Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.
Truven Health Analytics™ evaluated the extent to which community need— a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing—is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.
Why do patients so often forget to tell you about their new insurance plans? And what can you do to keep your cash flow running smoothly when it happens? Read this flipbook to learn how to avoid eligibility-related “surprises.”
Healthcare billing and claims handling has become increasingly complex. With the transition to Version 5010 of the HIPAA electronic transaction standards, the expansion of billing codes under ICD-10, and the ever-changing requirements of insurance companies and the Centers for Medicare and Medicaid Services (CMS), it can be nearly impossible for providers to keep up.
In October 2013, S&P Dow Jones Indices (S&P DJI) launched the S&P Healthcare Claims Indices (the indices). This new index series is designed to provide an independent, timely measure of the changes in healthcare expenditures and utilization for individuals enrolled in commercial health insurance plans in the United States.
S&P DJI developed these new indices in conjunction with healthcare professionals at Health Index Advisors (HIA), a joint venture between the premier actuarial and consulting firms Aon Inc. and Milliman Inc. S&P DJI combined its knowledge and experience in developing leading indices with HIA’s experience in the healthcare market to develop the first index series of its kind, based on actual healthcare claims data. These indices seek to increase transparency in the healthcare market and enable the analysis and tracking of changes in healthcare expenditures.
Establishing a startup’s business infrastructure early — that is, establishing support in the areas of legal, accounting, tax, insurance, and human resources (HR) — provides a number of critical benefits for any entrepreneur to consider. This paper discusses suggestions for management teams that will facilitate establishment of an appropriate infrastructure.
Benefits, especially insurance benefits, are extremely important to employees and one of the main things they take into consideration when they make employment decisions. Many employers that offer insurance generally offer a combination of health, dental, and vision insurance. Sometimes dental and vision insurance are offered separately from health insurance, or they may all be rolled into one plan.
Published By: Nextgen
Published Date: Sep 25, 2019
Your practice can save time and money by delivering on patient expectations. You can better keep up with regulatory demands and reporting requirements—and avoid unsatisfied and unresponsive patients—when you employ best practices that address patient needs.
In this eBook, you’ll learn strategies to avoid missed revenue and save staff effort by using smart efficiency improvements, such as checking insurance information up front. You’ll also learn how you can get back to caring for patients, not chasing payments—and the secret to achieving strong financial outcomes. Finally, you’ll discover how you can get paid quickly, easily, and fully—all while addressing your patient demands for an improved, more efficient experience.
In September, leading insurance professionals joined TIBCO for an exclusive and interactive roundtable dinner. During the course of the discussion, it became clear that while AI will significantly alter the customer journey, a lot still needs to be done in terms of both defining AI's capabilities as well as acknowledging where it best fits in an insurance business, how it will impact the workforce and reinvent the customer journey.
Connected Intelligence in Insurance
Insurance as we know it is transforming dramatically, thanks to capabilities brought about by new technologies such as machine learning and artificial intelligence (AI).
Download this IDC Analyst Infobrief to learn about how the new breed of insurers are becoming more personalized, more predictive, and more real-time than ever.
What you will learn:
The insurance industry's global digital trends, supported by data and analysis
What capabilities will make the insurers of the future become disruptors in their industry
Notable leaders based on IDC Financial Insights research and their respective use cases
Essential guidance from IDC
A perfect storm of legislation, market dynamics, and increasingly sophisticated fraud strategies requires you to be proactive in detecting fraud quicker and more effectively.
TIBCO’s Fraud Management Platform allows you to meet ever-increasing requirements faster than traditional in-house development, easier than off-the-shelf systems, and with more control because you’re in charge of priorities, not a vendor. All this is achieved using a single engine that can combine traditional rules with newer predictive analytics models.
In this webinar you will learn:
Why a fraud management platform is necessary
How to gain an understanding of the components of a fraud management platform
The benefits of implementing a fraud management platform
How the TIBCO platform has helped other companies
Unable to attend live? We got you. Register anyway and receive the recording after the event.
What if you could use just one platform to detect all types of major financial crimes?
One platform to handle the analytical tasks of fraud detection, including:
Data processing and aggregation
Statistical/mathematical/machine learning modeling
One platform that could successfully reduce complex and time-consuming fraud investigations by combining extremely different domains of knowledge including Business, Economics, Finance, and Law. A platform that can cover payments, credit card transactions, and know your customer (KYC) processes, as well as similar use cases like anti-money laundering (AML), trade surveillance, and crimes such as insurance claims fraud.
Learn more about TIBCO's comprehensive software capabilities behind tackling all these types of fraud in this in depth whitepaper.
