Insurance Management System

HealthQuest's HealthGuard-IMS (Insurance Management System) is a health insurance benefits monitoring and analysis package that is designed to assist large enterprises in managing the relationship between their Human Resources department, their employees, and the health insurance benefits provider used to provide health, dental, and disability benefits to the enterprise.

HealthGuard-IMS

The Challenges

HealthQuest Data Systems understands the many challenges facing those responsible for the delivery and financing of health care services to employees of large enterprise organizations. That’s why we created HealthGuard-IMS.
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Measuring the provision of healthcare and its outcomes is quickly becoming the standard by which large health care purchasers and patients evaluate their prospective health care providers. As health care delivery systems continue to evolve, purchasers and informed consumers are placing greater emphasis on measurable outcomes.

HealthGuard-IMS' Benefits

HealthGuard-IMS eliminates the need for IS professionals to respond to decision support information processing requests by offering end users easy-to-use tools, powerful, built-in data management capabilities, and the ability to perform meaningful, ad hoc analyses "on the fly." Standard HealthGuard-IMS data views provide quick, logical insight into data while ad hoc drill downs allow more advanced users to immediately answer questions that arise from an analysis. HealthGuard-IMS employs an open SaaS-based (or optional on premise client/server) architecture that allows data and system resources to be shared throughout your enterprise.
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Cost-effective, simple to use, and high in quality - HealthGuard-IMS offers it all:

Reduce IS Costs -- Implement new rules and processing efficiencies whenever they are needed without any involvement from your programming staff or claims system vendor

Enhance Operational Quality -- Process provider management issues in an accurate, timely, and consistent manner

Achieve Administrative Simplification -- Streamline claims decision making so there are fewer stops along the way, lower suspense rates, and utilize our comprehensive audit trail to document each decision

Need for Insurance Classification

A health insurance benefits classification system that identifies discretely occurring episodes of care has long been at the center of analytical demand for those enterprise HR professionals responsible for the funding, analysis and contracting of health insurance services. In simple terms, unless one can consistently and meaningfully quantify those services offered by health care providers, attempts to manage the cost effectiveness of benefit plans are elusive at best.
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Increasingly, in order to achieve cost-effective insurance benefits programs, enterprise HR departments must work with carriers to go beyond the simple tailoring of "one-size-fits-all" contracts and benefits packages. However, customized contracts generate more rules for HR departments to remember, more exceptions for them to apply, and more special conditions to slow down processing - increasing costs, mistakes and quality concerns.

Advanced Technologies

HealthGuard-IMS uses a broad range of advanced technologies, multiple platforms, and "best-of-breed" components to deliver robust data warehousing and decision support products, process automation software, and analytical systems that increase productivity and bottom line results.
From overall system development consulting (e.g., needs assessment, plan development, implementation, training, and testing) to tactical services, HealthGuard-IMS provides solutions to streamline complex data integration efforts and accelerate the transformation of multiple data sources into warehouses
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HealthGuard-IMS unlocks the power of information in a way that is unlike anything you've seen, bought or built, empowering your entire organization to make better and faster clinical and financial decisions. HealthGuard-IMS is the only benefits decision support solution to meet the data complexity, performance and volume demands of large organizations. HealthGuard-IMS is a comprehensive data warehouse, analytic engine, and suite of applications, providing superior data analysis capabilities for the information needs of medical benefits management, premium optimization analysis, employee "best practices" training, and marketing decision makers.

Why HealthGuard-IMS?

HealthGuard-IMS's insurance benefits monitoring and analysis capabilities are designed to provide the most sophisticated and insightful data decision support tools and software to enterprises contracting medical coverage for their employees, enabling greater cost reduction and operational efficiency. Recognizing the complex nature of the provision of medical insurance services, HealthQuest designs and creates its analytic products by uniquely organizing data to define and clarify for maximum insight. More . . .

The result is a transformation of data to actionable information, which is logically understood by clinicians as well as administrators.
HealthGuard-IMS' client/server, mainframe, and SaaS-based product versions manage data efficiently, automate many processes, and assure operational integrity. HealthGuard-IMS meshes data warehouses and analytical systems, adding value by quickly returning information to meet your most critical operation requirements.

Unique Capabilities

As part of its extensive feature set, HealthGuard-IMS includes a case mix adjustment and episode building system that uses routinely collected claims data as input. The resulting clinically homogeneous groups adjust for severity by the presence of complicating conditions, co-morbidities and other characteristics of employee claims requests that affect resource utilization. HealthGuard-IMS' unique program and analysis capabilities make the system a breeze to use
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Profile Benefits Programs -- Evaluate carrier performance using accurate and objective measurements. Measure cost effectiveness carrier premium programs. Compare plan performance to external standards -- or those developed to suit your needs

Statistical Quality Analyses -- Provide employer HR groups with access to service and quality of service information. Use drill down and trending features to reveal the problems behind the statistics. Manage the impact of changes in plan enrollment and stability