OREANDA-NEWS. GE Healthcare (NYSE: GE) and Accenture (NYSE: ACN) today introduced a new offering to help improve medical claims processing and related cash flow for healthcare providers. The alliance, targeting medical claims management, one of the largest areas of lost revenue in the U.S. healthcare system, was announced at GE Healthcare’s annual software users conference in Phoenix, where more than 1,500 users are gathered.  

GE Healthcare estimates that, through the combination of analytics and consulting services, these offerings could help healthcare providers to, on average, save between 25-50 percent of their current costs to re-process denied claims.

Part of the GE-Accenture alliance announced in 2013, the offering combines GE Healthcare’s advanced analytics solution, DenialsIQ—which flags claims denials and uncovers potential hidden patterns and root causes therein—with Accenture’s experience and expertise in consulting. The comprehensive solution can help providers, including large health systems, physician groups and hospitals, understand how claims management affects their financial performance and then take action to redesign workflows and financial operations based on those insights.

“Our alliance with Accenture is an example of how GE Healthcare is developing game-changing partnerships to deliver what our customers want and need in an era of value-based care,” said Jon Zimmerman, VP and general manager, GE Healthcare IT Clinical Business Solutions. “GE Healthcare’s leading analytics technology, combined with Accenture’s proven consulting capabilities, will help our customers deliver better outcomes, putting financial savings to better use improving clinical care and health system operations.”

Managing claims denials has proven challenging for healthcare providers. Accenture estimates1 that of the one in every five claims that’s denied, it will cost a typical health system, on average, $25 per claim to re-process. For a $1 billion health system, reducing claims denials can yield a 0.5-1 percent lift in operating margin amounting to $5- 10 million annually. 

DenialsIQ uses powerful algorithms originally designed by GE’s Global Research Center for GE’s Aviation business. Similar to online shopping software that prompts a user with product recommendations, DenialsIQ can show administrators hidden patterns and root cause factors before medical claims denials negatively impact the revenue cycle.

Leveraging GE’s DenialsIQ solution, Accenture will offer services to help support three types of revenue cycle engagements:

·         A denials management assessment

·         A more extensive consulting engagement that uses DenialsIQ data to help redesign claims workflow and help reduce the volume of denied claims; and

·         Claims management and operations support services using DenialsIQ

“Accenture and GE are building on our strong alliance to help address a critical pain point for U.S. health systems,” said Matthew Collier, managing director, Accenture Strategy, Health. “We see the challenges providers face with the medical claims process. We are pivoting to the new by combining our capabilities to bolster the use of analytics in driving financial performance and provide health systems with actionable insights to reduce claims denials.”

DenialsIQ, launched in late 2014, has had tremendous commercial success, helping healthcare providers improve their revenue cycle management. “At less than 5 percent, our denials rate is considerably below the industry average, but at any given time we still have approximately 16,000 outstanding  denied claims, representing about $1.5 million in potential revenue,” said Val Cina, chief revenue officer, Southwest Diagnostics. “Speed is critical to successfully appealing claims, and with Denials IQ we are seeing that research and analysis that can take a month, can now be done in a week.”

DenialsIQ is built in the GE Health Cloud, which runs on Predix, GE’s platform for the Industrial Internet designed to meet the unique strength, scale and security requirements of industrial big data. As a global strategic partner of GE Digital, Accenture and GE are using the Predix platform to jointly develop new technology services and solutions across a range of industries.