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© 2015 Cognizant
© 2015 Cognizant
June 2016
Solution Overview
1
© 2015 Cognizant 2
4500+ Domain and Technology Experts
50+ large provider clients with 250,000+ care
providers served
Clinical Systems Integration at 35+
Hospitals
Strong partnerships with RCM vendors
Over 2 billion transactions processed
annually – over 5 million per day
Alliance
RCM Integration Partners
Provider Solutions / Framework
Serving a Large and Diverse customer base in Provider industry with a multi-faceted team of experts
Product Services Clinical Systems-EHR, HIE
Care Management/PHM
Administrative/ERP Systems
Portals
Healthcare Mobile Apps
Clinical and Enterprise Data
Warehouse
IT Professional Services System Integration
App Dev and Maintenance
Quality Engineering
Infrastructure Services
Data Integration
IT Infrastructure Services Business Availability Services
Business Productivity Services
Business Connectivity Services
Business Cloud Services
Integrated Value Management
Revenue Cycle Management Contract Management
Patients Access
Claims Management
Remittance and Collections
Denial Management
Consulting Healthcare Advisory
Business Optimization
Integrated Health Management
Health Intelligence
Compliance
PMO
Clinical and Business Process Services 1000+ Clinicians in Philippines
and India
US Licensed BSN RNs in
Philippines
MDs and Pharmacists
Bio Statistician
Partners Service Offerings
CareInsight - Provider Analytics Platform
WellSERV - Population Health Management
TriZetto Provider Solutions
Revenue Cycle Management
HealthActivate - Patient Engagement Platform
Care Coordination Lite - Care Management
Health TranZform - Integrated Network Design
STAR performer in the Provider ITO PEAK Matrix
from Everest Group
Industry leading RCM Product: Rated by KLAS as the only large
vendor in “very satisfied” category
#2 in number of providers utilizing revenue cycle services;
with 250,000+ providers
Provider Practice Overview
OnVida - Multichannel Customer Experience
Video Vantage - Video Engagement Platform
iKare -Paperless Remote ICU Solution
© 2015 Cognizant
Cognizant’s RCM Capabilities
3
Current state assessment Gaps Identification and Requirements creation Identification of business benefits and resource
needs Design technology landscape and governance Develop implementation and project roadmap Measure KPIs and evaluate benefits
Customer and Physician call center Coding Services Charge Capture Services Payment Posting Services Accounts Receivable Management
Services Denials prevention and recovery
RCM Optimization Consulting Solutions RCM BPO TPS Offerings
20 YEARS IN BUSINESS 2B ANNUAL TRANSACTIONS
3,400+ PAYERS
250,000 CARE PROVIDERS
275+ CODERS SUPPORT 400+ PM/EMRs INTEGRATED
Only large vendor in KLAS RCM “very satisfied” category
Cognizant Solutions supporting RCM:
Gateway EDI and Claim Logic: SaaS solutions supporting efficient RCM to help providers get paid fast. Helps to optimize practice efficiency with electronic alternatives to manual/paper transactions
NHXS / EOB Resolve : SaaS suite of workflow and analytic products to manage denials, contract compliance/modeling, and patient responsibility estimation. Helps providers maximize reimbursement from payers and payment from patients .
