The significant forces driving and enabling payer businesses are:

Consumerism: Healthcare insurance product designs promote increased consumer expenses and consumer involvement in financial and clinical decisions. The business and IT initiatives associated with the defined product across all product lines, are designed to improve customer satisfaction, and the delivery and management of administrative and clinical resources for all healthcare payer products and services. Some examples are Web Benefit Selection and Enrolment, Web Customer Service, Provider and Service Cost, and Quality Information and Modelling of healthcare benefit and service decisions.

Connectivity: Collaboration can only occur in an industry where timely information can be shared. Challenge for Payers is to access, integrate, analyze and deploy results for their business decisions. Transcending silos of information with embedded business rules still stacked across heterogeneous application environment defines the existing Payer Systems today.

Analytics: The biggest pain point for payers today is to manage information. Transforming transaction-based to information-based system is the order of the day. The critical components of this transition are for payers to ensure that operational applications (Financial, Customer Relation and Patient Care) can move data to the appropriate analytic applications, build information delivery architectures that integrate information requirements of new constituents and continue to evaluate information requirements from all stakeholders.

Administrative: The primary administrative objective is to respond to client demands for applications that enable better product speed to market, product flexibility and better customer service through effective and quick transaction processing, real-time enterprise capabilities and administrative cost reductions.

This entails the Payers to embrace next generation architecture such as n-Tier SOA, Customizable Rules Based Applications, Configurable Work-flow Engines, Outsourcing Applications and Web Enablement as well as real-time third-party integration helps the Payer to realize this objective.

Covansys Offerings

At Covansys, we custom-fit our offerings against our solutions map. This provides a starting point for understanding how applications will fit holistically within the payer setting.

Our expertise lies in understanding methodologies and effective practices predominantly used extensively in the health/health-related industries. This can optimize business and care supporting processes with associated enabling technology.

We focus on technologies based on the HIPAA regulatory guidelines that promote transaction automation, connectivity and collaboration with industry stakeholders.

We transform transaction-oriented payer businesses to the next generation applications, which showcase even more complex product designs, customer demands, rationalizing and aligning IT with business processes to achieve:

1. Leveraging incremental technology to the established businesses
   
• Develop integration based on healthcare industry standards and propose technical solutions on the n-tier Service-oriented Architecture, as well as real time third party integration.
• Provide customizable rules based application.
  
2. Implementing emerging technologies to product line or business processes