Today, Americans spend more than $3 trillion on healthcare annually. This cost continues to increase and shows no signs of stopping. Zelis Healthcare, a healthcare technology company and market-leading provider of integrated healthcare cost management and payments solutions, is helping to reduce overall healthcare spending by $1 trillion.
The majority of healthcare costs stem from errors, waste, and abuse from claims post-adjudication and pre-payment. To date, New Jersey-based Zelis has helped healthcare payer clients across the U.S. save more than $24 billion in network and claims costs using advanced technologies and expert clinical resources. But the company was looking for a more efficient way to reduce the staggering cost of healthcare.
Building a next-generation healthcare savings platform with Azure
Historically, healthcare cost management processes are deployed after a payment for a claim is made to a healthcare provider. This approach can be less effective and can delay the process of determining claim cost appropriateness. Zelis’ proprietary technologies help speed up the cost management process and enable determination of claim cost appropriateness before claims are paid. By changing up the process, Zelis has made a name for itself as the leading healthcare payment company.
“When we look at a claim, we take a 360-degree view. We deploy proprietary technologies and expert clinical resources to identify network cost savings along with clinical and specialty clinical claims cost savings, while leveraging technology to optimize claim workflows. This combination of activities is executed in parallel to deliver market-leading transparency, efficiency, and cost saving effectiveness on every network, every claim, every payment, every day,” says Doug Klinger, CEO of Zelis.
Zelis’ new Intelligent Claims Routing Platform allows it to maximize network and claims cost savings opportunities for payers by identifying hard-to-detect instances of errors, waste, and abuse in claims costs before they are paid; deliver customized, actionable insights to healthcare payers to maximize their network and claims cost savings; and accelerate the evolution of next-generation cost management technologies.
Azure was the best fit for Zelis’ platform because of its PaaS offering and Microsoft’s approach to technology licensing. Zelis found that Azure could provide the agility and cloud capabilities needed to develop a secure solution tailored to its unique needs. Azure is also able to support a hybrid solution that will allow Zelis to maintain productivity and avoid costly downtime, all under one artificial intelligence (AI) umbrella.
There are billions of healthcare claims made every day, and Zelis needed an infrastructure that could scale at that input. Azure Machine Learning and Azure Data Lake were the answer.
Leveraging the cloud for results at every level
Planning for Zelis’ new platform began in early 2018. It was designed, built, and launched in mid-2018. Azure’s cloud capabilities will help power the foundation for a scalable platform.
“We are very excited about leveraging proven, scalable, integrated platforms enhanced by Azure functionality. We look forward to continuing to collaborate with Microsoft on innovative solutions to serve our clients,” says Thiyagu Gnanasekaran, Zelis’ SVP of Enterprise Application Development.
Azure allowed Zelis to merge its legacy system with the cloud and create a hyperconvergence infrastructure that could leverage massive amounts of data.
By unlocking the claims data stored in the cloud, Zelis is able to drive maximum savings outcomes. Providers are no longer burdened with the complicated ins and outs of billing because the actual cost comes before payment, not after. Healthcare premiums can be kept at more reasonable rates across the board, which means employers are able to use the money they’re saving elsewhere to invest in their workforce and business.
Reducing the rising cost of healthcare is a long-term challenge for all Americans. Zelis wants to apply its new claims review platform to the accuracy of every claim flowing through the system, from annual visits to bloodwork referrals to organ transplants. It hopes to continue to scale its platform to the healthcare market and potentially apply this technology to other aspects of business and healthcare.