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1、Contract Intelligence for the Healthcare IndustryIndustry OverviewThe Modern Healthcare Industry and Contract IntelligenceThe healthcare industry stands at a pivotal moment.Nearly every week,it seems,the marketplace is disrupted by news of acquisitions,mergers and emerging players.At the same time,r
2、egulatory uncertainty has created huge challenges.National and regional regulatory regimes present major compliance hurdles for companies that want to avoid the fines and bad PR that come from violations,and have left a long trail of multimillion-dollar fines for those that have fallen short of the
3、mark.Meanwhile,the way companies across all industries operate is being fundamentally altered by digital innovations that represent an opportunity for organizations that successfully adopt them and an existential threat to those that dont.The disruptions presented by new industry players,new regulat
4、ions and new technologies are not isolated.At the forefront of these new technologies is advanced contract intelligence software.Healthcare companies are re-imagining whats possible with contract lifecycle management(CLM)and structuring and connecting their contracts to the systems and processes the
5、y touch.Contracts define how healthcare companies run,and advanced CLM can transform these documents into strategic advantage.In this eBook,we will guide readers through the principles of contract intelligence from a healthcare perspective,and explore how this technology can make companies more resi
6、lient,agile and competitive.About IcertisIcertis is the undisputed leader in contract lifecycle management,including in the healthcare industry.The Icertis Contract Intelligence(ICI)platform has been selected by large health insurers including Humana and Australian Unity and providers including Alli
7、na Health to transform their contracts into strategic advantage.Icertis has established this leadership position with its bold vision,unrivaled expertise,and enduring commitment to organization-wide CLM.Icertis has the deep knowledge and powerful AI tools to help companies ramp up quickly,streamline
8、 contracts and processes,close deals faster,and connect the dots across departments.Icertis customers have accelerated their contract processes while reducing risk and improving performance.Our customers in the insurance industry have been able to use mass amendments to stay compliant with governmen
9、t regulations and fast-changing commercial terms with provider networks,while our provider clients have been able to improve operations from HR to procurement.Contract Intelligence for Healthcare PayorsHealth insurance companies and other healthcare payors like PPOs and HMOs face serious challenges
10、in containing costs for their clients while staying in compliance with government regulations.Take,for example,the process of provider contracting,in which insurance companies enter into contracts with physician groups and hospitals that operate under the payors network.Provider contracting is extre
11、mely complex and leaves plenty of room for inefficiencies to creep in.Yet,with customers demanding the lowest possible healthcare costs and the emergence of disruptive players in the market,inefficiencies could pose an existential threat to these organizations.Meanwhile,health insurance companies ar
12、e tightly regulated across the world.In the European Union,marketplaces and regulations vary based on the“nature and performance of publicly financed health systems and by the historical contexts in which they have evolved.”1 In the United States,the Patient Protection and Affordable Care Act(ACA)co
13、mpletely overhauled the health insurance industry.While the ACA is a federal law,all 50 states have their own insurance regulators,creating an even more challenging compliance landscape.Similar challenges exist across the world.In this section,well explore how contract intelligence can help insuranc
14、e companies improve their provider contracting processes as well as stay flexible in the face of a constantly shifting regulatory environment.1http:/www.euro.who.int/en/publications/abstracts/voluntary-health-insurance-in-europe-country-experience-2016FIVE BIG CONTRACT FRUSTRATIONS FOR PAYORSAny of
15、these sound familiar?1.Discrepancies betweenprovider contracts andprovider credentials2.Billing errors due to pricesnegotiated in contracts notmigrating to billing system3.Miscommunications withproviders who cantself-service and updatetheir contract information4.Price discrepancies and otherissues a
16、re difficult to surfacebecause contracts are noteasily searchable5.Manual contract updates make itdifficult or impossible to executemass amendments in reaction toregulatory changesAccelerating and Optimizing Network ContractingAnyone with health insurance has heard the phrases“in-network”and“out-of-
17、network”providers.But how are those networks built?At their foundation,with contracts.Every year,health insurance companies,preferred provider organizations and health management organizations negotiate and execute contracts with hospitals and physician groups that operate under the payors networks.
