Payer-Provider Collaboration for the Health Care Industry

In today's health care industry, payers and providers are forging new relationships built upon connective technologies to achieve high performance.

Both payers and providers are experiencing a never-ending escalation in health care costs. In the United States, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) promised tangible value, but that remains elusive for many health organizations and, in other countries, single-payer, public-sector models are under pressure to change.

In addition, comparison shopping for health plans and care providers by technology-savvy consumers is increasing competition. Technology, however, also presents an opportunity as mature and emerging solutions reduce previously prohibitive infrastructure requirements.

The time is ripe for an innovative, collaborative approach to address overall cost issues, including a reassessment of technology infrastructure. This can help both parties to improve their relationships by developing a better understanding of each other's expectations, processes, policies and capabilities—and help both advance toward high performance.

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Payer-provider collaboration can help enable high performance by improving margins, reducing operating costs and improving customer relations while increasing market share.

Accenture provides an innovative approach that is based on data-driven solutions as well as extensive health care and project management experience. We help organizations implement policy changes, process flow, training enhancements and technology modifications. Our approach is customized for market and scope, and can focus on administrative, infrastructure and/or clinical issues.

Our experience has shown that effective relationships can be developed anywhere, at any time and with results that can deliver high performance for all parties involved.

While collaboration may start in a single area such as revenue cycle, many opportunities for improvement exist, including:

• Revenue Cycle: Accenture helps payers and providers collaborate on revenue cycle issues with one of the goals being to reduce claim denials.
  
  
• Provider Portals: We help design, build and implement collaborative portals to enhance communication and reduce transaction costs.
  
  
• Care Management: Accenture assists clients in developing collaborative medical management techniques to help reduce clinical appeals, medical expenses and premiums.
  
  
• Accounts Receivable/Incurred but Not Reported: We have extensive experience in reviewing administrative appeals and denials, identifying problem trends with claims submission, and helping clients achieve real-time claims adjudication.
  
  
• Contract Management: Accenture helps facilitate contract negotiations, establish contract terms and conditions, and implement systems and processes for payment verification.
  
  
• Information Systems and Compliance: We help clients leverage regulatory requirements imposed by the Health Insurance Portability and Accountability Act of 1996 to improve transaction efficiency and achieve real-time claims submission and adjudication.

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