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Creating new products or optimizing existing processes is complicated and expensive for many health plans. Years of organic growth and industry consolidation have left organizations with intricate and inflexible claims processes and incompatible supporting systems. Untangling and modernizing those systems and processes has become a top priority. Recently, several health plans evolved an approach based on Service Oriented Architecture (SOA), a conceptual framework for describing and creating standardized, reconfigurable systems that support rationalized, flexible business processes.
This study will examine the forces driving the healthcare market and how health plans can take advantage of SOA concepts and methods to build more agile, competitive, member-centric organizations and uncover opportunities for incremental savings from optimization and targeted sourcing of business processes.
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