Introducing Unified member view for payors 

In this release, we continue to expand our investment across a new vertical with Unified member view (preview), our first solution for health payors. Similar to Unified patient view, Unified member view provides a single place to aggregate access and utilize different types of data instead of toggling between multiple screens and systems. Using Microsoft Power Apps, Unified member view enables payors to view complete records that combine data from various sources throughout the healthcare system.   

Built on a common data model derived from Fast Healthcare Interoperability Resources (FHIR) that make it easier for payors to securely exchange data with their providers and other FHIR-supported systems. Unified member view is a highly customizable and extendable solution that enables customers and partners to create innovative solutions targeting different payor scenarios.  

Using Unified member view, users can access all the aspects of member data and health insights in one solution in a single view. As part of a seamless experience, users can view information from various sources, including claims and lab reports. Member events such as admissions, discharge, and appointment history can also be visualized. Actionable information, such as gaps in care, suggested next best actions, and pending immunizations, can be computed in custom services and surfaced in this solution. Using this, data health organizations can derive insights to drive better member engagement, coordinate care, and manage population health. Unified member view is designed to help payors proactively reduce costs while also managing care.

Empowering Patient journeys 

Improving patient experience and satisfaction begins with understanding the patient journey. The series of experiences and interactions that a patient has with a healthcare organization—from initial contact to post-treatment follow-up—makes up the patient journey. By identifying various touchpoints, health organizations can pinpoint areas for improvement and ensure that patients have a seamless experience at every stage of their journey. By understanding the patient journey, healthcare organizations can optimize their services and tailor their efforts to attract and retain patients and members. 

Patient outreach is a patient campaign management application that helps organize and automate marketing and outreach to patients. Extending the customer journey orchestration engine from Microsoft Dynamics 365 Marketing to support diverse users, the Patient outreach application enables health organizations to engage patients in patient care decisions with personalized patient engagement solutions. Updates to Patient outreach include the addition of the Patient journey (preview)—empowering health organizations to effectively map and analyze Patient journeys. 

Optimizing each touchpoint in a patient’s experience can help providers improve patient satisfaction, retention, and loyalty, while payors can address efficiencies and the return on investment of their health plans. This application enables health organizations to orchestrate trigger-based workflows across patient touchpoints to automate repetitive tasks and allow patients to get personalized care faster. We see this as an opportunity not only to improve communication with the patient but to make it more efficient for healthcare workers.  

Device data support for Care Management 

As healthcare expands beyond the clinician’s office to include wearable devices and in-home patient care, Microsoft Cloud for Healthcare has developed solutions and data integration capabilities for health organizations to make it easier for them to provide care anywhere. Our aim is to make it easier for caregivers to access and track patients’ vitals and to gain early insights into patient conditions. Device data support for Care Management (preview) leverages the MedTech service in Azure Health Data Services to normalize data from diverse medical devices and convert it into the FHIR format in a secure way. The MedTech service enables data coming from the Internet of Things (IoT) devices to be integrated with other clinical data across health systems. 

By integrating the device data support capability inside Care Management, care managers can access the patient’s vital data, assess trends, and determine the next best actions for their patient. This enables clinical users to stay on top of a patient’s long-term health. Health organizations can add new health devices when required as well as maintain an inventory of these devices. Care managers can also assign, modify, and track data on devices, and Microsoft Power BI charts offer visualization of tracked data for easier evaluation. With readings analytics through Care Management, organizations can deliver personalized care by understanding the needs of the individual patient as well as the needs of the broader patient population.  

Life365, a leading remote patient monitoring solution provider is building solutions on top of Microsoft Cloud for Healthcare—empowering payors and providers to connect and scale to large patient populations. The Life365 Virtual Care Platform will offer the ability to provide a virtual first approach to connecting with patients and access to more than 400 medical devices intended for home care. This integration will allow remote patient monitoring data to be accessed through the cloud and enable health organizations to scale to large patient populations, mitigating the high utilization of resources and associated costs. 

“Life365 integrated to the Microsoft Cloud for Healthcare platform allows health organizations to shift from a reactive to proactive approach to care. By receiving insights into patient conditions, clinicians can intervene proactively and determine the appropriate course for care, ideally, helping reduce the risk of emergency room visits.”—Kent Dicks, CEO, Life365.

