Navigating healthcare transformation
Why KPMG is the premier consultant for healthcare payors
In a rapidly evolving healthcare landscape, successfully navigating the sea of change necessitates collaborating with consultants who can bring profound industry knowledge and experience with leading technologies. At KPMG, we are dedicated to utilizing strategic alliances to help streamline our clients’ strategies and transformations.
Addressing the most common problems for healthcare payors
Operational inefficiency is one of the most critical issues faced by the healthcare payor sector and it is imperative to analyze workflows at a more granular level, creating digital twins of current state processes providing a real-time pulse of performance to enable continuous identification and removal of bottlenecks, redundant processes, and tasks that contribute to operational inefficiencies. While not comprehensive, we’ve listed the top six most impactful common issues:
- Claims management is a complex process that encompasses a number of different factors, leading to a lack of visibility and potential cracks for things to fall through
- As a high touch area, appeals and denials offers a large opportunity for automation and efficiency improvements
- Inefficient manual processes around utilization management, care management, premium collections, and network management
- Compliance regulations with heavy penalties for noncompliance:
- Ensuring appropriate coverage around insurance reporting and fraud prevention
- Difficulties around managing contact centers to promote customer service and satisfaction, contributed to by lack of visibility
- Limited support for decision-making due to lack of data-driven insights from overwhelming data sets.
Maximizing value through AI-enabled process intelligence
Understanding the intricate healthcare payor landscape and addressing the problems above, KPMG acknowledges the need for tailored solutions and leverages artificial intelligence (AI)-enhanced process intelligence technologies like process and task mining, with market-leading platforms such as Celonis, to first find the inefficiencies, then frame the opportunities by quantifying business value and providing recommendations benchmarking against our industry knowledge, and eventually helping you fix those operational problems through various leading technology solutions (data modernization, automations, GenAI, etc.) and operational change approaches. Following are different ways we apply process intelligence to help maximize value for enterprises by embedding into every function, business process, and product:
- System transformations – Accelerate and de-risk all transformation initiatives and facilitate continuous business improvement by optimizing processes premigration, automating documentation, accelerating fit-gap analysis, and streamlining user adoption during system migration.
- Cost optimization – Anchored on EBITDA, focus on increasing cost savings and labor productivity to drive insights for organizational right-sizing and working capital optimization. Simplify financial planning and analysis and accounting processes while increasing automation.
- Process excellence – Geared to drive process adherence and standardization, monitor wide-ranging process flows, to identify inefficiencies, find and justify GenAI use cases, and automate repetitive tasks leading to an increase in productivity.
- Risk transformation – Provide a 360-degree view of risk that is foundational across the 1st, 2nd, and 3rd lines of defense to enable continuous monitoring, automated preventive controls, and detective analytics for near-real-time risk response.
Why KPMG?
In conclusion, KPMG is well-equipped to navigate the complexities of the healthcare payor industry, offering a wide range of knowledge and experience to fully support your business. Our alliance partnership with Celonis further strengthens our commitment to providing exceptional value for our clients. With deep industry experience, powerful technologies, tried and tested methodologies, and a dedicated team of specialists, KPMG can help your organization work better, faster, and smarter. Whether it’s process redesign, network efficiency improvement, or member/provider experience optimization, our experience in working with large-scale payors makes us a trusted ally in driving timely and effective transformations in the healthcare sector. Together, KPMG and Celonis are pioneers in this field, dedicated to delivering the results you expect. Contact us to discuss further and see how we can support your business.
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