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Business Technology Solutions - Healthcare Technology Solution
(Gold Winner)

PO#

#TBA03204

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Paid

PO Created Date

2024-09-10 04:29:12

Paid Date

2024-09-10 04:30:18

Competition

2024

Season

Entry ID

TBE103563

Entry Submission Date

2024-09-10 04:13:51

Member's Name

Fardin Quazi

Member's Email

fardinq@gmail.com

Entry Level

Information Technology

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BT24020 - Healthcare Technology Solution

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Project Description

Project Description for Judges

Question 1 : Describe the brand, features, functions, and benefits of your product or service. (Your response to this question will be used for public display if your entry is awarded.)

Cognizant's Healthcare Business Process-as-a-Service (BPaaS) is a cutting-edge, cloud-based solution designed to transform healthcare operations and accelerate the shift to value-based care. This solution, powered by Cognizant’s TriZetto® core administration platforms, integrates people, processes, and technology to deliver scalable, cost-effective services tailored to the specific needs of healthcare payers and providers.
Features:
•	Automation and AI Integration: BPaaS utilizes advanced automation and AI to streamline workflows, enhance decision-making, and minimize manual processes.
•	Cloud-based Flexibility: Operating on a scalable cloud platform, BPaaS ensures cost-efficient service delivery and seamless integration with other cloud services.
•	End-to-end Functionality: BPaaS covers a broad range of healthcare administration functions, including member enrollment, claims processing, customer experience management, and clinical support services.
•	Compliance and Security: HITRUST CSF certified, the solution ensures secure data management and adherence to industry regulations.

Functions:
•	Claims Administration: Automates claims processing to ensure accurate and timely payments, reducing administrative overhead.
•	Enrollment and Member Services: Enhances member onboarding and benefits configuration, providing a seamless experience across all touchpoints.
•	Provider Data Management: Streamlines provider credentialing, contract loading, and data management, ensuring data accuracy.
•	Clinical Support Services: Offers expertise in utilization management, case management, and population health management to drive better clinical outcomes.

Benefits:
•	Cost Reduction: By shifting to a pay-per-use model, BPaaS significantly lowers the Total Cost of Ownership (TCO) for healthcare organizations. It reduces administrative expenses by up to 50%, offering substantial cost savings without compromising service quality.
•	Scalability: The platform easily scales to meet fluctuating business needs, supporting rapid expansion into new markets.
•	Improved Outcomes: Enhanced automation and data-driven insights enable better health outcomes, compliance, and member experiences. The integration of AI and analytics further drives operational excellence.
•	Operational Efficiency: The integrated approach reduces manual effort, increases throughput, and ensures consistent regulatory compliance.
Cognizant’s BPaaS solution is a key enabler for healthcare organizations aiming to modernize operations and thrive in a value-based care environment. It offers the flexibility, scalability, and efficiency required to meet the evolving demands of the healthcare industry, while significantly lowering costs and improving overall outcomes.

Question 2 : Outline the market performance, analytical response, and customer satisfaction of your products or services, to date.

Cognizant's Business Process-as-a-Service (BPaaS) in healthcare has proven to be a powerful driver of efficiency, cost savings, and customer satisfaction, underpinned by advanced technologies such as Intelligent Process Automation (IPA), Robotic Process Automation (RPA), and machine learning. This platform has enabled healthcare organizations to streamline their operations, resulting in substantial improvements in performance metrics and financial outcomes. To outline the performance parameters the below Key Metrics are picked from our successful implementations for our clients. These KPIs are supported by the attached PDFs and links provided to substantiate the claim.
•	Cost Savings and Efficiency Gains:
o	Projected $900 million in cost savings for a major health plan in over seven years by leveraging IPA to manage claims and improve customer experience.
o	17,000 hours of increased efficiency achieved by deploying RPA to verify medical appointments, eliminating 100% of input errors.
•	Operational Improvements:
o	15x reduction in claims inventory and a 4x reduction in average days in-house for pending claims.
o	75% faster investigation response by automating the claims appeals process with standardized workflows and a centralized repository, leading to a 50% increase in productivity.
o	95% encounter utilization monitoring (EUM) acceptance rate, up from 83%, indicating improved compliance and operational accuracy.
o	25% increase in average daily collections and an 8% productivity boost from client’s investment in Revenue Cycle Management (RCM).
•	Enhanced Claims Processing:
o	600% faster claims processing by strategically adding 2,000 IPA bots and establishing an Automation Center of Excellence, saving $40 million annually and boosting capacity by over 43 million claims per year.
o	99%+ claims pricing accuracy achieved through advanced automation and streamlined processes.
o	30% decrease in claim denials, resulting in $13 million in additional revenue.
•	Customer Satisfaction:
o	15% reduction in call volumes and a 30-second decrease in call times for 51% of remaining calls, thanks to a modern IVR system that automates HIPAA authentication and allows 24/7 claims status checks.
o	25% lower plan administration costs by introducing BPaaS to automate claims processing and simplify regulatory compliance, which also reduced call volumes by 15%.