Easily build applications for health with Power Platform

Health organizations are considering low-code development to improve productivity, gain faster time-to-market, experiment more easily, and overall, be more agile when responding to market changes. A key blocker has been the inability to pull health data from multiple sources and manage it in a secure and compliant way.   

Microsoft Cloud for Healthcare includes configurable solutions to exchange data between Dataverse and external systems using the FHIR standard. Dataverse Healthcare APIs provide bidirectional synchronization between Dataverse and FHIR services such as Azure Health Data Services.  

As part of the April 2023 release, Virtual Health Data Tables (general availability) has been updated to include support for the create, update, and delete FHIR operations. Utilizing this functionality, customers can perform real-time updates to FHIR resource data on the remote FHIR service directly from within the Power Platform. This enables health customers to leverage Microsoft no-code and low-code Power Platform to build health applications, greatly simplifying the complexities of the FHIR standard. With the new capabilities, Microsoft is helping organizations reduce the cost of duplicate health data by directly connecting apps to where the data exists. Keeping data in fewer places means security improves by reducing the number of integration points and stores that need to be secured. 

Learn more about new capabilities with Microsoft

Read the links below and visit our team at HIMSS 2023 to learn more about new clinical and operational insights capabilities such as Project Health Insights (preview), the new Azure applied AI service that leverages multiple Cognitive Services, Healthcare API services , and other Azure resources.  

• Explore our demos and visit our in-booth Learning Center at HIMSS 2023 booth #1201.
• Learn more about Microsoft Cloud for Healthcare.
• Try Microsoft Cloud for Healthcare with a free trial.
• Learn more about the latest feature release for Microsoft Cloud for Healthcare.

Transform the healthcare journey

Deliver better experiences, insights, and care with Microsoft Cloud for Healthcare.

Discover our solutions

MEDICAL DEVICE DISCLAIMER. Microsoft product(s) and service(s) (1) are not designed, intended or made available as a medical device(s), and (2) are not designed or intended to be a substitute for professional medical advice, diagnosis, treatment, or judgment and should not be used to replace or as a substitute for professional medical advice, diagnosis, treatment, or judgment. 

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In our latest feature release for Microsoft Cloud for Healthcare, we’re excited to share how we can help your organization deliver exceptional patient and member experiences, accelerate data-driven decision-making, support your healthcare workforce, and enhance collaboration across the care continuum.

New Microsoft Cloud for Healthcare features accelerate transformation for health payors

We continue to help our customers and partners maximize the value of their investment in Microsoft Cloud technologies with industry specific apps, connectors, workflows, data, and AI models. With today’s announcement, and building on our October 2022 release, we’re accelerating value of the Microsoft Cloud and expanding our investment across a new vertical for health payors and insurers, which will complement the existing capabilities for healthcare providers:

• Unified member view for payors (preview). Helps organizations foster deeper member relationships by delivering useful member data to help relationship managers with a deeper understanding of a member’s wellness goals, important life moments, and other personal attributes. This application provides a comprehensive view of member data and member insights in one place for payor organizations. It builds upon the Microsoft Cloud for Healthcare Payor data model, previewed in 2022, and combines member information about claims, coverage, risk profile, care plans, and more. Customers can utilize this feature within existing Microsoft Dynamics 365 Customer Insights instances or utilize Microsoft Power Platform for building new member profile templates.
• Care journey templates for care management outreach (preview). Now payors and providers can automate workflows with common scenario templates (for example, patient discharge, care plan off track, diabetes management, and more) for Microsoft Dynamics 365 Marketing that can be used out of the box or customized for care management scenarios and help improve the quality of the care journey for patients and members. Providers and payors can send messages through Microsoft Teams, surface to-dos in the patient interaction timeline, and allow for secure messaging through Patient Access Portal. The patient journey feature extends communication channels beyond email to include text messaging and push notifications.
• Device data support for remote care management (preview). Built within Microsoft Power Platform, this feature enables healthcare organizations to support better hybrid care services, resulting in fewer patient visits to clinics and more frequent insights into patients’ health. This feature allows care teams and care managers to remotely monitor their patients’ vital health data, identify trends with that data, and manage their inventory of assigned medical devices. This feature builds upon the capabilities of MedTech service in Azure Health Data Services as well that of our independent software vendor (ISV) partner, Life365, that has integration to more than 400 original equipment manufacturer (OEM) devices.
• Enhanced operations support for Virtual Health Data Tables (general availability). We have further enhanced the Virtual Health Data Tables functionality to include support for creating and updating, as well as deleting Fast Healthcare Interoperability Resources (FHIR) data. This feature now allows users of Microsoft Power Platform based applications, built leveraging Microsoft Cloud for Healthcare Common Data Model and Virtual Health Data Tables, to also trigger real-time updates of clinical data stored in FHIR servers like Azure Health Data Services without the need for duplicating that data in Dataverse.