PowerHealth: Assists in pre-visit functionalities like scheduling/registration, eligibility verification, appointment reminders, referral/authorization management
HPA Robotics: Performs charge entry and mail processing
RCM SERVICES
Performance tracking using RCM KPIs
Benefits tracking and monitoring benefits
Enterprise reporting services
RCM Analytics Improve Revenue Management from start to finish Patient Access Claims Collections Denials Management Contract Management
© 2015 Cognizant CORPORATE STRATEGY CONFIDENTIAL 4
Cognizant Has Built the Broadest and Deepest Solution Portfolio in
the Healthcare Market
Strategic Investments
Plan Build Operate
• Advisory
Services
• Readiness
Services
• Digital Strategy
• Business
Optimization
• Operational
Strategy
• Health
Intelligence and
Analytics
• Cognizant Digital
Works
• Analytics
• Cognizant
Technology Labs
• Cognizant
Business Cloud
Solutions
• Mobility
• Social
• Configuration
• Front-End
Processing
• Claims
Administration
• Enrollment
• Billing
• Customer
Service
• Healthcare
Process
Automation
• Medical
Management
• Credentialing
• Systems
Integration
• Configuration
• Program
Management
• Migration
• Requirements
• Portals
• Mobile
• Testing
• Core
Administration
• Network
Management
• Care
Management
• CMS Enrollment
& Data
Submission
• Payment Integrity
• Portals
• Value-Based
Solutions
• Provider RCM &
Contract
Analytics
• Business
Availability
• Business
Productivity
• Business
Connectivity
• Business Cloud
Solutions
• Integrated Value
Management
Business Consulting
Next Gen Technologies
Business Process Services
IT &
Professional
Services
Software & Tools
Infrastructure Services
© 2015 Cognizant 5
We are winning in Core Provider Areas Solution Wins Pipeline
EHR
First Epic Account- Epic 2014 Upgrade
LS Synergy Engagement: EHR CRF
Integration Gap assessment
Epic Implementation for clinics nationally
Epic Clarity Reporting
End-to-end AllScripts and GE Centricity
Testing
Epic Implementation and Allscripts AVM
EHR/EMR Interface design and CDI for device
NHXS Integration, new feature development
TZ Synergy Migration to AWS and TPS platform. Provides access
to large New England Providers
First Provider ERSS Account. Security
Landscape assessment Product enhancement & modernization
Digital &
Product Eng..
Ascension Subsidiary. Product Modernization
First Large Physician Group Account. Babysteps EHR modernization
Patient Portal Development PACS Support and broader partnerships
International IT Strategy Consulting EMR Implementation
Portal Development for HAAD
EIM Analytics Analytics and DWBI Roadmap & Implementation MDM, BigDecisions Big Data platform development
Build, manage and support EDW solution
Infrastructure Migration to AWS and Support End to end Infra
outsourcing
Infra AWS Cloud Migration
Infra User Provisioning, DBA Infra + App
Managed Services
Others Development of post acute care portal
IT Strategy and DWBI Strategy
DICOM Interface Development
ERP Upgrade
ERSS, SMaaS, EAM
RCM
End to end RCM BPS services in a
PMPM model Chart Abstraction & Clinical Coding BPS RCM Program Expansion
First ORCM Engagement. Whitelabeled RCM BPS Svcs. RCM BPS Services RCM Pilot Progam
HealthActivate Post
Discharge care pilot
PHM/CM
Platform + Services for Chronic Disease Management
Physician Communication, Patient Satisfaction PHM implementation with EQ Health
DSRIP Program
Consulting
Home Health Care Tool Requirements Management
Wellness Programs Assessment & Strategy
Patient Engagement
Strategy Optimizing patient
engagement Remote Patient Monitoring iOT for PHM
© 2015 Cognizant
Str
ate
gy &
Pla
nn
ing
IP EHR
OP EHR/PMS
Claims
Management
Ap
pli
cati
on
Po
rtfo
lio
La
yer
Imaging Systems
OP Coding, CDM
and Billing
IP Coding, CDM
and Billing
PHM Platform
Patient
Engagement
Care Management
ERP Apps
Performance
Mgmt. & Reporting
CRM & Network
Management
…
…
…
…
Scheduling
Registration
Eligibility
Verification
……
Patient Access Systems Clinical Systems RCM Systems Care Coordination
Systems Enterprise Systems
Data
Layer
Enterprise data Warehouse and Analytics
Provider Value Chain Mapping to Our Capabilities
Patients Clinicians Non clinical
Users
Partner
Organizations Payers
HIE
Clearing House
Integration Hub
Data
Exchange
Layer
Portals
Mobile
Devices
Users
XaaS Government
End User Computing • Desktops
• Software Management
Security and Privacy • IAM
• SSO
• VPN
• HIPAA/HITEC
Data Center • DC Operations
• Virtualization
• Storage
• Backup
• DB Management
Network and Telecom
Infr
astr
uct
ure
La
yer
Cloud
Infrastructure
Serv
ice S
up
po
rt
BU
SIN
ES
S &
IT
CO
NS
UL
TIN
G:
IHM
, C
onsum
erism
, O
pera
tio
nal Im
pro
vem
ent,
Health I
nte
llig
ence a
nd
Analy
tics, In
vestig
ative S
vcs.,
Regula
tory
PRODUCT CONSULTING:
Build/Buy, Product Requirements, App Rationalization, Modernization
EHR Services: • EHR Consulting
• Implementation
• Upgrade
• Testing/Validation
• Support
ERP Services: • ERP Implementation
• Upgrade
• Cloud Enablement
Clin
ical H
elp
desk:
G
lobal C
linic
al S
erv
ices
IT H
elp
desk:
CLINICAL DATA INTEGRATION & HIE SERVICES
RCM CLEARINGHOUSE SERVICES
DIGITAL ENABLEMENT
Mobility, Cloud Enablement, Social , CRM
ENTERPRISE INFORMATION MANAGEMENT
Build/Buy, Big Data/ Analytics Use Cases Enablement
Outsourced RCM
Services
Proactive
Clinical
Outreach
RCM Services: • RC Optimization
• Claims Processing
• Denial & Contracts
Mgmt.
