Healthcare payer analytics
Achieve operational excellence with intelligent digitization of your value chain
The healthcare industry is gradually shifting towards data centricity and value-based care.
With a mounting pressure to curb fraudulent claims, achieve profit margins, meet customer acquisition/retention goals, and improve medical loss ratio (MTR), payer organizations are focused on investing in analytics-driven optimization across the value chain.
Apart from achieving immediate goals such as more effective claims acceptance and management, controlling cost of care, reducing FWA (fraud, waste, and abuse), and improving HEDIS management, analytics helps payers to achieve larger organizational goals. With timely predictions, payers can take appropriate actions to outperform peers across the customer life-cycle – from acquisition through engagement to retention.
Take appropriate actions with Virtusa’s healthcare payer analytics solution to outperform your peers across the customer life-cycle – from acquisition through engagement to retention. Our solution helps improve the performance of the payer departments and functions across the provider journey management KPIs and the member journey management KPIs.
Enterprise components of healthcare payer analytics
Using a three-phased approach to discover, define, and deliver, Virtusa analyzes the payer’s analytics landscape. Our consultative and advisory services help us identify the right business, functional and sub-functional areas for focus, shortlist KPIs, and prepare a detailed future-state functional architecture. Our solution includes four key capabilities to help payers achieve profitable outcomes.
- Analytics and AI-as-a-Service
AI/ML-driven analytics, task routing, business rules driven integration, intelligent workflow leveraging cognitive analytics, smarter intake leveraging NLP, OCR, and HCR, efficient claims processing using adaptive and predictive AI models, and focused care management based on the propensity of member parameters.
- Intelligent visualizations
Descriptive, predictive, and prescriptive provider functional and sub-functional reports and dashboards, and member functional and sub-functional reports and dashboards. It also includes operational and strategic shared services reports and dashboards.
- Data governance (DG)
DG orchestration for provider onboarding, claims, membership enrollment, and care management. Also includes master data management, data quality management, data security and privacy management, and data reconciliation platform for members.
- Data and process integration
Analytics process alignment across business processes and functions, shared services processes and functions, and analytics tools, methodologies and capabilities for on-boarding, claims, services, enrollment, care management, services, etc.
Success stories
A leading healthcare analytics firm gains 50% improvement in processing time with Virtusa’s claims inventory analytics implementation.
Virtusa partners with a regional healthcare payer to streamline the HEDIS reporting process and drive actionable insights from data.
A regional healthcare payer achieves 94% reduction in manual effort and >60% reduction in report execution time with improved accuracy using Virtusa’s compliance and prompt pay audit.
Virtusa collaborates with a national Blue payer to identify the right level of care for patients by stratifying into risk pools using HL7 CCD data.
Helps strategize and host data lake both on-prem and cloud, cloud data lake implementation (AWS, Snowflake), NoSQL implementation (MongoDB, Cassandra, neo4j), real-time data integration, and execute cloud data migration leveraging HITRUST and HIPAA standards.
Virtusa implements analytics-led root cause identification of appeals and grievances and automated balancing, control, and exception reporting for a national Blue payer.
A regional Blue payer partners with Virtusa to leverage CMS Medicare Datasets for prediction of membership enrollment of a health insurance plan.
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