We recently announced our expanded collaboration with Cognizant and the plans to integrate Cognizant’s TriZetto healthcare products with the Microsoft Cloud for Healthcare. Through this integration we will be able to help support our mutual clients, deliver enhanced patient and member engagement, have access to improved data interoperability, improve insights, and achieve operational efficiencies in a significantly shorter time-to-value. Our companies will also collaborate to develop and run Cognizant’s current and future healthcare software as a service (SaaS) solution on Microsoft Azure, migrate new and existing clients from on premises environments to streamlined functions managed on the Microsoft Cloud, and support future technologies designed to deliver new insights for payers, providers, and consumers.

Seize the full potential of AI, while safeguarding your business, your data, and your health workforce

At Microsoft, we believe that AI is the defining technology of our time. Our company has been at the forefront of cutting-edge AI research and continually integrates powerful, innovative AI technologies into our products and services to help customers do more. We also recognize that data is the fuel that powers AI technology, and peak performance requires clean, integrated, accessible data. We continue to make huge investments in data and AI research, technologies, and partners because we’re committed to bringing technology and people together to realize the promises of AI responsibly.

Our momentum continues with updates across our Azure AI Services for Health:

• Text analytics for health released social determinants of health (SDoH) and ethnicity support. Enables unlocking mentions of social, environmental, and demographics factors from unstructured biomedical data including assertion detection such as negation of substance uses. Moreover, timing, frequency and amounts mentioned in the context of SDoH will be captured and associated with the entities using semantic relations that will now be surfaced as well. Healthcare organizations, providers, researchers, and pharmaceutical companies can extract insights, improve care, assess health inequity issues, track health outcomes, as well as incorporate underrepresented groups into clinical trials and research, breaking cycles of disparity. 
• Project Health Insights (preview). New Azure applied AI service that provides pre-built models which perform a decision support conclusion that can help health organizations solve high-value productivity challenges for clinical trial matching, and OncoPhenotypes. Project Health Insights models will enable healthcare providers to rapidly identify key cancer attributes within their patient populations based on their tumor site, tumor histology, and cancer staging. The models also matches patients to potentially suitable clinical trials, according to the trial’s eligibility criteria and patient data helping find clinical trials, that patients could be qualified for, as well as finding a cohort of potentially eligible patients to a list of clinical trials.
• Azure Health Bot integration with Azure OpenAI Service (preview). We are releasing a new Azure Health Bot template that allows our customers to experiment with the integration of Azure OpenAI Service into their Health Bot instances for fallback answers. This feature does not aim to facilitate the bot to answer unknown queries in the medical space, rather, it enables customers to access the Azure OpenAI Service API and decide how to use the model to improve their bot built through the Azure Health Bot service. Currently, we are offering the preview for internal testing and evaluation purposes only.

Today, we are also excited to announce the general availability of the accelerator kit for healthcare as part of the Responsible AI Dashboard in Azure Machine Learning. The Responsible AI Dashboard is applicable across industries; the accelerator kit for healthcare is aimed at training and debugging models for fairness, explainability, biases, and more before they are implemented in healthcare settings. The Responsible AI Dashboard accelerator kit for healthcare is a valuable tool to help check models for fairness prior to model adoption, allowing for confidence to use AI to inform space planning in hospitals or dispatching medical staff in facilities.

In addition to model debugging, the Responsible AI Dashboard accelerator kit for healthcare in Azure Machine Learning can equip healthcare providers with directional and causal relationship analyses between historical patient data and health scores to better provide lifestyle recommendations and modifications for patients.

Foster better collaboration and empower your healthcare workforce

Today, global health systems and payors are turning to collaborative technology platforms—intended to reduce administrative burden and proactively share data for interventions—to drive much-needed change. Technology should offer better ways of working, evolving the parts of healthcare delivery that are working and eliminating those that aren’t.  

