Healthcare Industry- Overview
The Healthcare industry is one of the biggest spenders on IT across the globe. The U.S. alone spent about $2.2 trillion in 2006 on medical care and the net spending of the US Healthcare industry on outsourcing was U$39.6 billion in 2003-2004. The market for Healthcare Claims processing alone was expected to grow to $4.39 billion in 2008. The emerging trend in the Healthcare market is towards outsourcing more value added services than were traditionally outsourced. One of the emerging outsourced high-end solutions is Revenue Cycle Management which includes services including:
- Managed Care Enrollment
- Eligibility Administration
- Claims Processing
- Provider Relations
- Third-party Liability
The Healthcare BPO services market in India grew by around 60 percent in 2006. The revenue from off-shored Revenue Cycle Management Services to India was $125 million in 2006, and expected to grow to $410 million by 2011. However, the Indian Healthcare sector has been slow in IT adoption, and is now steadily catching up with other sectors that are using IT to conduct business. Some of the areas where IT is being adopted to enhance operational efficiencies and to improve the customer experience are:
- Patient Records Archival and Maintenance
- Patient Billing
- Inventory Management
Challenges in Healthcare
- Reducing Healthcare costs
- Improving the quality of medical care
- Extending the reach of effective Healthcare
Off-shored services have unique demands
- The main objective for Automation of Health Claims processing & Enrollment for organizations in the outsourcing space is to make the transaction processing - more efficient, productive and streamlined, while continually reducing costs
- Healthcare organizations face the challenge of processing large volumes with substantial Turn Around Time (TAT) and highly competitive SLA
- Critical quality standards need to be met
- Claims processing & Enrollment are paper intensive and regulated by strict regulatory & compliance requirements like HIPAA
- There is need for stringent monitoring of agents and transparency to clients
- Standard EDI output formats need to be managed by applications
Newgen’s Solutions
Newgen leverages their expertise in imaging, document and content management, automation of work flows and innovative application development to provide hybrid solutions to the Healthcare industry.
Electronic Patient Records (EMR)
Newgen’s Electronic Patient Records (EMR) solution allows capture of patient records and archival of electronic records in relevant folders as per the organizational hierarchy and business rules. Patient and diagnostic information from various sources can also be integrated into this solution to provide an end-to-end patient record to consultants and specialists at a glance. The easy to use, highly customizable interfaces of Newgen’s solutions ensures that the training requirements for Healthcare providers are kept to a radically low level and patient information can be referred to, by consultants any-time any-where. Moreover, the solution does not warrant heavy investments in infrastructure and can leverage existing IT setups. The architecture of the solution allows it to be extremely flexible to cater to changing demands and typical business requirements of Healthcare providers. The solution is also highly scalable to allow future growth and expansion with capability to integrate multiple systems and applications into a unified platform.
Automation for Outsourced processes
Newgen has provided automation with its workflow solution backbone for outsourced processes such as Health Claims Processing, Managed Care Enrollment, Provider Contracting, Disenrollment and Credentialing to name a few.
Key Benefits
- Better patient care with information available as and when required
- Processes transitioned to a single platform providing end to end visibility and quality control
- Status tracking in real time
- Replaced multiple legacy systems to provide a single application for all users
- Immediate benefits noticeable in process efficiency and TAT post implementation of workflow platform
- Enhanced productivity of FTE brought about by image assisted data entry
- Over 99% accuracy in captured data
- Reduced Costs of Operations
- Enhanced Productivity and Reduced Cycle Times
Future Approach
Newgen has conceptualized a radical and innovative platform to extend the reach of Telemedicine and take it beyond the current limitations and challenges, as have been experienced so far in nascent initiatives. This platform will leverage Newgen’s software back bone with re-engineered and cheaper probes, over 3G and/or WiMax networks for providing consultation and diagnostics to patients in remote areas which have limited or no access to Healthcare services. This model is envisaged to be very cost effective and will optimize the time spent by consultants in attending patients remotely and ensure that the maximum number of patients get medical attention. This approach has been conceptualized for use in developing countries as well as developed countries, with applications ranging from health care in urban slums to niche medical services and care for senior citizens in old age homes.
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