Payer Provider Government | IQVIA
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A Human Data Science Company 11+ 28+ where Human Science meets Data Science Billion USD Billion USD 2019 Revenues Market Cap (June2020) 68+ 100+ Thousand Countries More Effective Pay for Improved Employees Health Delivery Value & Outcomes Health (2020) Copyright © 2020 IQVIA. All rights reserved. 1
68,000+ Copyright © 2020 IQVIA. All rights reserved. 2
PPG Products and Services Monitor Excellence $ HIS & EMR Patient Level Revenue Cycle Information & Clinical & Insurance Performance & Consulting Services Costing Management Transactions Management Management Quality Insights $ Y G System S O The IQVIA Core Access, Quality, Neutral E L Transparency, Financial C O I N Sustainability, V H Size & Outreach Interconnectedness Comprehensive R C & Governance Offerings E E Solid References S T Solid Partnerships towards an Orchestrated Ecosystem Coding Costing Pricing Contracting Billing Exchanging Processing Monitoring Reforming Governing 3 Copyright © 2020 IQVIA. All rights reserved.
How Can We Help with the IQVIA PPG Core Patient Revenue Information & Clinical & Performance & Public Health Level Cycle Transactions Information Quality Insights & Consulting Costing Management Management Management Services Data Dictionaries Information Generation Information Decision Support Public Health & & Standards & Management Exchange Consulting Services • Medical Necessity, Safety & • Health Insurance Market • Medical Codes & Health • Electronic Medical Records • Patient Information Coding Edits Language • Eligibility/ Authorizations & • Contract Management Strategy, Analysis & Entry • Health Finance Applications • Health System Financing • Transaction Schemas • Resource Management Claims • Activity Based Costing • Health Insurance Operational • Medical Coding & Mapping Efficiency • Validation & Business • Registries • Referrals • Health Financing Rules • Electronic Orders (Lab, Performance KPIs • Health Promotion & Disease • e-Prescribing Solutions Prevention Programs • Costing Standards • List Management Utilities Radiology, etc.) • Dynamic Analytics & • Project Management Unit Dashboards towards an Orchestrated Ecosystem Coding Costing Pricing Contracting Billing Exchanging Processing Monitoring Reforming Governance Copyright © 2020 IQVIA. All rights reserved. 4
Community Healthcare Platform Envisioned community exemplified Software as a Service Costing Solutions Revenue Cycle Electronic Medical Hospital Information Decision Support Performance & Management Records Systems Systems Quality Insights PARTNERS PROVIDERS PAYERS SUPPLIERS REGULATORS BENEFICIARIES/ MEMBERS Mainly on PaaS | Open to Third Party Solutions Copyright © 2020 IQVIA. All rights reserved. 5
Community Healthcare Platform Home of digital healthcare communities Payer Community (Insurance Company) Interconnected Community towards Universal Health Coverage Community (Country 1) e-Prescription Community Provider Community Interconnected Community towards Universal Health Coverage (Country 2) Provider Community (Hospital 1) The Concept of Digital Healthcare Community Create & Replicate Communities (SaaS), Standard Languages with Communities, Open to Third Party Solutions, mainly based on Open Source Database (PaaS) Copyright © 2020 IQVIA. All rights reserved. 6
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Regional References Solution Provider for the National Claims Platform “Hakeem Claim” & National Implementation of PLC and National Implementations RCM in Jordan RCM at the Provider Side – Hamad 6 in the Middle East 9M+ People Covered Medical Corporation in Qatar National Healthcare Insurance 2 Program Management Units The Entire Claims Platform of the Dubai Government in the Solution Provider for the National UAE Claims Platform in Partnership with 250 Transactions per sec. Proven Track Record at Payer, Vodafone Provider & Regulator Settings eClaimLink Platform with National PMU Solution Provider for the National DHA since 2012 Claims Platform (UniPlat) through Sehati – in KSA Trusted by Governments & Different Payer Schemes Solution Provider for National Program Management Unit to support Claims Platform through National Health Authority at MoH for the Infoline roll-out of the National Health Protection Scheme in India 500M+ People Covered Great ROIs Demonstrated on Technology & Services Offered National PMU Copyright © 2020 IQVIA. All rights reserved. 7
Information & Transaction Management 8
Information & Transaction Management Payer Provider Regulator Improper Standard Business Decentralized Communication & Validation Rules between Poor Information Management between Payers-Providers Healthcare Payers-Providers System Poor Regulatory Monitoring & Sector Transparency for Payer- Challenges No Unified Language, Rejection of Medical Claims Provider Transactions Standard Coding, Schema post-encounter Challenging to do Population & Structure Health Management Standardized Centralized Information & Transaction Management Solutions How to Centralized Data, Unified Monitor, Analyze, Intervene Enable Population Health tackle it? Language, Schema, enabled and Control Expenditure Management Decision Support Systems Copyright © 2020 IQVIA. All rights reserved. 9