In our booth at HIMSS 2023, attendees can experience the power of Microsoft Teams to simplify care coordination to help reduce clinician burnout, streamline communication and data sharing, facilitate multidisciplinary collaboration, and improve the patient-care team relationship—without compromising data security and compliance or adding unnecessary friction.

Virtual care tools reduce constraints on what clinical teams can accomplish and enable new and different ways to work. By leveraging virtual care, you remove barriers that hinder traditional care delivery models and empower people to create new solutions that are far more flexible, efficient, and supportive. Virtual Appointments in Microsoft Teams provides an out-of-the-box solution for clinicians to make patient-care team interactions as easy and personalized as possible, now generally available. Built on top of scheduling solutions like bookings or integrated with your scheduling solution through application programming interfaces (APIs), Virtual Appointments enable care teams to serve their patients in new and innovative ways. And with Teams Premium, healthcare organizations get advanced Virtual Appointments to manage the end-to-end appointment experience with capabilities like text messaging, custom-branded waiting rooms, analytics, and more.

For healthcare organizations using Epic® or Oracle Cerner, the Microsoft Teams EHR connector enables care teams to schedule and launch Teams virtual visits directly from their electronic health record (EHR) system. The connector gives patients flexibility with the option to join virtual visits via browser, the Teams app, patient provider portals, or text messaging, and offers support for group visits. Microsoft Teams with Teladoc Health Solo’s medical-grade whole-person virtual care delivery solutions for hospitals and health systems helps to optimize clinical efficiency, improve patient satisfaction, reduce burnout, and increase profitability, all while supporting an organization’s telehealth goals for today and tomorrow.

Health that connects and tech that cares at HIMSS 2023

We’re excited to join other innovators at the HIMSS 2023 conference to showcase how customers’ need for flexibility, choice, and future innovation doesn’t have to mean more complexity, people, and cost. For those of you traveling to Chicago for HIMSS 2023, I look forward to seeing you there. And I look forward to showcasing our latest Microsoft Cloud for Healthcare capabilities and more.

Here are additional ways you can learn more about Microsoft updates:

• Explore our demos and visit our in-booth Learning Center at HIMSS 2023 booth #1201
• Learn more about Microsoft Cloud for Healthcare
• Try out a free limited trial of Microsoft Cloud for Healthcare

Transform the healthcare journey

Deliver better experiences, insights, and care with Microsoft Cloud for Healthcare.

Explore resources today

• Epic® is a registered trademark of Epic Systems Corporation.
• For Oracle Cerner customers, the EHR Connector is only available in the United States.

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Everyone plays a role in combating FWA, but healthcare payers are on the front lines. Recently, three major trends emerged that present an opportunity for healthcare payers to play a major role in combating FWA. Let’s take a look at the way these trends are changing the healthcare landscape.

1. Plenty of healthcare data, not enough insights

Healthcare executives would like to leverage big data, but only a few are able to gain the insights and visibility needed to garner the results they need to address FWA in their organizations. Many healthcare executives have access to an unprecedented amount of data, such as the information stored in electronic medical records, smart devices and online portals. In a recent Managed Healthcare survey, 51% of respondents said their organizations are using big data, but when asked, “how well would you say your organization is using big data to improve healthcare quality and reduce costs?” only 11% of respondents said, “very well.”ⁱⁱⁱ As a result, healthcare providers have a limited capacity to recognize and reduce wasteful spending. Organizations will not be able to address improper spending due to FWA until they have the visibility and insights needed to identify where it is happening.

2. Decentralized communication between payers and providers

Failures of care coordination between providers can harm patients and add to the expense of healthcare. Healthcare systems today are expanding. The problem is that as these healthcare systems continue to grow, so will the need for providers and payers to coordinate care. For example, a physician could interact with as many as 229 other physicians across various practices each year.^iv With these critical interactions occurring across locations and practices, important information is obscured. For healthcare payers it’s essential to have visibility into diagnoses and care decisions to prevent FWA. As care coordination becomes more technical, added complications in billing arise, leading to an increase in unintentional, but costly, mistakes that contribute to FWA. Healthcare systems will continue to grow and become more complex, and without greater collaboration FWA will continue to grow as well.

