Critical challenges to measurable results


Critical challenges to measurable results

As the healthcare industry is increasingly faced with regulatory changes and widening risk exposure, the manner in which such risk is dealt with is requiring new tactics and tools. Bonnie Clark of Delphi Technology discusses the innovations being used to respond to this rapidly developing environment.

Hospital systems today are facing an increasingly difficult operating environment. With claims frequency and severity increasing, the total cost of risk is on the rise, and regulatory requirements and reporting are increasing. Adding to this challenging financial and operational landscape is the fact that increasing numbers of physicians are closing their practices and moving to hospitals, the volume of services is rising due to a growing geriatric population and an increase in defensive medicine, and increasing levels of care are being pushed to extended caregivers.

As physicians continue to migrate to hospitals, and hospitals integrate into larger hospital systems, medical professional liability is also consolidating under hospital systems. In other words, claims are shifting from individual physicians’ medical professional liability to hospital professional liability, which has resulted in health systems absorbing claims that would previously have been settled or defended in the physician’s name. It’s becoming increasingly important that hospitals are able to track their risks at a much more granular level.

The bottom line? If you can’t accurately measure your risk exposure, you can’t manage it effectively.

Hospital risk managers know that in order to manage risk effectively, you must first understand your exposure. Then you must be able to use that data to apply sound policy and claims management across facility, department, specialty, and provider. Business processes need to be automated from end to end, with high quality and flexibility to adapt to new conditions. After all, one of the biggest keys to succeeding in today’s rapidly changing business environment is to have dynamic and flexible business processes and systems that can change when your organization’s needs change.

Today’s technology solutions give you that flexibility by automating your medical professional liability business processes and decisions in order to support your organization’s best practices. This agility enables you to streamline operations from the front office to the back office through process automation, intelligent decision-making, and system flexibility. This results in improved operational efficiencies, enhanced levels of customer service, and a technology solution that provides the flexibility and scalability required for ongoing demands and future growth.

The latest technology and software applications also give your company the ability to tackle diverse process improvement initiatives and realize various benefits.

• Collaboration across and beyond the risk management and insurance environment reduces the time, errors and the complexity of executing processes.
• Straight-through processing driven by predefined business rules automates the routing and processing of tasks—often reducing the amount of human intervention needed by more than 80 percent.
• Real-time visibility and control over processes enable managers to view real-time process performance and proactively manage bottlenecks.
• Extending the value and life of core systems with modern technology and open architecture.
• Ensuring that the process documented is the process that is executed provides consistency, adherence, and audit trails to ensure compliance with regulations such as those of the Sarbanes–Oxley Act (SOX) and the Health Insurance Portability and Accountability Act (HIPAA).
• Responding more quickly to organizational and regulatory changes.

Delphi Technology, a leading provider of software solutions for the healthcare professional liability market, has developed OASIS Healthcare Professional Liability to take the pain out of managing comprehensive medical professional liability claims. OASIS is the only solution on the market today designed specifically for healthcare professional liability. From determining liability risk to analyzing claims data to updating and improving claims business processes as needed, OASIS delivers the tools needed to face today’s challenges.

OASIS Healthcare Professional Liability offers:
• Management of liability risks at a granular level;
• Targeted benchmarking to inform cost allocations;
• Standardization of business processes and reporting;
• Easy-to-use data reporting and analysis; and
• Ability to rapidly adapt to changing business needs.

OASIS Healthcare Professional Liability, a comprehensive suite of highly configurable best-in-breed components that integrate seamlessly via the OASIS service oriented architecture, gives you power over your medical professional liability claims and offers the ability to intelligently access and plan for liability and then manage the claim process in a way that reduces cost-per-claim and reduces the potential for future claims.

OASIS’s proven software applications include policy management, claims management, financial management, risk management, reinsurance, document management, advanced workflow, policy holder services, online applications, incident management, data warehouse and reporting, advanced business analytics, and predictive analytics.

Policy management
OASIS Policy Management is an automated underwriting solution that enables your organization to apply its best practices for underwriting across all new business and renewals to maximize benefits such as improved underwriting productivity and reduced underwriting expense, reduced loss ratio, ease of doing business, improved individual risk selection and pricing, and streamlined processes and reduction of expenses. Leveraging these benefits allows you to gain consistency in risk acceptance, rejection criteria, and premium pricing.

Claims management
OASIS Claims Management is a multi-line claims tracking and management system that lets you capture extensive information for all claims functions and puts the data at your fingertips, resulting in improved claims handling efficiency, decreased losses, and improved data integrity.

Business intelligence
Delphi Technology offers a comprehensive suite of business intelligence solutions—Data Warehouse and Reporting, Advanced Business Analytics, and OASIS Predictive Analytics—that deliver a full range of capabilities including interactive dashboards, ad hoc queries, notifications and alerts, enterprise and financial reporting, data and text mining, and forecasting and optimization.

Data Warehouse and Reporting provides a robust web-based reporting environment offering multiple online analytical processing cubes for different levels of summarization of policy, claims, and financial data; a Report Wizard that enables end user report development using drag and drop to select attribute filters, sorting, aggregation, and format; and an advanced Report Designer tool that enables more technical users to develop more complex reports.

Advanced Business Analytics provides a robust ad hoc analytic experience enabling you to dynamically explore data by dragging and dropping data elements into the main pane of this web-based solution. Data can be displayed in both tabular and graphical format.

OASIS Predictive Analytics enables you to access large volumes of internally generated, geographically disbursed medical professional liability risk, financial, claim, and loss experience data; leverage a common data structure to make it easier to compile data and maintain its quality; integrate external data sources for greater insight than a typical insurer can obtain using internal data alone; use state-of-the-art modeling techniques, methodologies, and resources; and facilitate operational integration by deploying the model within OASIS.

Organizations can simplify complexity by controlling multiple sources of data through intelligent business rules and workflow management. Automated underwriting reduces the cost of processing new business and renewals by streamlining underwriting workflows and eliminating steps in the process—without sacrificing any of the business intelligence that goes into sound underwriting decisions. In addition, by automating key activities throughout the claims process, the claims solution delivers increased productivity in the back office and reduces the operational cost of processing and settling claims.

The ability to adapt to rapidly changing market conditions often determines a company’s ability to retain its competitive edge. Solutions are built to empower business users to rapidly modify operations in response to new product opportunities, market conditions and regulatory requirements. Business processes and rules become corporate assets, enabling easy deployment across departments and geographies while allowing for the specialization needed in each area. This enables organizations to use their business rules, policies, and processes for competitive advantage, achieving rapid change, and efficient deployment.

Having all the information available for coordinated reporting facilitates risk management, reconciliation of books, actuarial work, program analysis, loss runs, and refinement of future risk assessment procedures enabling you to make informed business decisions.

Online audit tracking and workflow automation ensure procedures are followed and traceable, as required for SOX compliance.

Configurable architecture means your organization will never find technical limitations to be a barrier when a growth opportunity presents itself. 

Headquartered in Boston, MA, Delphi Technology has sales, support, and development offices throughout North America, as well as in Shanghai, China. For more information, visit or call 617-259-1247.

Bonnie Clark, Delphi Technology, business intelligence, OASIS Predictive Analytics