Health Plans: TIBCO Optimizes the Business of Health

TIBCO's Event-Driven Healthcare platform allows health plans to improve the cost, quality, and experience of healthcare.

TIBCO helps health plans connect, correlate, understand, and act upon information across systems, improving data visibility, member management, and coordination of care. Our transformative real-time, event-driven platform enables health plans to manage massive volumes of data to identify potential problems faster, intervene proactively, and influence clinical and financial outcomes, rather than analyzing them after they occur.

As a result, health plans realize greater value, improve operational efficiency, eliminate waste, and mitigate financial, operational, and clinical risks. TIBCO solutions provide value across all areas of a health plan's operation, including:

  • Population Management
    • Increase market share and reduce member acquisition costs
    • Engage members to improve member satisfaction
    • Enable risk stratification and targeted intervention to improve population health
  • Partner Management
    • Manage the value chain, including payment cycles, to improve operational efficiencies
    • Improve trading partner performance to increase first-pass rates
    • Ensure compliance with HIPAA, ICD-10, PHI, security and other requirements
  • Provider Management
    • Manage the provider network proactively
    • Facilitate contracting with provider organizations

TIBCO Event-Driven Solutions for Health Plans

  • Intelligent Payer Pipeline. Gain visibility and efficiency to improve first pass rates and track-and-trace claims though the entire lifecycle, ensure compliance, and monitor trading partner performance with an advanced transaction management platform.
  • Event-Enabled Marketing. Grow market share by improving member capture and retention, speeding quote-to-card, and optimizing acquisition channel performance with a real-time, event-based approach to marketing.
  • Event-Enabled Early Warning System. Improve member and population health by proactively identifying members who are following clinical or behavioral patterns of prior patients who experienced negative outcomes, then facilitate outreach to change their health habits or enroll them in an appropriate care management plan.
  • Partner Collaboration Blueprint for ICD-10 Transition. Facilitate the ICD-10 Transition through Partner Collaboration by ensuring business neutrality through the ICD-10 transition and beyond using a re-useable platform for project governance, stakeholder collaboration, code mapping, partner testing, comparative analysis, and continuous improvement.

Industry Track Record

TIBCO enables health plans to correlate massive volumes of information in real-time to identify patterns and trends, then implement rules that enable proactive response to improve results, whether they are clinical, financial, or operational outcomes. With the ability to detect events and identify patterns in real-time, health plans are better positioned to make decisions and take action before the data becomes stale or irrelevant.

Leading health plans have deployed TIBCO solutions to:

  • Improve claim processing efficiency and track-and-trace transactions to prevent bottlenecks, facilitate research, and improve customer service.
  • Gain real-time reporting of business and partner performance so operational improvements can be made on the fly, without waiting for period-end reports when it may be too late to make adjustments.
  • Eliminate waste by avoiding unnecessary readmissions and inefficient processing.

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Customers

Meridian Health Care Management automated EDI transactions with customers, reducing the number of employees needed to manually correct errors by 70%.

PruHealth enabled business process management on an SOA infrastructure, achieving ROI within a year.

Geisinger Health System uses TIBCO BPM solutions for clinical and business processes, saving about $1.2 million a year.