• RCM BPS
TRANZFORM PLATFORM
PHM Services: • PHM Consulting
• PHM Platform
• Patient Engagement
Platform
• Risk Analytics
PRODUCT ENGINEERING:
New product development, Enhancements, Modernization
Access Services: • Eligibility Verification
Platform
End User Computing
Services
Enterprise Security and
Privacy Services
Data Center and Ops Network and Telecom
Services
CROSS FUNCTIONAL INFRASTRUCTURE SERVICES
Incident Mgmt., Config. & Asset Mgmt., Change Management
Inte
gra
ted
In
fra A
pp
Mo
nit
ori
ng
Reactive
to
Proactive
Platform Capabilities
Dedicated
VIP
Clinical
Helpdesk
Cognizant
Capabilities
2015
Capabilities
Build Out
2016 Top 5
Focus Areas
TPS
Capabilities
6
© 2015 Cognizant 7
EHR Offerings
Our Credentials
• EPIC
• Cognizant Epic Services - 3 clients across implementation, integration,
support, upgrade; strong pipeline
• RCM Services – Only large player with dedicated clearing house for EPIC
customers. 70 + customers on this platform including 19+ AMCs. Ready
integration and automated denial & underpayment management to EPIC
customers has led to many customer choosing TPS solutions
• Payvider Strength – Our respective platforms are strongest in the market;
many common clients
• Platform Development Experience with many leading EHR vendors
• Testing experience established – GE Centricity, AllScripts
• Strong Integration Experience with strong HL7/CDI competency and tools
Market Opportunity
• Global EHR market on an trajectory that will surpass $22 billion in 2015 with 7% CAGR
• Epic is the dominant market vendor controlling ~19.3 % of the Inpatient EHR market
and ~20% of the Ambulatory EHR market
• Epic users spend an additional sum between 40 and 49 percent of the system's initial
costs in major and minor upgrades
• Other major players include Cerner/Siemens, AllScripts, GE, NextGen etc.
Top 5 Solutions
2016 Goals
• Scale up EPIC EHR services. Target 5 EPIC customers
• Target $ 8 M revenue and build strong pipeline in 2016
• Establish presence in other EHRs & Clinical platforms like AllScripts,
GE, Cerner
• Leveraging TZ channel partnerships & Payvider market strength
Plan of Action
• Differentiated partnership with EPIC & major EHR vendors
• Industry Convergence value add: Leverage our connectors with all
major payors and enabling an industry leading collaborative
platform for payer-provider collaboration and ‘payviders’. Overlap
in customer base
• RCM Value adds : Faster processing of claims/eligibility across
platforms and Price transparency as a unique differentiator
• Implementation/SI partnership for key deals
• Develop our services presence across select EHR platforms
© 2015 Cognizant 8
Infrastructure Services
Our Credentials
• Positioning as next-gen infrastructure player
• Established footprint in Kaiser, CAP, AWS Cloud win
at NEHEN
• Hosts healthcare data for millions of lives in TZ DC
• Key deals in pipeline - UC, Cloud Migration - Heritage
Valley, CAP, Medxcel Active Threads - Walgreens,
BSW
• Connects with intermediaries (W group, Pace Harmon)
Market Opportunity
• ~$7 Billion worth of renewal business happening over
the next 24 months. ~ 10 Billion over next 5 years
• Larger end to end type deals with deal value averaging
around $100Million.
Top 5 Solutions
2016 Goals
• Win at least 1 large deal and 2 mid-size deals
• Win a next gen infra/cloud deal
Plan of Action
• Full Stack Provider Reference Architecture based solution
• Smaller to Mid Size Providers
• Outsourced end to end Infrastructure services through Channel Partners
• White labeling of Cognizant-Trizetto’s services including hosting, Infra+App Support, Clinical
service desk, Cloud enablement etc.