3. Growing government requirements

Healthcare regulations are increasing around the globe. From increased coding standards to the various reauthorization acts, it has been said that “healthcare is turning into an industry focused on compliance and regulation rather than patient care.”^v Although these standards and acts are well intentioned, this is putting a strain on healthcare organizations in the form of wasted time and money. For example, 41% of payers see their biggest challenge as “complying with new government requirements and mandates.”^vi One example of these increasing regulations is ICD-10, which contains a new level of classification for coding diseases and symptoms. While these standards enable precise care documentation, they also introduce a new layer of complexity and can cause confusion. With the right level of visibility and centralized communications, healthcare payers will be better able to manage these increasing regulations. Today, new tools enable healthcare payers to predict and prevent FWA.

Introducing CGI ProperPay

To ensure that healthcare payers detect and correct improper claims quickly and accurately, they need a solution that provides visibility and insights to reduce FWA. CGI ProperPay, built on Microsoft Cloud Technology, is a medical claim analytics solution enabling healthcare payers to easily and securely identify, predict and prevent improper payments of medical claims. The solution helps healthcare payers gain insights with Power BI dashboards showing claim statistics, trends, relationships between doctors and patient-provider relationships.

A large northeastern insurer commented that, “With CGI’s ProperPay, we have an auditing, tracking and reporting tool all in one.” The northeastern insurer went on to say that CGI ProperPay “has greatly streamlined the audit process. It has allowed for a more efficient way of tracking our financial dollars.” CGI ProperPay analyzes claims to generate information and does the heavy lifting so payers can realize business benefits while freeing up valuable resources for other priorities.

Visit Microsoft AppSource for additional information and a free trial.

ⁱhttps://www.cgi.com/sites/default/files/white-papers/cgi-health-challenges-white-paper.pdf
ⁱⁱhttps://www.pianoo.nl/sites/default/files/documents/documents/thefinancialcostofhealthcarefraud-september2015.pdf
ⁱⁱⁱhttp://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-10-takeaways-managed-healthcare-state-industry-survey?page=0,1
^ivhttps://medicalreview.columbia.edu/article/communication-healthcare/
^vhttps://www.forbes.com/sites/physiciansfoundation/2013/11/05/healthcare-is-turing-into-an-industry-focused-on-compliance-regulation-rather-than-patient-care/#4a507b812e3c
^vihttp://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-10-takeaways-managed-healthcare-state-industry-survey?page=0,1

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That’s why I’m thrilled about the launch of Cognizant TriZetto health solutions on our industry-leading trusted cloud services. Their new solutions are on a secure, compliant managed services platform that empowers healthcare payers of all sizes to adapt quickly and cost-effectively to ever-evolving market forces, regulations and reform, and member needs.

Based on Cognizant’s leading TriZetto FACETS and QNXT end-to-end core administration software, the new solutions are deployed on the Microsoft’s HITRUST CSF-certified intelligent cloud platform . They can help your payer organization be more efficient, automate processes, and reduce administrative costs. With a flexible, on-demand cloud infrastructure, you have the agility to introduce innovative new products, including value-based care offerings faster than was previously possible.

My colleague Nasir Ali, Vice President of Product Management for Cognizant, is excited that Cognizant will be able to help payers digitally transform not just now but into the future with the power and intelligence of trusted Microsoft cloud assets.

“Moving forward, we plan to take advantage of the Azure platform to include innovative capabilities such as Stream Analytics, Machine Learning, and advanced management functionality in our solutions so our customers can continue to improve members’ health and experiences as well as their organization’s bottom line,” says Ali. “With the scalability of the platform, we’ll be able to rapidly test and release new functionality. All of this will help our customers react smartly and efficiently with new products and ways to engage their members as the healthcare landscape continues to evolve.”

With the new TriZetto health solutions, Cognizant and its customers will be able to scale in our high-performance cloud to run proof-of-concept experiments without disrupting business operations. They can then “turn on” new capabilities once they’ve been tested and they’re ready to put them to use. It’s faster, easier, and less expensive to do all that in the cloud versus in on-premises datacenters. The result? Speeding time to market for innovation.

A major new development in our nearly two-decade partnership with Cognizant, TriZetto Healthcare Cloud Solutions will fuel exciting new possibilities for how payers can digitally transform and innovate to succeed in today’s health ecosystem.

To learn more, read the Cognizant press release.

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Sometimes, it seems that healthcare spending is rising at uncontrollable rates. Over the past 20 years, global spending on healthcare has risen from 8.5% to nearly 10% of the Gross World Product. While worldwide health has improved during that time, there is nonetheless a constant tug-of-war between a desire to meet health goals and pressures to control spending. Decisions on healthcare spending present tremendously challenging and sensitive issues, as budget cuts and reallocations can cost patients their lives.

