditional cost-intensive approaches to Test automation and refocuses on ROI for automation. Our award-winning accelerator, VTAF, enables automated testing of a system with minimum knowledge of any automation tool, thus significantly bringing down resource/expertise costs and allowing for faster time-to-market. The accelerator generates high-quality automation scripts with maximum reusable components and low maintenance effort. ​ ​Your automation initiatives become 2X faster and cost 70% less, automation suites incur 60% less maintenance costs, and porting scripts across tools and frameworks incur 90% less effort.

Cloud Migration

Transforming the way healthcare applications are implemented

Cloud Migration

Software running on the cloud is slowing starting to gain momentum in healthcare. Organization are increasingly building apps in the cloud and the public cloud is the default backbone for the “Internet of Things”. On the other hand, stringent regulatory controls have caused hesitance in undertaking of cloud migration initiatives. However, as regulators are recognizing the criticality of cloud to streamline IT infrastructure and cut costs, sufficient safeguards have been put in place to mitigate safety and security concerns. Industry change makers are fast learning that cloud adoption is an accelerator for digital innovation and business disruptors to enhance payer operations and business operations.

At Virtusa, we help clients accelerate cloud adoption through domain and technology expertise and strategic partnerships with Leading CSP Solution and Service Providers. We help healthcare clients transform enterprise IT, improve business capability and reduced overall TCO through cloud led enterprise-wide application transformation. Our Leading solution accelerators & frameworks to reduce implementation time.

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.