solution

Healthcare Payer Analytics

Optimize payer performance across efficiency, quality, and costs

Healthcare organizations can leverage analytics to improve patient experience, support population health, improve clinician experience, and reduce care costs.

Despite access to emerging technologies, payers continue to face real-world, day-to-day challenges that contribute to disputed claims, undue rejections/denials, workflow inefficiencies, and re-work efforts.

By shifting towards data centricity, predictive analytics, and machine learning payers can reduce healthcare costs by increasing efficiency. It improves utilization management, helps in decision making, and enhances the patient and clinician experience.

Why clients are choosing Virtusa

We bring our platform and data science accelerator assets to the table and rich experience from working with healthcare payers of different types.

  • Global premier partner with IBM Watson Health (including Truven Health Analytics, Explorys, Phytel)

  • Dedicated technology practice – with advanced data management and analytics services arm:
    • Technology capabilities and services to deliver successful engagements in the healthcare domain
    • 5000+ certified data and analytics resources
    • End-to-end capabilities in modernizing data platforms, analytics and AI/ML, data strategy and consulting, DWBI, data lake + cloud, and data governance
  • Dedicated consultative and advisory services practice specializing in the healthcare payer domain
  • Partnered with 9 of the top 10 healthcare payers 
Features
  • 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 provides orchestration for provider onboarding, claims, membership enrollment, and care management. It 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, analytics tools, methodologies and capabilities for onboarding, claims, services, enrollment, care management, services, etc.

  • IBM Watson Health resources
    Data-sets (MarketScan, Explorys, SpringPulse (SDoH), MarketResearch), and analytics methodologies (Flexible Analytics)
Features

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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Frequently Asked Questions
What is Virtusa’s Healthcare Payer Analytics?

Virtusa’s Healthcare Payer Analytics optimizes payer performance by leveraging AI-as-a-Service and machine learning (ML) for an intelligent dashboard. It improves workflow inefficiencies, helps decision-making, and enhances the patient and clinician experience. 

The Healthcare Payer Analytics platform uses data centricity, predictive analytics, and ML for reducing healthcare costs. The platform increases the efficiency of provider onboarding, claims services, enrollment, and care management of patients. 

Healthcare Payer Analytics provides intelligent, descriptive, predictive, and prescriptive visualizations. It creates provider and member functional and sub-functional reports and dashboards that include operational and strategic shared services. 

Virtusa’s Healthcare Payer Analytics has data governance that maintains provider onboarding, claims, membership enrollment, and care management. It includes master data management, data quality management, data security and privacy management, and data reconciliation platform for members. 

Virtusa’s Healthcare Payer Analytics uses AI/ML-driven analytics, task routing, business rules-driven integration, and intelligent workflow by leveraging cognitive analytics. Smarter intake leverages Natural Language Processing (NLP), Optical Character Recognition (OCR), and Handwritten Character Recognition (HCR). Efficient claims processing uses adaptive and predictive AI models, while focused care management is based on the propensity of member parameters. 

IBM Watson is a data analytics processor that uses Natural Language Processing (NLP) and analyzes vast data repositories. It helps payers quickly go through large data sets, such as claims reports, and isolate desired information for improved workflow. Virtusa’s Healthcare Payer Analytics uses data sets – MarketScan, Explorys, SpringPulse (SDoH), market research, and analytics methodologies such as Flexible Analytics. 

 

 

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