However, not all healthcare costs are correlated with better care. The healthcare industry is still struggling to eliminate wasteful practices that are rooted in habit, carelessness, or even intentional fraud. In order to get healthcare spending under control and improve quality of care, those in healthcare must pursue ways to improve efficiency and eradicate waste. Doing so requires an understanding of what drives wasteful spending.

Multiple studies estimate that over 20% of global healthcare expenditure is due to wasteful costs that are not actually associated with better care. Here, we break down six major ways that the healthcare industry can reduce wasteful spending and increase efficiency of care.

1. Identify cases of overtreatment

When physicians do not act on best practices and provide excessive treatments for their patients, the result is expensive and often harmful. For example: prescribing antibiotics for viral infections or resorting prematurely to surgery for back pain are wasteful and careless practices that consume healthcare budgets without leading to better health outcomes. Often, overtreatment is the result of carelessness or ignorance of best practices on the provider’s part. But sometimes, providers intentionally over treat patients in order to turn a greater profit.

Today, some providers are working to combat the overtreatment epidemic by taking part in movements like the Choosing Wisely Campaign. The group identifies and spreads information to providers about common, unnecessary treatments that should be avoided.

2. Reduce clinical errors

Everyone makes mistakes – and mistakes in the hands of medical professionals have the potential to be deadly. Procedures and treatments that are supposed to heal can result in serious complications when established practice guidelines are not followed – such as surgical site infections and incorrectly-prescribed medications. Mistakes such as these are life-threatening, expensive, and far too common – one in ten patients is adversely affected during treatment by preventable errors, and more than 10% of hospital spending is allocated to correcting such harm. While we can never eliminate all errors in medicine, disseminating and enforcing measurable best practices can significantly improve the safety of healthcare delivery.

3. Strengthen care coordination

In most healthcare scenarios, patients are being treated by more than one person: this could include multiple doctors, nurses, home care providers, and more. This is especially true of chronic care patients who visit multiple specialists. When care is not fully coordinated, harmful mistakes can result: miscommunication between physicians can lead to improper diagnoses, harmful drug interactions, and more. Half of healthcare-related communication errors occur during handoffs between providers. Failures of care coordination harm the patient and add to the expense of healthcare. By investing in better technologies and practices to deliberately organize care efforts and tear down communication barriers has a tremendous impact on improving patient care and reducing readmissions.

4. Simplify administration

Anyone who has worked in the healthcare industry can tell you about the headache-inducing complexity of healthcare administration. In the US, a multitude of private insurers, each with different payment practices, contributes to this problem. Furthermore, government rules and regulations that are designed to help can cause a lot of pain in the process. Burdensome administrative requirements that are designed to reduce errors and stamp out fraud sometimes lead to more pain than they are worth by requiring physicians to jump through time-consuming hoops without evidence-backed effects on outcomes. The expenses of healthcare administration is a classic case of wasteful spending, as there is no apparent link between higher administrative costs and better-quality care.

One of the most straightforward ways to simplify administration and trim excessive spending is increasing standardization of processes between diverse providers and payers. For example, credentialing and other systems that are used to establish contracts between providers and health plans are filled with redundancy. Standardizing administrative processes could save as much as $29,000 per physician annually.

5. Accelerate medical research efforts to reduce prices

Particularly in the United States, the prices of prescription drugs are all too often prohibitive for those who need them. When patients cannot afford to take their prescriptions, their health is put in jeopardy, and they are more likely to require even more costly treatment down the line. One factor that contributes to prohibitively high prices is the fact that new devices or pharmaceuticals usually have a lengthy research and development process. For manufacturers, this means years of rising production costs, followed by a narrow window of opportunity to market the item before the patent protection lapses. This can result in seemingly exorbitant initial prices. Advances in faster and more effective analytical methods for drug and device testing could speed up the process of identifying successful treatments and eliminating harmful ones. In turn, this would allow pharmaceuticals and devices to get to market more quickly, ultimately reducing costs.

6. Fight fraud and abuse

Finally, an appalling 6-7% of healthcare spending around the globe is lost to fraud and abuse every year. This is most often perpetrated by providers billing for their services incorrectly. This could take the form of adding nonexistent treatments or goods to a claim, or billing for more expensive services than those actually provided. As a result, funds are siphoned away from patient care and are pocketed illegally by providers.

