Healthcare payers and providers are facing a unique challenge to improve the quality of healthcare being delivered while being challenged with the double digit rise in healthcare spending through appropriate medical management initiatives. To be competitive, the payer organizations also have to take into account the consumerism and regulatory needs in addition to balancing the conflicting needs. This has become a business necessity rather than an option and the payer industry is looking at ways and means that can help improve their internal process and maximize their existing investments.

Payers	Providers
Commercial Insurers  Medicare & Medicaid Services Managed Care Charity Care	Physicians Pharmacies Hospitals Clinics Laboratory Services

Services for Payers

	Claims management - Auto claims adjudication for institutional, professional, dental pharmacy claims with customized business object models
	Benefit management - Easy and flexible benefit plan design structures for rates and network design
	Pharmacy management - Scalable extensions to Medicare Part D and e-Prescriptions
	Care management - Plug and play care management support for disease management and pay for performance accelerators dental pharmacy claims with customized business object models

 

Payer Analytics

Healthcare organizations in the US are grappling with managing the growing gap between clinical needs and financial resources. The aging population in developed countries is demanding more and better care, while the cost of care is surging. The changing demographics combined with rising consumerism and increased competition is forcing payers to look at advanced analytical tools to empower healthcare business strategists the power of complex decision making with a high degree of accuracy to contain costs while improving access to best quality care.  These analytical models help in increasing operational efficiency by:

	Reducing billing errors
	Managing claims in time
	Managing fraud and abuse
	Deriving profitable plan designs
	Designing optimal benefit pricing and design
	Identifying cross selling opportunities
	Increasing customer satisfaction / retention

LGS’s Business Intelligence and Analytics Solution help Payers
Meet the Above Goals, by Focusing on the Following:

	Validating the precision bias and stability of quality performance indicators
	Aligning best practices policies within and outside the organization, making a huge difference in the efficiency of routine operations
	Providing visibility and complete granularity on various processes needed to plan and execute accurate operations

 

Payer Analytics Provides Service in Seven Key Areas:

Member Analytics	Provider Contracting
Member satisfaction analytics Demographic market segmentation Outcomes analytics Risk pooling and monitoring Consumer innovation	Reimbursements optimization Contract Analytics P4P Analytics Credentialing Analytics

Underwriting Analytics	Financial Analytics
Health benefit pricing Risk solvency Actuarial and pricing models Reserve calculation	Rate filing analytics Capital Analytics Spend analytics Performance evaluation Reserve analytics

Regulatory Analytics	Market Analytics
Rating mandates analytics Product and benefit mandates HIPAA preparedness Impact of new regulation on business	New product impact Commercial market share Distribution channel analytics Service line analytics

Strategy and Planning	Market Analytics
Market assessment Financial analyses Operational analyses Claim analyses	New product impact Commercial market share Distribution channel analytics Service line analytics

EHR / EMR Services:

LGS Healthcare Service offerings will help to improve Patient Safety and enhance care delivery by providers in response to the increasing pressures they face on improving safety, streamlining operations and controlling costs through a proven global sourcing model. Our model uses a strategic and flexible combination of on-site and off-site resources coupled with dedicated teams of industry-seasoned managers to bring you the highest-quality services at the lowest possible cost. Our Services in EMR / EHR include:

EMR / EHR Reporting Services:

Provider organizations can leverage LGS's strong reporting team, a blend of associates with deep clinical and technical expertise to meet and exceed your organization EMR / EHR reporting requirements. LGS associates are trained and certified by EPIC Systems and CERNER Corporation in both clinical and financial applications. Leveraging our resources and services will enable hospital staff perform more pertinent duties and while LGS's reporting team to handle any future requests.

Data Analytics Services:

LGS's Data Analytics Services, with the help of data warehousing and statistical modeling techniques, can help providers bring about significant changes in clinical, financial, operational outcomes using previous transaction data. LGS's services increase visibility of clinical, financial and operational information across the provider organization, to enable strategic improvements and improvement in delivery of clinical care for patients.

 

Stakeholder Relationship Management:

Healthcare providers are increasingly realizing the role of effective communication and collaborating with all members of the healthcare value chain in increasing patient satisfaction and cutting operational costs. LGS helps providers communicate effectively and collaborate with all stakeholders by delivering:

	CRM solutions for effective patient relationship Management
	Internal stakeholder solutions for enhancing collaboration between physicians, care givers and administrative departments of providers
	Patient Outreach, Improving therapy adherence & Behavioral & Lifestyle Modification Support
	Decision Support reporting for quality care delivery

 

Our Solutions and Services for Above Areas of Focus Stakeholder Portals / Dashboards such as:

	Patient Portals - Health Status, Alerts & reminders, Visit Scheduling and Educational contents
	Physician Portals - Day to day workflows, Decision support & Report and Professional service reports
	Administrative Portals - Operational metrics dashboards, Resource management and Financial Management

Operational & clinical Analytics

Drill down reports for KPI tracking and decision Support components for various stakeholders.

Laboratory Services

LGS laboratory services comprise the entire gamut of automation from the sample collection to the report preparation. Our services for laboratory include the following areas:

Lab specimens Patient ID Supply-chain management Tracking pharmaceuticals Pharmaceutical administration

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