Health Plans

Healthcare technology has advanced to unprecedented levels, but dramatic changes in the business and political climate are making it hard for health plans to keep pace. Today’s health plan executives and government health insurers must guide decision making in what is arguably the most complex IT system in any industry.

The IBM Health Integration Framework is a platform for implementing comprehensive solutions to help you transform from a product model to a service model. Solutions such as enterprise health analytics and core systems and customer service modernization enable smarter healthcare to help you:

• Improve operational effectiveness, reduce costs and build flexibility and agility into core operations.
• Achieve better quality and performance to create new member/patient value and improve financial results.
• Deliver connected and personalized care for prevention and wellness.

See how Highmark worked with IBM to position their organization for success by establishing a roadmap of initiatives to realize value from SOA investments.

Enterprise Health Plan Analytics

• Detect patterns in sales, membership, claims, and providers.
• Use data to modify your products and services to increase profits.
• Become smarter by unlocking and integrating clinical and financial information, managing unstructured data, using real-time predictive analytics and measuring and monitoring performance.
• Streamline claims processing, improve disease management and detect fraud.

Solution projects include:

• Channel Modernization / HIPAA 5010 and ICD-10 conversion
• Enterprise Health Plan Analytics

IBM has proven enterprise software products which are used by health plans worldwide.

To learn more about how IBM Health Plan solutions can help your business grow, contact your IBM representative or IBM Business Partner.