Fraud and abuse is difficult to detect: it takes many forms, and most of the money lost to fraud and abuse is due to widespread, low-level scams rather than large, complex schemes. Auditors just don’t have the resources to take on the task of screening out all fraud manually. They need precise, data-driven tools that have the power to automatically identify aberrant claims and focus the auditor’s attention on the most important cases for review.

Fighting fraud, waste, and abuse with powerful analytics

In order to free up life-saving money for treatment, every party involved in the healthcare process needs to chip in to fight wasteful practices. In particular, healthcare payers are on the front lines of preventing healthcare fraud, waste, and abuse (FWA), and thus are tasked with screening claims for signs of improper payments. With powerful, data-driven tools that can detect historical trends and identify anomalies, auditors can spot FWA and ensure that improperly paid claims are returned.

CGI ProperPay for claims analytics, built on Microsoft cloud technology, is an industry-leading claims screening solution that can help healthcare payers to preserve funds and fight wasteful spending. CGI ProperPay leverages the cutting-edge analytics abilities of Cortana Intelligence Suite to identify improper payments, and stores all data on the highly secure Azure cloud. Better screening tools will help auditors to identify fraud and abuse, as well as call out cases of overtreatment and wasteful excess. By taking advantage of advances in analytics and cloud technology, healthcare payers can now enhance their fight against wasteful spending and further the goal of making healthcare more accessible and affordable for all. Find out more about the powerful CGI ProperPay solution on Microsoft’s AppSource marketplace.

The post Diagnosing healthcare spending: the top 6 ways to increase efficiency in healthcare appeared first on Microsoft Industry Blogs.

Like all health plans and payers, Family Health Network (FHN) needs to be agile in order to keep up with unprecedented change in the healthcare industry. As a result of both federal and state reform, the organization has expanded into new markets in recent years. It now provides healthcare coverage through commercial, Medicare, and Medicaid plans, and its revenues have grown from $60 million in 2010 to $650 million in 2015.

I recently caught up with Keith Kudla, President and Chief Executive Officer of FHN, and Bryant Grimes, Chief Information Officer of FHN, to find out how the healthcare payer is staying ahead of its increasing infrastructure and compliance needs with VIDASuite™, a cloud-based, modular solution to streamline core processing from Invidasys.

Why did you choose a component-based solution?

FHN is in a highly dynamic period of change and rapid expansion, so we were outgrowing our existing core administrative system. Rather than going through a 15-month implementation for a total system replacement, the Invidasys cloud-based components allowed us to address our areas of need right away by adding functionality and scalability to our existing system. With the fast deployment the cloud enables and the Invidasys team’s deep understanding of payer administrative solutions, we were able to light up the first three components—which were for eligibility, encounter, and provider management—within about four months. And within five months after that, we had the component for customer service up and running.

What have been some of the benefits of the solution being based on the Microsoft Azure cloud platform?

Scaling and adding new capabilities has been quick, easy, and cost-effective. We didn’t have to buy and set up more hardware and go through test runs. It’s like a utility for us, not much different than the electric company—the cloud services are on, and I don’t have to worry about them. And now our IT team is freed up from infrastructure growth and maintenance tasks so they can focus more on strategic IT initiatives.

Plus, because VIDASuite is based on Microsoft Azure, it works easily with our other Microsoft investments products such as SharePoint and Office 365.

Finally, as a company we want to be able to easily bring together information and turn it into insight we can use to help our members lead healthier lives, and cloud-based solutions are helping us do that.

How is the solution helping you keep up with evolving regulations and maintain compliance?

The security of our data and applications is of foremost importance to us. The disaster recovery and geo-redundancy features of Invidasys’ Azure-based solution are very attractive features to us. Frankly, the solution is far more secure than anything our IT department could provide internally.

We’re regulated by both federal and state governments, and there are lots of constantly changing rules, oddities, and interpretations to keep up with, which a less agile system could never hope to support. The Invidasys cloud-based solution is very responsive in meeting our compliance needs.

Want to hear more from Keith and Bryant about how they’ve been able to increase FHN’s agility and meet compliance regulations—quickly and cost-effectively? Check out this on-demand webinar, in which they discuss how a cloud-based, modular solution has helped them stay ahead of their growth needs and mitigate risk.

Please let us know if you have any questions or feedback via email, Facebook, or Twitter.

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