AA Ireland specializes in home, motor, and travel insurance and provides emergency rescue for people in their homes and on the road, attending to over 140,000 car break downs every year, 80% of which are fixed on-the-spot.
“In each of the last five years, the industry lost a quarter billion in motor insurance," says Colm Carey, chief analytics officer. "So, there's a huge push for new data, models, ways to segment and pick profitable customer types—and get a lot more sophisticated. Our goal is to optimize pricing, understand the types of customers we're bringing, and the types we're trying to attract. We would like to tie that across the business. Marketing will run a campaign, trying to attract a lot of customers, but maybe they're not the right type. "We wanted to step away from industry standard software and go with something that was powerful and future-proof. In 2016, we had an opportunity to analyze all software.
We chose the TIBCO® System of Insight with TIBCO BusinessWorks™ i
"Considering switching to a single system for finance, planning, and analytics? These leading insurance companies did just that—and they achieved amazing results.
This infographic shows how Workday helped them stay competitive, deliver a customer experience like no other, and ensure compliance as well as:
Save $400,000 annually with better transactional control
Reduce time spent on manual processes, such as quarterly reports
Spend more time analyzing data than gathering it
Hybrid cloud adoption is accelerating within the financial services industry. Just recently IBM led a financial services focus group meeting with 20 banks and insurance companies. All of them indicated that they will be accelerating adoption of cloud technology over the next 12 to 18 months.
Published By: Iovation
Published Date: Aug 02, 2019
Insurance fraud is back with a vengeance. With four out of ten mobile claims estimated to be fraudulent, using connected devices have made it easier than ever for fraudsters to commit insurance crimes. Gather insights from the live panel discussion hosted by MoneyLIVE & TransUnion. As fraud experts examine current trends & impacts of insurance fraud in today's digital age and learn how to overcome insurance fraud while protecting your customer relationships.
What you will learn:
Key trends behind fraud and the way in which they are impacting insurers.
How to tackle fraud and identify red flags by using a holistic approach.
Explore trigger points that can help warn insurers of when there is a high chance of fraudulent activity.
Identify the genuine customers and their genuine claims from the fraudsters.
Published By: e-SignLive
Published Date: Oct 11, 2013
While we tend to think about mobility largely as a consumer phenomenon, it is also changing how the workforce carries
out business. With so much being done beyond traditional office walls, many insurance companies, financial service
organizations and even government agencies are adopting mobile tablets and smartphones as productivity tools for
agents, representatives and personnel, and developing enterprise apps for these devices.
Insurance is a part of an environmental contractor’s and consultant’s daily work life. Are you over extending your insurance policy? Are you opening yourself up to multiple lawsuits? Do you have the correct coverage? Find out in this whitepaper.
Case management frameworks built on business process management platforms help IT solutions architects deploy case-handling applications and offer an alternative to specialized case management applications and custom coding. According to Gartner, the complex architecture required to support case management has relegated it to the status of a niche application, typically addressed by specialist, commercial off-the-shelf application providers and system integrators. Case management as a process style is being applied in many sectors beyond government, legal and insurance, including healthcare, banking, higher education and retail. Industry and cross-industry case management frameworks are now available. "Adaptive case management" hype exceeds the reality of what buyers need. Gartner evaluated 12 vendors including Pegasystems against nine critical capabilities in four use cases.
Download this Gartner analysis and gain a better understanding of the case management frameworks solutions offe
When augmenting the benefits package for your organization, it’s natural to focus on traditional perks that employees have come to
expect: PTO, health insurance, and maybe a tuition assistance credit here or there. But if you’re looking for creative and effective ways to stimulate employee engagement while also driving business results, you’ll want to consider the powerful impact of offering language-learning opportunities.
Where’s the connection? And how can you reproduce these benefits within your organization? This playbook offers a deeper look at why language learning has such a positive influence on employee engagement and business performance, as well as step-by-step instructions for implementing a language-learning program in your organization.
While the Affordable Care Act (ACA) increased the number of Americans with access to health insurance, U.S. employers and employees continue to struggle with rising health care costs and changing workforce demands. Recent Aon research shows that 20% of health care consumers cite high health care costs as the major reason they have either declined health care coverage, stopped taking medications, or avoided care altogether. If the U.S. health care system is to succeed, stakeholders across the health ecosystem must influence change in each market—employer, individual, and government (Medicare, Medicaid, and Tricare).
While each part of the three-legged stool is important, this paper focuses on five strategies Aon believes will strengthen the employer-based system—a system that provides health care coverage to well over half of Americans (61%, or 177 million).