HARTFORD, CT – Payers need to re-engineer and restructure their legacy systems to adequately handle rising inflation, healthcare spending, employer pressure to reduce premiums and marketplace pressure to cover the uninsured, said Siva Namasivayam, CEO of SCIOinspire.
The business process solutions provider recently acquired two companies to offer payers a wide variety of knowledge- and data-driven tools and services to help contain costs and increase revenue.
The acquisitions of Solucia Consulting, an actuarial services and care and disease management consulting firm, and Socrates, a coordination of benefits software provider, enhance the company’s resources in the areas of actuarial services, case and disease management, transaction management and coordination of benefits through analytics, data mining and predictive modeling.
Jaan Sidorov, MD, consultant to SCIOinspire on population-based healthcare strategies, noted that SCIOinspire’s knowledge of actuarial services, managed care policies and regulations and clinical and cost implications enable disease and care management companies, managed care companies and physician networks to develop the right combination of programs to achieve desired outcomes.
The Brooklyn, N.Y.-based Freelancers Union, a 75,000-member nonprofit organization representing independent workers, had already been working with Solucia to become its own insurance company.
Solucia provided actuarial data and analytics, helped design benefits and put together the workflow process, among other services, said Bart Bracken, managing partner of Solucia, now a subsidiary of SCIOinspire.
“They were able to negotiate rate increases from carriers for two consecutive years,” said Sara Horowitz, executive director of Freelancers Union. “Having the actuary be part of the bargaining team lends credibility to the endeavor and supports our actuarial argument.”
Horowitz said the actuarial and legal expertise were the “most crucial pieces” to putting the benefits program together.
Two-thirds of Freelancers Union members were previously uninsured or coming off COBRA, noted Bracken. The model the union created is a formula that seems to be working for the habitually uninsured, he said.
Namasivayam said SCIOinspire’s services and ROI are “very measurable,” and its strategy of containing costs and increasing revenue will play well with mid-size payers, the company’s target base.