Information & Transaction Management Solutions enabling Supported by EMR Information & Transaction Solutions, Pharmacy Management throughout At home or any place At reception of hospital At physician office of Management Systems the Patient Journey or clinic hospital or clinic & Specialized ERP Capabilities Uses Demographic, Medical, Financial, Policy, E-Prescribing Solutions Administrative & Lifestyle connecting Payers with Information Physicians & Pharmacies Insurance company Regulator or payer Patient at pharmacy or TPA Connecting Stakeholders Supported with Advanced using a Common Healthcare Decision Support Language & Communication Systems Approach At home or any place At hospital/center for At hospital/center for claiming medical services medical services Copyright © 2020 IQVIA. All rights reserved. 10
Revenue Cycle Management 11
Revenue Cycle Management Improper Revenue Cycle Management Ineffective Payer-Provider Transaction Management Healthcare Sector Block Budgets / Pay-for-Volume / Pay- Loss of Revenues across the various Challenges for-Value stages at Facilities Proper Patient Billing missing in most Weak Decision Support Systems Public Settings Revenue Cycle Management Solutions & Services How to Reconsider Process Flow Provide Expertise to ease Technology-must tackle it? of the Organization the Transformation Environment Copyright © 2020 IQVIA. All rights reserved. 12
Comprehensive Revenue Cycle Management Services with RCM Technology specifically designed for each Country where it is installed Front End Mid-Cycle Back Office Quality Analysis Reports Appointment Revenue Integrity Claims Processing Audits and QA Gap Discovery SLAs Services Charge Capture Bill submission Medical Necessity Recommended Contract Strategies KPIs Management & Eligibility Check Clinical Reimbursement Payer Monitoring Alternative Documentation Validation Approaches Staff Scorecards Status Reports Follow-up and Organizational Clinical Coding Collections Training & Change Education Management Authorization Requests Strategic Pricing Denials and Professional Envisioning Future Dashboards Appeals Managed Services State IQVIA Revenue Cycle Management Software System Copyright © 2020 IQVIA. All rights reserved. 13
Revenue Cycle Management Patient Patient Pre-Encounter Statements Scheduling & A/R Registration Insurance Back Office Operation requiring Follow-up Verification minimal or no human intervention Setup, Denial Coding & Appeals Engagement Tools Driven by Rules Engine Payment Revenue Patient Co- Post-Encounter Processing Pay & Posting Cycle Collection Seamlessly Bidirectional Interface- Management able Solution to HIS/CIS/ERP Claim Patient Exam- Submission Documentation Comprehensive Workflow Based Claim Checking Order Solution & Error Management Resolution Encounter Coding & Coding Supports known Clinical, Business Charge Analysis & Services Error Tracking Engagement & Interoperable Standards Functionalities Enabling Tools Supported By Financial, Quality, Human Capital & Compliance Information Technology Performance Management Copyright © 2020 IQVIA. All rights reserved. 14
Patient Level Costing 15
What is Patient Costing & Analysis IQVIA’s Patient Costing & Analysis is Conforms to all published Healthcare Costing an Activity Based Costing system Standards Activity Based Costing is the process by Integrates to any ERP and HIS datasets, providing which hospitals can assign all their costs a single source of data to patient activity outputs Specifically designed for Healthcare, in Automated rule engine creates patient level conjunction with Hospitals assignments automatically Copyright © 2020 IQVIA. All rights reserved. 16
Healthcare Sector Challenges The Healthcare Sector is facing Patient Costing addresses multiple challenges: these challenges: Shrinking margins, Rising Costs & Increased Accurate patient level cost analysis (macro to regulation micro) Lack of detailed data for Pricing of Services Business Decisions can be made using accurate, detailed financial information Resourcing & Infrastructure issues Automation of Financial metrics from many systems (near real time) Reliable & Consistent Data Availability Actionable insights for increasing profitability Copyright © 2020 IQVIA. All rights reserved. 17
How IQVIA Tackles the Challenges? Patient Costing & Analysis Solution IQVIA’s Costing Engine Financial GL Data HIS Patient Data links Finance & Activity data, “Bridging the Gap” Operational Statistics Other Patient Data between Datasets COSTING ENGINE The Engine Automatically generates “Activity Drivers” & populates “Financial Cost Buckets” from the Data. The results are held in the IQVIA Reconciliation Reports IQVIA Reporting Cubes IQVIA Costing Data Warehouse for use in Dynamic Reporting, and full Reconciliation Traceability IQVIA Data Warehouse Copyright © 2020 IQVIA. All rights reserved. 18