• Phased approach to build out of the end to end stack for partners. Focus on digital re-imagination
and transformation
• Larger Providers
• Direct market approach offering a coffee table, modular approach of preferred EHR vendor+ other
end to end services
• Leverage Cognizant+ Trizetto solutions and services to offer an end to end offering
• Partnerships to close gaps in key areas such as Clinical help desk, cloud etc.
• Focus on building Intermediaries relationships to target large Infra deals
© 2015 Cognizant 9
PHM/CM Offerings Market Opportunity
• The PHM market expected to grow at 26% to reach $40.6 Billion by 2018
• The global population health management market is a highly fragmented market
(>100 vendors) with few major players
• 62% of hospitals making investments in PHM are leaving their current vendors and
seeking new partners.
Top 5 Solutions
2016 Goals
• Establish as an end to end PHM solutions and services vendor with key
strategic partnerships
• Generate 5M+ revenue from PHM deals
Plan of Action
• Build an end-to-end service offering with Platform + Services
• Solution – Partner (Wellcentive) platform + Cognizant digital
solutions
• PHM Consulting
• PHM Technology Services
• PHM BPS/Clinical Services
• Leverage and expand on key win at LifeBridge
• Trizetto data leverage for prepackaged PHM insights
Our Credentials
• Made inroads with PHM consulting and strategy engagements (LifeBridge, WAG,
Vermont State etc.)
• Recognized by industry(HFS) as leader in PHM
• Partnership discussions with Wellcentive for joint GTM
• Developed P4P Solution
• Good pipeline – Mount Sinai (DSRIP), Expansion at LifeBridge etc.
Winner's Circle -
HfS Blueprint 2015 Research Report on Population Health and Care
Management
Winner's Circle -
HfS Blueprint 2015 Research Report on
Population Health and Care Management
© 2015 Cognizant 10
PHM Offerings: Platform + Services
Population Health Strategy, Maturity Assessment, Regulatory compliance, Vendor Evaluation, Platform selection, Program Implementation,
Care Process Redesign, Health Intelligence Strategy and Roadmap, Consumer Experience Assessment, Organization Change Management,
Training and Adoption
PHM
Consulting
Business
Process
Services
Global Clinical Services
RCM BPO
Technology
Services
Clinical Data Integration & HIE Services
Infrastructure, Cloud and Security Services
Data Analytics
Mobility, Social Media, Innovation and other services
Technology Architecture Consulting/Blueprint
Platform Implementation Services
Measure
Outcomes
Coordinate
Care
Engage
Member/ Patients Stratify Population &
Identify Care Gaps
Define Population
Enroll Member/
Patients
Interoperability
Platform
HealthActivate Patient Engagement
Platform
Video Vantage Video Engagement
Platform
OnVida Multichannel Customer
Experience
HealthActivate Patient Engagement
Platform
PH
M S
olu
tio
ns
TPS Eligibility, Auth services
OnVida Multichannel Customer
Experience
HOUR Health Test Orchestration
Using Research Kit
© 2015 Cognizant 11
EIM Analytics Services
Our Credentials
• Won EIM Analytics engagements with Alliance Healthcare Services
• TranZform/BigDecisions as a differentiator platform
• Platforms – Big Decisions, NHXS, CareInsights, P4P
• Key wins at UC, CTCA, OSF, UC; Good pipeline – U of Iowa, HSHS
Market Opportunity
• Global healthcare analytics market is expected to reach $18.7 Billion by 2020
from $5.8 Billion in 2015, at a CAGR of 26.5% during the forecast period
• Providers are investing heavily in EDW, Big Data and Analytics with need to
bring data together from variety of sources for care/marketing/financial use
cases
Top 5 Solutions
2016 Goals
• Strengthen consulting, analytics and EDW engagements
• Win a BigDecisions/TranZform deal in provider
• 10 M revenue from EIM Analytics practice
Plan of Action
• Build provider specific use cases for analytics
• Build out P4P platform
• Platform approach:
• Leverage TranZform branding as an integrated Big Data analytics platform
with BigDecisions
• Leverage existing point solutions (NHXS RCM Analytics, CareInsight P4P
Analytics etc) and overall TranZform positioning
