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Health plans receive stress from many directions—government mandates, market consolidation, competition (including new entrants), advances in technology, and the eternal squeeze on price and profit, to name a few. Core operations has to make sense of these stressors, anticipate the next wave and keep things running efficiently, carefully and in a timely manner. Deloitte has teams of professionals who can help—they have been where you are now, with experience in disciplines like retail, M&A, and regulatory affairs that increasingly matter to plans.
The heart of your business
Core administration operations like product administration, claims processing, enrollment and billing are the crossroads where the needs of your plan’s key constituents intersect. To make those interactions smooth and profitable, you should use efficient platforms—or move to preferred new ones. You should have a business readiness framework that accounts for real and likely challenges.
Getting core operations right can be your secret weapon in an industry that prizes efficiency everywhere it can find it. A sound approach can help you keep up with the market, but a forward-looking approach can help you catapult ahead. If you become a leader in operations, it can even evolve into a value-add you sell as a service. Our specialists can help you make critical business changes become a part of your DNA and, ultimately, a potential springboard to help you capitalize on strategic opportunities.
Potential benefits can include increased efficiency and cost reductions, the ability to build and fill more capacity based on economies of scale and the ability to sell your operational prowess as a service.
• Migrations / business transformation
• Product launch
• Master data management
• Performance improvement
• Customer experience & retention
• ICD-10 / coding solutions
• Emerging plans / innovation solutions
• Network management
• Core admin maintenance
• PBM / formulary management
• Testing services
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