IQVIA Costing Solution Performs Multi-Dimensional Analysis Multivariate Data Analysis Tool Data Warehouse helps us drill down to details of business: Cost, Revenue & Specialty/ Department/ Patient cost drill Profitability Slice Physician deep dive down • Hospitals in network • Top/ Bottom procedures • True cost of treating a Payer type, Cost Pool, Income • Department (OPD, • Performance/ Profitability patient category IPD, etc.), Payer type analysis • Understand variation in • Specialty/ Procedure/ care Doctor/ Physician Specialty, Doctor Procedure Actionable Business Insights for Hospitals Revenue, Expenditure, Profitability • Determine the true cost of performing a procedure • Generate business and operational reports automatically • Reduce ALOS and standardization in practices Copyright © 2020 IQVIA. All rights reserved. 19
Performance & Quality Insights 20
Performance & Quality Insights Lack of Standard Indicators Monitoring Payer- Healthcare Provider Settings Patients/Members need to have visibility on Sector Payers & Providers Performance based on Challenges Improper Linking of Health Financing with Quality Simplified Indicators for Cost Effective, Quality of Care (Pay-for-Quantity vs. Pay-for-Quality) of Care & Patient Experience Powerful Analytics on International Based Indicators How to Integrate Data-driven Insights Healthier Patients, lower Care Drive Pay-for- tackle it? into Clinical & Operational Costs, more Visibility into Performance Processes Performance & higher Staff & Consumer Satisfaction Rates Copyright © 2020 IQVIA. All rights reserved. 21
Performance & Quality Insights Clinical Quality Measures Measure Identify Engage Healthcare Effectiveness Data & 200 Information Set Measures 250+ Process of Care & Outcomes Evaluation Channel Measures integration Journeys 120+ 900+ Campaign Medication Treatment Quality KPIs Mobile management Surveys Measures 115+ Digital Website Measures Avoidable & Preventable Events Communication migration Cost Measures Performance Engine Dashboards – Actionable Targeted Digital Overall Cost Scoring At All Information Engagement Levels 220 Condition, Disease or Episode Scoring Multiple Channels & Devices Conditions Cost Drivers & Savings Regulator Dashboards Surgery Episode Scoring 85 Quality & Care Gaps Provider Dashboards Regulatory Engagement Surgeries 160 Procedures, Tests & Visits Scoring Benchmarking Payer Dashboards Direct Interventions Procedures Copyright © 2020 IQVIA. All rights reserved. 22
Health Information System & EMR 23
Current HIS Technology Challenges Adopting true cloud solution (Multi-Tenant) that can cater for multi regulations under one solution Limitation of the existing HIS products which was built on legacy Current HIS solution companies technology is becoming obsolete and very expensive to maintain are facing major challenges and majority of them have failed continuously in Cost impact on rebuilding a new HIS product that will impact adopting or changing their product and current HIS provider existing customer portfolio cope with multi-national reform changes The continuous increase of cost of Product ownership related With higher cost of implementation, to the enhancement , changes , configuration and interfaces Healthcare Providers are driving their cost down to improve business profitability The need of e-commerce HIS platform which is mobility ready for small and larger Healthcare provider Copyright © 2020 IQVIA. All rights reserved. 24
Why IQVIA HIS System Developed on Open Source Ubuntu Security Standards Platform making the solution Cost HIPAA Compliant Effective, highly secure and Scalable Implemented in 300+ Global Nomenclature Human Centric Design Approach Locations Across 7 SNOMED CT and ICD 11 is the Core of the Solution Design Countries Ready Scrum Methodology for Interoperability Standards Deployment Capability to interface with Adopted to encourage incremental other clinical systems with change and customization HL7 V2.x and FHIR standards Out-of-the-Box AI Assisted User Digitized Solutions Trainings and Technology Decentralized and Processes Granular level Safe and Secure Leveraging GSM SMS Source Code Sharing Technology for Through Escrow Accessing Patients Account Records in Offline Mode Copyright © 2020 IQVIA. All rights reserved. 25
Logical Architecture sm tes Syb Su Patient Administration System Electronic Medical Record Specialty Configurations Clinical Ancillary Modules Admission, Discharge,Transfer CPOE Dental Laboratory OutpatientClinics Clinical Decision Support Ophthalmology Blood Bank sle ud Inventory Management Clinical Documentation Cardiology Radiology oM Nursing Management Physician & Nursing Workbench Acute Natal Care Pharmacy Core Appointment Scheduling Charting & Assessments Paediatrics OR & CSSD Billing Medication Management Emergency Nutrition Platform agnostic & Device agnostic Available in Linux, Mac, Windows PCs & in Android & iOS tablets & smart phones re Multiple Deployment Models – Cloud hosted, on premises tuc tehi High level of system configurability Allows implementers (not programmers) to build highly customised solutions, Arc Including speciality applications if required. This results in quicker, lower-cost implementations. Open Scalable Architecture Allows horizontal & vertical scalability for deployment at small to very large hospitals Copyright © 2020 IQVIA. All rights reserved. 26
Thank You 27
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