Zelis Helps Address the Rising Cost of Healthcare in America with Cloud Solution

The company is focused on helping to reduce healthcare spending by $1 trillion

Bedminster, NJ – April 8, 2019 – The cost of healthcare in the United States has been rising steadily for decades, with Americans now spending more than $3 trillion each year. Zelis® Healthcare, a healthcare technology company and market-leading provider of integrated healthcare cost management and payments solutions, is focused on helping to reduce healthcare spending by $1 trillion. The New Jersey-based organization has helped healthcare payer clients across America save more than $24 billion in network and claims costs, using advanced technologies and expert clinical resources to reduce errors, waste and abuse. Zelis has also made more than $19 billion in timely, accurate payments to healthcare providers, helping convert the more than $500 billion in paper-based healthcare payments to more efficient, effective electronic payments.

With more than 800 dedicated associates across nine locations nationwide, Zelis integrates network analytics and design, network access and cost management, claims cost management and electronic payments to serve payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis drives market-leading performance by deploying advanced technologies and leveraging secure, streamlined cloud innovation to optimize healthcare cost management and payments processes.

Building the Next Generation Zelis Intelligent Claims Routing Platform with Azure

Innovating and changing the way people think about the healthcare claims cost management process is a key part of Zelis’ overall strategy to improve the efficiency, effectiveness, and accuracy of the processes necessary to help control the rising cost of healthcare.  Zelis also focuses on removing errors, waste and abuse from claims post-adjudication and pre-payment by leveraging proprietary technologies and expert clinical resources with an integrated, centralized digital infrastructure.

Historically, healthcare cost management processes have been deployed after a payment for a claim is made to a healthcare provider.  While effective to some degree, that approach can be less effective and often unnecessarily delays the process of determining claim cost appropriateness.  Zelis’ proprietary technologies speed up the cost management process and enable determination of claim cost appropriateness before claims are paid. These advanced technologies power Zelis to help lead the way forward in the healthcare payment integrity industry.

“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.” explains Doug Klinger, CEO of Zelis Healthcare.

Key objectives for the Zelis Intelligent Claims Routing Platform are to:

  • Maximize network and claims cost savings opportunities for payers by further identifying hard-to-detect instances of errors, waste and abuse in network and claims costs before they are paid
  • Deliver customized, actionable insights to healthcare payers to help them further maximize network and claims cost savings
  • Accelerate evolution of next generation cost management technologies

Zelis considered the full range of available cutting-edge cloud solutions before deciding that Azure was the best fit.  Between Azure’s PaaS offering and Microsoft’s approach to technology licensing, Zelis found that it could provide the agility and cloud capabilities needed to develop a secure solution tailored to its unique needs.  Additionally, Azure’s ability to support a hybrid solution will allow the company to maintain productivity and avoid costly downtime.

“We are very excited about leveraging proven, scalable, integrated platforms enhanced by Azure functionality,” says Thiyagu Gnanasekaran, Zelis’ SVP of Enterprise Application Development. “We look forward to continuing to collaborate with Microsoft on innovative solutions to serve our clients.”

Leveraging the cloud for measurable results at every level

Planning for the solution’s digital architecture, including Azure Data Lake capabilities, began at the start of 2018, and was designed, built, and launched in mid-2018. The cloud technology will power the foundation for a scalable platform.

“We serve nearly 600 healthcare payers, from the largest national payers to regional health plans and third-party administrators in the medical, dental and workers compensation markets.  We’re focused on delivering our trademark better service and better performance through capabilities that new technology provides,” Thiyagu Gnanasekaran adds.

Using innovation to improve the affordability of healthcare

Reducing the rising cost of healthcare is a long-term challenge for all Americans. “We are on a mission to help make healthcare more affordable. This type of transformative technology will help us make that possible and will benefit everyone,” says Doug Klinger, CEO of Zelis Healthcare.

 

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Zelis® Healthcare is a mid-cap healthcare technology growth company and market-leading provider of integrated healthcare cost management and payments solutions including network analytics, network access, network cost management, payment integrity and electronic payments to payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis Healthcare is backed by Parthenon Capital Partners. www.Zelis.com