Capgemini’s combines a highly trained team, proprietary nurse network, and comprehensive discount provider networks to help insurers cost effectively manage long term care
Client Challenges Today
Inaccurate assumptions about lapse and morbidity rates and rising healthcare costs have forced long-term care insurers to increase capital reserve requirements and impeded investments in new strategic initiatives. Many insurers have closed their long-term care blocks but legacy systems and inefficient operational practices are eroding profit margins. Most individual long-term care carriers cannot afford to address these worrying trends.
Capgemini’s Long-Term Care Solutions: A cost effective way to address industry challenges
Capgemini has invested in creating a centralized and integrated solution to service the long-term care market. Our Long-Term Care Solutions Hub leverages standardized and efficient operational approaches to drive reductions in current and future claims costs using technological and process levers. The hub is a technology ecosystem that includes a scalable policy administration platform to enhance consumer experience, align with business needs, and reduce costs. We use a highly trained team, proprietary nurse network, and comprehensive discount provider networks to provide end-to-end services for long-term care.
- Claims and care management including individual components such as claims eligibility assessments. We have a service portal reference architecture for effective stakeholder services, standard report specifications to provide efficient claims management, a reference process model based on industry best practices, and a rule repository (product and claims) for bringing automation and consistency to claims adjudication
- Discrete business processes such as plan of care creation, initial phone interview, caregiver assessment, cognitive assessment, and facility evaluation which can be purchased separately
- Network of care providers who are credentialed by and contracted with Capgemini to provide quality, discounted services to our clients. The network includes various long-term care provider types including home healthcare agencies, nursing homes, assisted living facilities, adult day care facilities, and other community-based providers. We currently have 7,000+ contracted providers with access to over 40,000 additional providers nationwide. We have experienced credentialing specialists on our staff list who manage the contracting, onboarding, and ongoing management review of these providers. Over 99% of the contract providers offer discounts averaging 10% off private-pay rates across the network.
- Network of registered nurses with over 1,500 nurses contracted with us as part of our propriety CareForce™ network with nationwide coverage. These nurses are trained to perform long-term care assessments including benefit determination, underwriting, wellness, cognitive, and caregiver assessments, with an objective point of view.
- Nurse NavigatorSM. The Nurse Navigator program was helps seniors and family members manage aging and care in today's eldercare services environment. Our goal is to assist our members to find eldercare solutions, whether temporary or long-term. We provide a variety of services to inform and empower seniors and their caregivers. Visit the Nurse NavigatorSM website at www.nursenavigator.com.
Powered by an integrated technology ecosystem
Our integrated technology ecosystem includes core platform components for delivering business services:
- Digital Mailroom. Our mailroom operations are supported by a robust imaging and workflow solution that includes state-of-the-art, intelligent capture which easily take in documents from multiple channels—mail (paper), email, and fax. The system automatically extracts data, and indexes and classifies documents and data from unstructured content.
- Policy & Claims Administration Platform: A customized, third-party administration solution that offers integrated policy and claims administration on a single easy-to-use platform. User-driven menus provide business users with the ability to add or change products with just a few clicks enabling high flexibility and faster client on-boarding.
- Comprehensive Care Management Application: A fully automated, in-house comprehensive care management application, Your Care Assistant, which tracks claimants through the claims episode from intake to discharge.
- Analytical Tools: Our ecosystem provides real-time analytics and proactive alert facilities to better manage end-to-end business processes and create levers for optimization. With a constant view into the performance of the business, our clients can quickly take action to balance workloads among employees, set new priorities for processing, or identify trends that are impacting service levels.
With over 100,000 long term care policies under end-to-end services administration, Capgemini’s Long Term Care Solutions are a proven solution for insurers. Each year, we manage over USD 130 million of long term care premiums and more than USD 115 million in annual claim payments. Our solution provides:
- A flexible and scalable application portfolio comprised of our state-of-the-art policy administration platform
- Near real-time analytics for driving and optimizing a block performance
- A set of flexible and discrete service offerings that could be packaged as one holistic solution
- Complete technological and operational integration, which enhances efficiency and ensures superior responsiveness to market demands
- Highly qualified and experienced staff of underwriters, claims processors, registered nurses, actuaries, care managers, and customer care professionals