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Healthcare Payers Accelerate Business Performance with Sybase IQManage claims, manage costs, and meet mandates with a complete view of the business

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In today’s market, healthcare payers face unprecedented challenges.

Customer demands have never been greater, regulatory pressures have never been more pervasive, and the products and services offered have never been more complex. To meet these conflicting challenges, insurance providers must be quicker, more responsive, and more flexible. To fail in any of these dimensions is to risk loss of business and ultimately market share to a competitor who is making headway in all three.

Improving performance, and keeping strong performance on track, require a clear understanding of what is happening at every level of the business. Insurance providers must stay on top of revenue, sales performance, marketing effectiveness, and customer retention to strengthen the link between boardroom strategy and frontline execution. Providers rely on accurate and precise plans, scorecards, reports, and dashboards to provide up-to-the minute status on each of these key aspects of performance.

To deliver on these demands, insurance providers need:

• A robust infrastructure that captures detailed data points that can be easily shared, provisioned, and understood

• Timely access to prepared summary data, reports, and dashboards, providing a true measure of costs, profits, and other operational metrics

• Empowerment via analytical tools to enable analysis of various data dimensions at the speed of thought

Sybase IQ, the world’s leading column-based specialty server for data warehousing and analytics, is designed specifically to support sophisticated and complex queries and reporting. Its patented indexing and data compression technology ensure a smaller footprint than can be achieved with traditional solutions, and at a lower total cost of ownership. Its open approach to implementation and scalability means that Sybase IQ is ready to accelerate performance in the environment that insurance providers already have, and to enable them to grow their solution as their business grows.

SoluTion fEaTurES and

bEnEfiTS aT a glancE

• Consolidate multi-departmental

performance management data

in a centralized ‘single version of

the truth’ analytical repository

• Slash fast growing consolidated

data management costs by 40%

to 60% using industry-leading

data compression

• Significantly increase

organizational agility and

alignment with accurate, on-time,

visually rich and highly responsive

financial, operational, and claims

analysis dashboards and reports

• Roll out new metrics dashboards

and scorecards linking strategies

with execution-based, industry-

standard metrics and logical data

models

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Used in conjunction with SAP® BusinessObjects portfolio, Sybase IQ enables a consolidated environment for analysis and decision-making, giving insurance providers the leverage they need to track and manage performance. Here we examine how Sybase IQ can accelerate performance for Health Insurance payers.

Health insurance payers are under heavy pressure from both consumers and the government to control escalating healthcare costs, reduce the ranks of the uninsured, and provide greater value to their members. Increased enrollment in managed care plans (including HMOs, PPOs, and POS plans) has been dramatic. Conventional “fee-for-service” indemnity coverage, which was once essentially the universal model for health insurance, is quickly being supplanted by a vast number of options available to organizations and individuals shopping for coverage. Meanwhile, the Patient Protection and Affordable Care Act (PPACA) and other government initiatives raise a host of new challenges for payers requiring ever-greater insight into processing claims, managing customer relationships, and controlling costs.

Accelerating access to and understanding of both claims and business operational data yields great value for both tactical and strategic decision-making — how can a payer stay competitive, by finding new pools of customers? Which payers can deliver the contracted coverage? Which payers deliver better outcomes for less? How can payers improve processes and reduce administrative costs? Succeeding in this complex and rapidly changing business and regulatory climate requires being able to answer exactly these kinds of questions.

Health insurance payers demand timely and accurate reporting on several key dimensions of performance:

• Product, service, and claims management metrics

• Effective customer acquisition and enrollment metrics

• Distributor relationship metrics

• Cost management metrics

• Profitability metrics

AccelerAting business PerformAnce for heAlth insurAnce PAyers with sybAse iQSybase IQ is the engine driving accelerated performance for many healthcare payers. Working closely with

TriZetto® Facets® and other claims data sources, Sybase IQ routinely accelerates reporting performance by a factor of 200 times or more, enabling faster, more responsive, and better aligned business decisions. Typical reports provided in these Sybase IQ environments include:

• Daily claims queue and adjustments

• Enrollment productivity

• Due and unpaid premiums

• Denied claims

• Customer call by reason

• Member services productivity

• Daily open customer cases

• Emergency room visits

• High-cost procedures

“ThE diviSionS nEEd To bE

ablE To run analySiS on ThEir

own and cuSTomizE ThEm aS

nEEdEd. To accompliSh ThiS, wE

nEEd an iT SySTEm ThaT iS EaSy

To undErSTand, flExiblE, and

abovE all, vEry faST.”

andreas Seibert, head of iT-business department, aoK hessen

www.sybase.fr/detail?id=1059440

“...SpEEd, coST SavingS, low

mainTEnancE... whaT morE can

you aSK for?”

duane green, vice president of Systems operations, healthTrans

www.sybase.com/detail?id=1066410

Sybase, Inc. Worldwide HeadquartersOne Sybase DriveDublin, CA 94568-7902U.S.A1 800 8 sybase

www.sybase.com

To learn more about how Sybase IQ supports

accelerated performance for insurance

providers, and to see how Sybase IQ can

accelerate your company’s performance,

please contact your Sybase sales

representative or call 1-800-8-SYBASE.

Copyright © 2011 Sybase, Inc. All rights reserved. Unpublished rights reserved under U.S. copyright laws. Sybase, the Sybase logo, and Industry Warehouse Studio are trademarks of Sybase, Inc. or its subsidiaries. ® indicates registration in the United States of America. SAP and the SAP logo are the trademarks or registered trademarks of SAP AG in Germany and in several other countries. All other trademarks are the property of their respective owners. 09/11

TriZetto Facets is a registered trademark of The TriZetto Group, Inc.

Additionally, Sybase IQ is part of an integrated ecosystem of technologies that support accelerated reporting performance for health insurance payers, including:

• Sybase industry warehouse Studio™ for health insurers – Contains sample data, schema, scripts, and pre-built reports based on lessons learned from hands-on experience gained over many years in the health insurance industry

• Sap businessobjects Eim data Services – A versatile data movement technology suite that includes a Data Integrator ETL tool optimized for loading Sybase IQ from a variety of data sources combined with a robust data quality module

• Sap businessobjects Enterprise performance management Suite – Provides insurers metrics to ensure sustained profitability through revenue growth and expense containment

in summArySybase IQ has successfully supported many enterprise-wide reporting and performance management solutions

worldwide in the Healthcare Insurance Industry and has brought transformational business value to the adopting Insurance firms that have clearly demonstrated:

• Pivoting customer, claims, and operational data analysis across departmental boundaries

• Timely, responsive, ad-hoc, and stage-by-stage reports across various functional roles

diS

par

aT

E d

aTa

SE

TS

physician and facility claims data

administrative data

lab Test results

pharmacy claims data

Socioeconomic Elements

facets data

Sybase iQ

p E r f o r m a n c E w a r E h o u S E

which physicians have better outcomes

and lower cost?

what lifestyle behaviors increase claim payments?

Sybase IQ brings disparate data together and serves as the heart of a high-performance analytics and reporting environment, delivering faster, more accurate, and more complete answers.