18、These contracts dictate how much the insurance companies will pay the providers for various procedures,consultations,and visits.In order to properly oversee provider contracts,insurance companies must ensure all the medical professionals they are contracting with are properly credentialed;maintain d
19、etailed price sheets to standardize how much they are paying for services;and keep historical records of each account.And this is just scratching the surface.A contract intelligence platform removes these inefficiencies by structuring and connecting this contract data within a central repository,whe
20、re it can serve as the single source of truth throughout the provider contract lifecycle.The right system can integrate with systems across an company to make sure the right information is going into contracts and coming out of them.WHAT SPEED IS YOUR ORGANIZATION CONTRACTING AT?SlowManual approval
21、workflowsLimited vendor collaborationContracts siloed away fromother systemsFastDynamic contract routingIn-application collaborationportal for vendorsContracts integrated into EPR,CRM,and other systemsBetter Regulatory ComplianceAny company operating in multiple countries or even multiple states or
22、provinces must be able to adjust to regulatory changes at all levels of government,and do so swiftly and precisely to stay competitive and avoid heavy fines.A useful example of this recently came out of Idaho.Regulators there announced that they would stop enforcing certain aspects of the federal Af
23、fordable Care Act,in hopes of encouraging insurance companies to lower their premiums.To compete in the marketplace,companies will likely want to take advantage of the regulatory change.However,the state is expected to be challenged for not enforcing federal law,meaning plans could have to revert to
24、 the previous regulation.How does a company stay agile in such an environment?Contracts are a good place to start,as they provide deep visibility into every aspect of an organizations operation:where its doing business,with whom,under what terms,and for what purpose.With visibility comes the power t
25、o adjust all contracts impacted by regulatory changes.With an advance CLM system,health payors can execute mass amendments on their contracts based on relevant criteriasuch as geographical location.This means bringing all contracts in compliance with language adjustments instead of manually updating
26、 them one by one.So,when Idaho or any other state changes its rules,executives can quickly determine what contracts they have in Idaho and adjust them accordingly.They can then verify that the adjustments have been made before the compliance deadline,ensuring that no fines will be assessed.With cont
27、ract intelligence,insurers know contracts are in compliance at the time of their execution through rules-driven authoring processes that include approved versions of clauses using a robust clause and template library;tracking of all non-standard or deviated clauses;and automatic review of contracts
28、triggered by changed language.All of this ensures greater compliance with internal and regulatory rules.CASE STUDYWhen a major American health insurance company was looking for a new contract lifecycle management system,one of their top criteria was the ability to execute mass amendments on their co
29、ntracts.This functionality was necessary for the company to efficiently respond to regulatory changes that affect entire classes of contracts,such as every contract pertaining to a particular state,procedure,or type of provider.The company chose Icertis Contract Management for its deep insights into
30、 and control over every contract,giving the company assurance that it would be able to comprehensively execute the amendments on time to avoid regulatory fines.Contract Intelligence for Providers In the previous section we discussed contract management from a payors perspective,with an emphasis on h
31、ow contract management impacts their relationship with providers.Now lets look at contract management from the other side:What contract needs do hospitals,physician groups,and other providers have?In some ways,the challenges are similar to those faced by payors.Because contracts are the single sourc
32、e of truth for negotiated price sheets that fundamentally impact the bottom line,it is imperative that providers have a central,structured repository for this information to both detect inconsistencies and identify opportunities for improvements.But providers also have contract challenges that are u
33、nique to their mission.For example,many hospitals have significant procurement operations for their supplies.All of their supplier relationships are governed by contracts,and in many cases these contracts carry with them important entitlements that can present competitive advantages if properly moni
34、tored.Human resource contracts are also mission-critical to ensure the acquisition and retention of physicians.In this section,well explore how a contract intelligence platform can provide a single solution to all these challenges and help providers focus less on contracts and more on serving patien
35、ts.SNAPSHOTKey Provider Functions That Rely on Contracts1.1.Payor relationships:Contracts form the foundation of providers agreements with insurance companies on how much to bill for all services.2.2.Procurement:Providers rely on thousands of supplier contracts to ensure their patients receive safe
36、and quality care.3.3.Human resources:Providers are only as strong as the doctors and nurses who provide care.HR contracts make sure provider groups are acquiring and retaining top talent.Faster Insurer Contract TurnaroundJust as healthcare payors must keep close tabs on the various hospitals and phy
37、sician groups it contracts with,so must hospitals and physician groups keep close tabs on the various payors it deals with.Based on complex negotiations,hospitals may charge different amounts to different insurance companies for the same service.And considering there are thousands of different servi
38、ces a hospital can bill for,the matrix of how much is billed to which payor for which service becomes very complicated,very quickly.If the contracts in which these payment terms are codified are being managed manually,hospitals run the risk of forgoing terms and entitlements with health insurers tha
39、t could increase their revenue stream.They also run the risk of overlooking improper payments from insurance companies.This is not a hypothetical situation.According to some researchers,as many as 40 percent of medical bills contain errors.These errors may not be the fault of the hospital that submi
40、tted the claims,but without a good system to track what a hospitals negotiated entitlements are,the errors could easily be overlooked.This creates more work for the provider when the error is detected and must be corrected.Contract intelligence solves these problems by creating a single source of tr
41、uth for all terms negotiated in contracts with insurance companies.The Icertis platform can be integrated with billing and payment systems to ensure that the right amount is billed to insurance companies and the right amount is received.And because contracts on the platform are fully searchable,prov
