SunGard HIE Solution Attacks Fraud and Waste to Reduce Cost of Care

The vendor’s new iWorks HIE Connectivity offering can help to reduce length of stay, duplicative procedures and readmissions, fraud, abuse and costs while helping improve the speed, quality and safety of care.

(Photo credit: Dollar Photo Club.)

SunGard has launched iWorks HIE Connectivity, which analyzes health insurer data to identify and mitigate fraud, waste and abuse in health insurance claims toward the goal of reducing the cost of patient care. By linking a selected Health Information Exchange (HIE) to the health plan’s databases or processing system, the solution provides insurers with real-time access to critical information within patients’ electronic health records (EHRs). Analysis of the information can help to reduce length of stay, duplicative procedures and readmissions, fraud, abuse and costs while helping improve the speed, quality and safety of care, particularly for chronically ill patients, according to the vendor.

J.P. James, President of SunGard's insurance business.

J.P. James, Group President, Insurance, SunGard.

“The demand for electronic HIEs is growing along with nationwide efforts to improve the quality, safety and efficiency of healthcare delivery,” comments J.P. James, president of SunGard’s insurance business. “SunGard’s HIE Connectivity solution can play an important role in a health plan’s overall cost containment and customer service strategies, which will become more crucial as the number of individuals enrolling in health plans continues to grow.”

SunGard’s iWorks HIE Connectivity solution provides health plans with an infrastructure to receive alerts on patient care activity, manage and analyze data, and coordinate workflow with care managers, a vendor statement adds. SunGard reports that the solution also provides the data integration and information flows necessary to support new payment models and patient care standards.

 

Anthony R. O’Donnell // Anthony O'Donnell is Executive Editor of Insurance Innovation Reporter. For nearly two decades, he has been an observer and commentator on the use of information technology in the insurance industry, following industry trends and writing about the use of IT across all sectors of the insurance industry. He can be reached at [email protected] or (503) 936-2803.

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