Question 3 : Provide examples of the strategies / plans you have introduced, in order to attain your product’s or service’s performance standard? Explain why the highlighted achievements are significant / unique.

With my 19+ years of experience in Digital Transformation in Healthcare (Payer/Provider, Medicare/ Medicaid), I was appointed as the Lead Project Manager for multiple tracks. My role involved development & implementation of BPaaS factory model for various clients.
Strategies and Plans Introduced:
1.	Medicare BPaaS Factory Model:
I led the development of Medicare BPaaS factory model, establishing a "golden standard" for process design, tools, and platforms to set a new industry benchmark. This model streamlined workflow operations across Medicare-Medicaid services, including Provider Data Management, Claims Auto Adjudication, Mailroom, Front Office, Fulfillment, Contact Center, and Utilization Management. 
2.	DPP Claims Project for a Leading Medicaid Health Plan and Provider in Texas:
I managed the processing of 149,000 pending claims worth $258 million in just 2.5 months. As a Track Lead, I created a savings roadmap of $900 million over 7 years, deployed RPA, saving 17000 hours and eliminating 100% input errors in medical appointments. Achieved 15x reduction in claims inventory, and 4x reduction in average days in-house for pending claims.
3.	Change Management for a Leading Medicaid Health Plan and Provider in Texas:
As Change Manager, I led efforts within the client’s Project Prioritization Committee, implementing 23 Change Requests worth $686,500 in less than five months. This ensured the BPaaS platform’s agility and responsiveness to evolving client and regulatory needs.
4.	System Analysis and Implementation:
I played a key role in analyzing, designing, implementing the BPaaS solution, leveraging Facets core platform. This included integrating RPA/IPA tools, as well as third-party tools like UIPath and BluePrism. This integration made BPaaS platform highly efficient and adaptable through advanced automation.
5.	Provider Data Management:
I managed the post-production Provider Data clean-up project for a client, coordinating multiple stakeholders. The project involved cleaning up provider data and implementing changes in the QNXT system, with careful assessment of the impact on Member-data and Claims. 
6.	Vendor-Compliance Management:
I managed third-party vendors to ensure CMS compliance for Medicare operations, developing SLAs, a Scenario-based Transition playbook, KPIs. Successfully navigating complex regulatory landscape while enhancing operational effectiveness underscored the strategic importance of this role.

Optional Context for Judges (Not for publication. This section is solely for judges' evaluation.)

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Link List

Link	Password Protected	Display (Winner Info)
https://sites.google.com/view/fardinquazi/	No	Hide
https://www.youtube.com/watch?v=fKr8I95kO_E&list=PLcBCKk-o8bgx9R4YEzh3l7dhYVxYw4V5Z&index=9	No	Display
https://www.youtube.com/watch?v=Pbtxv3tr5dg&t=32s	No	Display
https://scholar.google.com/citations?hl=en&user=l_-ifdUAAAAJ	No	Hide
https://www.cognizant.com/us/en/industries/healthcare-technology-solutions/hts-business-process-services#spy-outcomes	No	Hide

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File Link	File Size	File Link (System Resize)	File Size (System Resize)	Display(Winner Page)
upload/entry/files/TBE103563/15901725941678.pdf	217.32KB	upload/entry/files/TBE103563/15901725941678.pdf	217.32KB	Hide
upload/entry/files/TBE103563/20131725941714.pdf	1.97MB	upload/entry/files/TBE103563/20131725941714.pdf	1.97MB	Hide
upload/entry/files/TBE103563/27501725941756.pdf	2.04MB	upload/entry/files/TBE103563/27501725941756.pdf	2.04MB	Hide
upload/entry/files/TBE103563/16131725941782.pdf	250.40KB	upload/entry/files/TBE103563/16131725941782.pdf	250.40KB	Hide
upload/entry/files/TBE103563/15461725941848.pdf	2.92MB	upload/entry/files/TBE103563/15461725941848.pdf	2.92MB	Hide
upload/entry/files/TBE103563/17421725941859.pdf	1.52MB	upload/entry/files/TBE103563/17421725941859.pdf	1.52MB	Hide
upload/entry/files/TBE103563/13121725941878.pdf	189.09KB	upload/entry/files/TBE103563/13121725941878.pdf	189.09KB	Hide
upload/entry/files/TBE103563/43081725941987.pdf	128.44KB	upload/entry/files/TBE103563/43081725941987.pdf	128.44KB	Hide

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