Health Plans
Optimizing the Business of Health
Health Plans manage information, empower quality collaborative care, and optimize operations to meet reform by using TIBCO's event-driven, in-memory technology to connect systems, automate people-centric processes, and respond to events in real time. Seven of the top ten global healthcare companies* rely on TIBCO in some of the highest-volume transaction processing operations in the world, and our customers – including BlueCross BlueShield organizations in 33 states – serve more than 100 million members.
* Based on July, 2009 Fortune global company list, by revenue.
Reduce Costs with Collaborative Care
With TIBCO, Health Plans can share, correlate, and understand information across systems, improving data visibility, member management, and the coordination of care. This provides the foundation for the enhanced management of chronic disease, patient centered medical homes (PCMH), and accountable care organizations (ACO), as well as data sharing between health information exchanges (HIE) and electronic health records (EHR):
- Reliable, coordinated records enable consistent delivery of best-practice care
- Programs for prevention, compliance, and wellness keep patients living healthy
- Accelerated identification and treatment of chronic disease minimize CDM costs
Improve Workflow and Process Claims Faster
TIBCO provides Health Plans with tools for designing, tracking, and delivering optimized workflows. Our claims processing technology can handle millions of HIPAA-based transactions per day with our blazing-fast validation engine – in real time, batch, or hybrid – while providing visibility into the details of every claim and enabling:
- Onboarding systems to bring new Providers and partners up-to-speed fast
- Dynamic work management for real-time scheduling and staffing
Industry Topics
- Quality Collaborative Care: Improve patient outcomes while enabling the transformation to coordinated and accountable care.
- Information Management: Increase data visibility, manage exceptions, and correlate information across systems.
- Operational Optimization: Reduce costs, accelerate transaction processing, and meet compliance from MLR to ICD-10 and HIPAA 5010.
- Transaction Modernization: Improve transaction processing and reduce administrative costs.
