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TRANSFORMING DIGITALLY-ENABLED HEALTHCARE FOR BETTER OUTCOMES
EXL HEALTHCARE OVERVIEW
© EXL Service, Inc. All rights reserved.
EXLSERVICE.COM
EXL HEALTHCARE OVERVIEW
Healthcare organizations across the spectrum are tapping digitally-enabled solutions to improve the cost and quality of care as they journey from volume to value. EXL combines unmatched healthcare domain expertise with data-driven insights and digital technology to transform how care is delivered, managed and paid. This ensures our clients achieve high-quality, effective healthcare at an appropriate cost. EXL’s digitally-enabled transformation solutions orchestrate innovation, automation and performance excellence to impact payment accuracies, cost management, quality outcomes, and appropriate utilization.
Here’s how we help:
TRANSFORMING DIGITALLY-ENABLED
HEALTHCARE FOR BETTER OUTCOMES
Value-Added Capacity
Domain expertise infused with intelligence to drive meaningful
outcomes
Technology and Analytic-Enabled Solutions
Digital and technology platforms informed by analytics and driven by
automation for a unique 360° data view
Insights and Advisory Services
A consultative approach to pinpoint precise recommendations, prescribe actions, and operationalize insights
2EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
EXL HEALTHCARE OVERVIEW
With a diverse client base, we solve business problems from a multi-dimensional perspective
• Payers: Supporting payers in decreasing administrative waste, reducing overall health claim expenditures, and optimizing revenue opportunities while improving member care quality, network performance and managing population risk
• Pharmacy Benefit Managers (PBMs): Helping PBMs to manage member drug benefits and reduce drug-spend expenditures without sacrificing quality
• Providers: Enabling provider organizations to proactively manage risk, improve quality outcomes and optimize network performance
• Life Sciences: Providing pharmaceutical, biotech and medical device companies with enriched data, data management expertise and advanced analytics to obtain value-based excellence
Covering more than 150 million lives, EXL partners with healthcare organizations to offer an array of services that offer insights, improve processes and deliver outcomes
CLINICAL SERVICES
EXL’s end-to-end clinical services and solutions support an integrated model to achieving efficient, effective and compliant operations. Our team of deep domain experts looks to advanced analytics, sophisticated technology and digital innovation and automation to help improve quality and efficiencies, drive effectiveness and deliver impacts on member health, network performance, cost, quality and utilization outcomes.
• Case management and utilization management • Population and risk management • Integrated care management platform • Clinical innovation and automation • Program and outcomes analysis
PAYMENT SERVICES
EXL’s payment services include comprehensive reimbursement initiatives that help payers and providers control costs, reduce overall health claim expenditures and optimize revenue opportunities while improving provider experience. We produce actionable insights at every touchpoint along the payment continuum.
• Pre-pay and post-pay audit solutions – Claims auditing – Data mining – Subrogation
• Payment and fraud, waste and abuse analytics • Provider experience • Payment capacity and payment transformation services
Care Management and Population Health
38INCREASE
in member engagement levels
17INCREASE
in productivity
Clinical Claims Review Automation
25-30SHORTERcycle time
30-35REDUCTION
in cost to serve
20ENHANCED
user experience
%
%
%
%
%
3EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
EXL HEALTHCARE OVERVIEW
DATA & ANALYTICS SERVICES
Leveraging our data assets, advanced analytics capabilities and subject matter expertise, we offer packaged and customized analytics services that help clients identify, optimize, create, capture, and grow business value.
• Data assets, claims benchmark and consumer data
• Data discovery, visualization and data platform
• Data engineering, enrichment and management services
• Advanced predictive and prescriptive analytics
PHARMACY SERVICES
EXL’s pharmacy solutions deliver operational effectiveness and efficiencies for our clients. We empower pharmacy leaders to focus on what matters most–quality care gaps, operational efficiencies, cost containment, capacity growth, medication adherence, and appropriate medication utilization.
• Pharmacy Utilization Management
• Pharmacy Quality and Care Management
• Payment Integrity for Rx Claims
LIFE SCIENCE SERVICES
By leveraging extensive patient-, consumer- and HCP-level data assets, advanced analytics and subject matter expertise, EXL provides real-world insights and value-based solutions.
• Patient intelligence
• Market access strategy development
• Market effectiveness
EXL Healthcare: A Recognized Leader
EXL takes a unique approach to delivering healthcare value. Our deep domain expertise, extensive technology- and analytics-enabled services and solutions uniquely positions us to deliver deeper value. We do this through what we call Digital Intelligence, the orchestration of domain and data, people and technology, to deliver breakthrough business outcomes.
EXL’s demonstrated value to healthcare clients and strong market leadership is recognized across the healthcare industry.
Patient/Member Incentives and Engagement
70DECREASE
in inpatient PMPM while incentives drove Medicaid behavior
286INCREASE
in participation in diabetes care management program
Accurate Revenue and Quality Outcomes
16IMPROVEMENTin HCC RAF Score
$1.5IDENTIFIED
opportunity from chart reviews
High Cost Drug Claims Auditing
$6MIDENTIFIED
in overpayments and improved claims processing
PBM Pre-Payment Cost Avoidance
$20Min annual cost avoidance
Utilization Mangement
40REDUCTION
in case handling time
72REDUCTION
in documentation related errors
%
%
%
+
M
+
%
%
4EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
EXL HEALTHCARE OVERVIEW
INDUSTRY RANKINGS AND RECOGNITION
ACCREDITATION AND CERTIFICATION
Leader - Everest Group's Clinical and Care Management BPS Services PEAK Matrix™ Assessment
Winner - NASSCOM Annual Technology Conference Award for EXL’s Digital Clinical Assistant solution
Top Ranking in KLAS Payer Quality and Risk Analytics
Leader - NelsonHall's NEAT for "Business Process Transformation through RPA & AI" for Healthcare
Leader - Everest Group's Healthcare Analytics Services PEAK Matrix™ Assessment
Leader - IDC MarketScape: U.S. Healthcare Clinical & Financial Analytic BPO Services Vendor Assessment
5EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
EXLSERVICE.COM
About EXL Healthcare
EXL combines unmatched healthcare domain expertise with data-driven insights and digital technology to transform how care is delivered, managed and paid. Our digitally-enabled transformation solutions orchestrate innovation, automation and performance excellence to impact payment accuracies, cost management, quality outcomes, and appropriate utilization ― all key to value-based performance. Covering more than 150 million lives, EXL partners with organizations across the healthcare spectrum including payers, providers, PBMs and life sciences companies.
To learn more visit www.exlservice.com/healthcare
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To find out more about how EXL uses Digital Intelligence to help healthcare transform, please contact us or visit www.exlservice.com/healthcare
© EXL Service, Inc. All rights reserved.