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Core Operations

The heart of your business.

If you operate a health plan, you receive stress from many directions— government mandates, market consolidation, competition (including new entrants), advances in technology and the eternal squeeze on price and profit, to name a few. These forces touch different parts of your organization. But their effects meet at the core, where the heart of the business has to make sense of it, anticipate the next wave and keep things running efficiently, carefully and in a timely manner.

Core administration operations like product administration, claims processing, enrollment and billing are the crossroads where the needs of your plan’s key constituents intersect. To make those interactions smooth and profitable, you should make sure you’re using the efficient platforms—or moving to the preferred new ones using an effective migration strategy. You should have a business readiness framework that accounts for real and likely challenges and you should select and hone new processes so they perform as needed.

Getting core operations right can be your secret weapon in an industry that prizes efficiency everywhere it can find it. A sound approach can help you keep up with the market, but a forward-looking approach can help you catapult ahead. If you become a leader in operations, it can even evolve into a value-add you sell as a service.

Deloitte has teams of professionals who have been where you are now, with experience in disciplines like retail, M&A and regulatory affairs that increasingly matter to plans. Our specialists can help you make critical business changes become a part of your DNA and, ultimately, a potential springboard to help you capitalize on strategic opportunities.

Potential benefits can include increased efficiency and cost reductions, the ability to build and fill more capacity based on economies of scale and the ability to sell your operational prowess as a service.

Related solutions:

  • Migrations / business transformation
  • Product launch
  • Master data management
  • Performance improvement
  • Customer experience & retention
  • Government programs
  • Value-based care
  • M&A
  • ICD-10 / coding solutions
  • HIX
  • Emerging plans / innovation solutions
  • Network management
  • Core admin maintenance
  • PBM / formulary management
  • Testing services

Contact us

 Chris Smith, Principal, Deloitte Consulting LLP

 

As used in this document, "Deloitte" means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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