Succeeding in the Government Healthcare Market Just Became Easier

Succeeding in the Government Healthcare Market Just Became Easier

Health plans today face many added pressures. With the shift to value-based care, evolving regulatory and compliance requirements, rising costs and advances in technology and the way customers consume information, keeping pace with the industry can be overwhelming. You have to not only keep pace, but get out in front of the pack in order to grow your membership and keep those members healthy and satisfied.

So, how can you successfully manage daily operations while focusing on updating technology infrastructure, advancing data analytics and providing quality care programs that lead to better health outcomes…and a better bottom line?

Cognizant can help.

Having the right strategic partner that can support end-to-end capabilities across your business can make all the difference!

Cognizant’s end-to-end capabilities can help you achieve business outcomes whether you are new to the government healthcare market or looking to evolve and scale your existing business. We can help you determine the best solutions for you to compete and succeed in the Government Healthcare market. We’ve built the broadest suite of government programs solutions that address regulatory requirements, emerging industry trends and operational improvements, and offer the most reliable, effective services in the market, including:

  • Healthcare Business Consulting and Advisory Services
  • Software Solutions
  • Quality Solutions (Star Ratings and HEDIS)
  • Healthcare Infrastructure Services
  • Business Process Services
  • Business Process-as-a-Service

Cognizant is committed to continuous innovation in our solution portfolio. We’ve built our extensive government-focused suite strategically, while offering the most effective and reliable services, in the healthcare government programs market. Our solutions combine technology innovation, passion for client satisfaction, deep healthcare industry understanding, a collaborative workforce and business process expertise.

Coming Together to Serve You Better

To further expand our capabilities in the government market, we recently acquired TMG Health, a top service provider for U.S. government-managed healthcare programs. The integration of TMG Health advances our solution portfolio with distinctive competencies for government program administration, including Medicare, Medicare Advantage, Medicare Supplement, Prescription Drug Plans, Managed Medicaid, Dual Eligible, Children’s Health Insurance Program (CHIP) and Managed Long-Term Services and Supports (MLTSS).

The Shift to “As-A-Service” Models

As the healthcare market continues to shift and evolve at record pace, many health plan executives are realizing the value of “as-a-Service” models. These efficient, cost-effective methods of administering a health plan change how businesses are investing in technology and provide the necessary operational agility to expand as the market grows.

Bringing together automation, insights, and best-in-class industry processes and platforms allows businesses to focus on creating new products, cultivating a better customer experience and establishing a strong competitive differentiation. Given the current political climate, financial pressures and compliance requirements that government health plans are now experiencing, “as-a-Service” models are the way forward.

The Value of Business Process-as-a-Service

Cognizant has established an integrated Business Process-as-a-Service (BPaaS) model that allows health plans to consume payer business services for each functional area, as per their demand, and pay for services based on membership (PMPM). Health plans can focus on core market needs, while we take full ownership and responsibility for back office and enabling functions. Health plans can create new products, focus on customer experience and have a strong competitive differentiation while addressing the pressures of both Medical Loss Ratio (MLR) and Administrative Loss Ratio (ALR).

Our Business Process-as-a-Service (BPaaS) model for government healthcare provides:

Our government programs BPaaS solution is built upon our 19+ years of experience serving the government healthcare market exclusively and our long history of successfully converting health plans to our platform and service.

That experience and expertise, coupled with our pre-configured IT landscape, standardized processes and government-specific technology (based on the Facets™ Enterprise Core Administration Platform), enables health plans to handle accelerated growth while reducing capital spend on regulation and technology modernization through:

  • Global and Regional Scale
  • Platform-based Services
  • SLA-based Outcomes
  • Subscription-based Pricing
  • Stringent Compliance Coverage

Our BPaaS model enables Cognizant to manage overall operations and technology services, which allows the health plan to focus on core strategy and business.

Business Operations

  • Membership & Configuration
  • Claims
  • Contact Center
  • Appeals & Grievances
  • Medical Management
  • Provider Management

Technology Services

  • IT Services & Infrastructure
  • Platform Strategy
  • Product Development
  • Go-To-Market
  • Hosting
  • Infrastructure Assets

Take the Next Step

To learn more about Cognizant’s government programs solutions and our BPaaS model, contact:

Anup Panthaloor
(860) 918-5781