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The changing business environment and the recently passed Healthcare bill not only open up opportunities also bring challenges to the health plans. Health plans are under pressure to improve profitability while members expect more benefits, providers demanding administrative simplification and employers seeking more affordable products. Meeting the stakeholders expectations are limited by legacy technology applications, lack of integrated view of information that resides in numerous data silos, sub-optimal business processes, and gap in communication with their members and participating clinicians. Upcoming mandates such as such as 5010 and ICDO-10 and evolving technologies such as cloud computing, mobile technology, and SOA are transforming the health plans in unprecedented ways.
For a decade, Symphony has empowered health plans to achieve member satisfaction and profitability goals by providing best of breed solutions from outsourced plan administration, custom application development, business intelligence, and chronic care management solutions in a cost effective manner. Our strong healthcare domain expertise, matured quality processes, industry-leading technology, and strategic alliances ensure that we deliver quality solutions in less time at lower cost. Our clients include leading health plans, third party administrators, HMOs, ASO services, PBM’s and care/disease management companies, and HIE / RHIOs. Symphony has working relationships with CMS and Health and Human Services agencies at both the state and federal level.
Symphony has extensive experience in customization, implementation and maintenance of claims administration, workers compensation, CDH subrogation, and eligibility & enrollment systems, and medical management applications. Symphony supports major claims administration applications such as Epic Tapestry, Trizetto, Facets and LuminX, and value add applications such as McKesson CRMS, 3M Case Management and Groupers. Symphony is a Microsoft gold standard partner and SAS strategic alliance partner. Symphony’s engagement models - pay for performance and risk and reward “wa”, combined with our mature methodologies bring accountability, quality and cost savings to every one of our engagements. |
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- Legacy systems modernization to newer platforms like Dot.NET, J2EE & RDBMS
- Deploying Service Oriented Architecture (SOA) and N-Tier Architecture
- Business Intelligence and Analytics
- Population Health management/Chronic care management
- Employer and patient portal
- Systems implementation support
- ICD-10 migration
- Quality center of excellence & testing
- Mobile applications
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| Symphony brings a unique value proposition to health plans. We combine our proven experience and knowledge in claims and clinical data, advanced data management, and visualization with our matured methodologies (CMMi Level IV) and well tested frameworks to provide healthcare data infrastructure that meet your needs. |
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| Symphony brings a unique value proposition to health plans. We combine our proven experience and knowledge in claims and clinical data, advanced data management, and visualization with our matured methodologies (CMMi Level IV) and well tested frameworks to provide healthcare data infrastructure that meet your needs. The end result is control over your report development process, transparent milestones, increased predictability and cost savings.
Symphony has significant experience in building BI solutions using Oracle, Business Objects, Cognos, Microstrategy, Amalga, Informatica, front-end visualization tools such as Adobe Flex, and Silverlight, and appliance based BI such as Netezza. Symphony is a strategic alliance partner with SAS & Microsoft Gold Technology Partner. Symphony certified consultants have experience in developing BI solutions, extracting data from multiple applications. Our experience also includes transforming data using tools from McKesson, Ingenix, 3M, John’s Hopkins ACG’s, and HCC’s, and enable HEDIS reporting.
We offer flexible engagement models that are designed to meet your specific needs including include onsite resources to support and supplement your existing team and fixed price, on demand analytics, pay-for-performance and risk-reward “wa” models.
Symphony services include:
- Data warehousing
- Data governance, Master & Meta Data mgt.
- Data integration: ETL and data quality
- Reporting Interface development
- Predictive modeling
- Utilization & Provider profiling
- Health plan intelligence (rate setting & actuarial)
- Customer intelligence
- Operational dashboards & KPIs
- HEDIS reporting & Population analytics
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| Symphony’s Care management product recognizes the need for collaborative disease management involving care managers, Physicians, nurses and health coaches. |
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Symphony’s Care management product recognizes the need for collaborative disease management involving care managers, Physicians, nurses and health coaches. Compliant with the NCQA’s Patient Centered Medical Home guidelines, Symphony’s chronic care management is designed to increase quality of care while enabling plans to achieve higher HEDIS scores and participating physicians to improve PQRI / P4P re-imbursements. Our hosted solution includes the following features:
- Customizable registry criteria
- Chronic care registry
- Patient portal including self-management
- Remote monitoring
- Population & cohort management
- Longitudinal view of the patient
- Prescription Fulfillment alerts
- Health Risk Assessment
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Our services include requirements analysis, implementation of data governance procedures including anti-trust, and policies development and implementation, design of data warehouse model – including federated, centralized, or hybrid models, data integration, ETL development and implementation, de-identification of aggregated data, master data and metadata management solutions, and roll out of the HIE functionality to end users.
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| Symphony has proven experience in applying lean manufacturing techniques in the administration of health plans. |
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Symphony has proven experience in applying lean manufacturing techniques in the administration of health plans. We have helped health plans save up to 40% in operations costs with a 24 hour turn-around-time and minimum 99.98% accuracy. In addition to cost savings, our outsourcing services help health plans and third party administrators spend less time on operations and focus more on expanding coverage, managing provider, reduce medical loss ratio and increase revenues. Some of our services include:
- Eligibility data maintenance & verification
- Data Conversion & Data quality management
- Document Management and workflow system
- Claims re-pricing & adjudication
- CDH Plan Implementation
- Premium billing
- Utilization reporting
- Out-of-network claims management
- Medical bill audit and review
- ASO (Administrative Services Only) processing
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