42、iders can easily extract important data from their contracts to identify possible areas of improvement.For example,an administrator can search across contracts for how much his or her hospital is receiving for a specific surgical procedure from various insurance companies,in order to detect wide dis
43、crepancies or other areas of improvement.An organization-wide contract system also ensures contracts negotiated with insurance companies follow a providers requirements.ICIs robust clause and template library and rules-driven workflow reduce the chance of maverick or otherwise noncompliant contracts
44、 being executed.FAST FACT40%According to some researchers,as many as 40 percent of medical bills contain errors.These errors may not be the fault of the hospital that submitted the claims,but without a good system to track what a hospitals negotiated entitlements are,the errors could easily be overl
45、ooked.More Secure Supply ChainsProcurement is central to a healthcare providers mission.Every service,be it emergency care,labor and delivery,or primary care checkups,requires medical devices and products that are safe and effective.Its not surprising,then,that according to one consulting firm,suppl
46、ies are the second largest expense for hospitals,following only salaries and wages.Supplies can represent 18-23 percent of a hospitals total costs.2 And unlike procedures,hospitals dont bill based on the use of most of these supplies,meaning that supply costs must be expertly managed lest they outru
47、n revenue from the healthcare services provided by the hospital.Procurement-focused organizations from a variety of industries have turned to advanced contract intelligence technology to get a handle on their supply chain.with an organization-wide contract intelligence platform,a hospital can levera
48、ge the contracting process to verify that its medical equipment is coming from properly credentialed sources,improving patient safety and ensuring regulatory compliance;and can monitor its contracting processes for efficiency.Contracts are searchable across fields,meaning an administrator can easily
49、 see how much a hospital is spending on everything from hand sanitizer to specific pharmaceuticals.With these capabilities,providers can control and optimize supply costs,translating into safer care for patients and a competitive advantage in the market.DID YOU KNOW?Supplies can represent 18-23 perc
50、ent of a hospitals total costs,second only to salaries and wages.2https:/ HR ContractingHospitals,physician groups and other healthcare providers face stiff competition when it comes to acquiring talent.A single physician can bring in hundreds of thousands in revenue per year for a hospital,or even
51、millions in the case of top-tier surgeons and other specialists.As such,human resource contracts are strategically critical for these organizations.Recruiters need a contract system that is flexible enough to allow them to add or remove terms based on physicians demands.At the same time,administrato
52、rs need to know that their physician contracts are compliant with internal rules and fit into overall organizational strategy.They must also be able to search across existing contracts to spot any potential risks or liabilities.With a manual contract management process,these capabilities are severel
53、y limited.HR and legal may have to go back and forth several times to agree on a single doctors contract language,and even then,there is ample room for error and oversight.Meanwhile,contracts have limited visibility,making any sort of comprehensive analysis cumbersome or impossible.Conversely,with a
54、dvanced,organization-wide CLM,a legal department can work with HR and other stakeholders to define a rules-driven process that allows recruiters to self-service contracts while streamlining approval.Active contract data can be integrated into HR systems so all contract data is easily accessible with
55、in the context of the relevant HR systems,thereby improving outcomes and compliance.In this way,the contracts become a strategic advantage.DOCTORS CHECKLISTDoes Your Contract Management Software Allow These Functions?Self-service by recruiters forstronger negotiationsClause libraries to ensure allco
56、ntract language complieswith legal and companyrequirementsDeep searchability toanalyze large amounts ofHR contract dataDynamic workflows to makesure the right people seethe right contracts beforethey are signedOur customers demand the highest levels of data encryption,and application and infrastruct
57、ure security.From the day we launched,weve taken advantage of the enterprise-grade security features built into the Azure platform to help provide the level of security our customers expect.”Monish Darda,Co-founder and Chief Technology Officer of IcertisIcertis Is Committed to Data SecurityThe infra
58、structure for the ICI platformdata centers,firewalls,networks and intrusion detectionis provided by Microsoft Azures cloud services.Hand in hand with the internal Icertis SAFE Information Security program,the ICI platform leverages Azure to provide a comprehensive program to ensure the security and
59、privacy of contractual data.ICI complies with,enables,or provides the following regulations,security standards and features.HIPAAENCRYPTION IN TRANSITDATA RESIDENCYSINGLE SIGN-ONGDPREU-US PRIVACY SHIELD AZURE KEY VAULTITARISO 27001/SOC 2(TYPE 1&2)ENCRYPTION AT RESTNo matter what role your organizati
60、on plays in the modern healthcare industry,it is facing both monumental challenges and opportunities.Industry disrupters,continued regulatory challenges,and the ongoing digital transformation will reshape the way healthcare organizations do business in the years to come.As such,there is simply no pl
61、ace for a manual contract management process.Contracts define what a companies buys,what it sells,and how it runs.And as weve shown in this eBook,there is hardly a facet of the healthcare industry that contract management does not touch:physician contracts,provider networks,even an emergency departm
62、ents supply of hand sanitizer.Advanced,organization-wide contract intelligence allows actors in the health insurance and health provider sectors to turn their contracts into strategic advantage.ConclusionSilicon ValleyNew York/New JerseyLondonParisZurichStuttgartFrankfurtSofiaPuneSingaporeSydneySeat
63、tleWith unmatched technology and category-defining innovation,Icertis pushes the boundaries of whats possible with contract lifecycle management(CLM).The AI-powered,analyst-validated Icertis Contract Intelligence(ICI)platform turns contracts from static documents into strategic advantage by structur
64、ing and connecting the critical contract information that defines how an organization runs.Today,the worlds most iconic brands and disruptive innovators trust Icertis to fully realize the intent of their combined 7.5 million+contracts worth more than$1 trillion,in 40+languages and 90+countries.About IcertisOfficesContact U