Operational Excellence for the Payer Industry

We partner with payer clients to reduce costs associated with claims processing and billing and membership processes and to help them take on better risk. Cost savings are achieved by transforming processes and systems in ways that also improve performance. Accenture has helped its clients reduce operating costs from 20 to 50 percent while increasing service levels.

Accenture combines leading-edge technology with unparalleled expertise in large-scale transformation to help payers drive significant performance improvements. The end result: claims and rating and underwriting capabilities that help drive healthy returns to the bottom line.

Our Core Administration Performance Services (CAPS) is an integrated, market-based, end-to-end solution. CAPS reduces core administration costs by a combined 50 percent and delivers improved efficiency and effectiveness. CAPS addresses: claims processing, billing and enrollment, and customer service. It achieves value through claims excellence, business process reengineering, business process outsourcing, systems integration and IT outsourcing.

Clients can gain significant annual savings through labor arbitrage alone. Process or technology improvements from other assets such as claims excellence can help clients realize further savings for both administrative and medical costs.

Claims Excellence
Accenture's Claims Excellence capability is a holistic approach to helping our clients reduce inappropriate payment of medical dollars. Overpayments are the result of a wide range of breakdowns in a complex process with multiple decision points. Claims Excellence focuses on identification and recovery of overpayments, and focuses heavily on avoiding overpayments going forward. Past experience has consistently shown that Claims Excellence can save even high-performing health payers an average of 1 to 2 percent of their claims cost on an ongoing basis.

Rating and Underwriting

• The Accenture Rating and Underwriting Solution focuses on four key levers to drive high-performance: accuracy, consistency, efficiency and visibility. Our solution has delivered 30 to 50 percent increase in predicted care cost accuracy and 20 to 40 percent reduction in average hours to price a case. The solution touches the full spectrum of rating and underwriting and includes:
   
• Rating and Underwriting Process Transformation: Accenture combines deep domain understanding, Six Sigma process analysis and design skills, and a pragmatic approach to help clients identify short-, medium- and long-term process improvements that last.
   
• Rating and Underwriting Technology Suite: Accenture offers an integrated suite of applications including our Pricing Analysis Workbench and our Underwriting Workbench that enable a higher level of performance. Actuaries and underwriters leverage Web-based applications to help improve the accuracy and consistency of pricing decisions, streamline and automate workflow, and collaborate effectively with the sales organization throughout the full quoting process.
   
• Enterprise Rating Engine: Enables any enterprise application to seek and receive a quote or rate from a single, XML-based rating service—in interactive or batch mode. The engine includes an intuitive spreadsheet development environment that actuaries/business analysts use to create and maintain rate models.
   
• Rating and Underwriting Implementation Assistance: Accenture has built rating systems from the ground up, and we have worked with nearly all of the major software vendors involved in rating and underwriting. We know their products. We understand the implementation issues. When required by our clients, our CMM Level 5 development capability delivers high-quality customizations and enhancements. For customers seeking to more aggressively lower deployment and maintenance costs, the Accenture Delivery Center Network, offers world-class development opportunities.