'TCS Customer Intelligence & Insights™ for healthcare' on AWS

'TCS Customer Intelligence & Insights™ for healthcare' is WAR/TFR -certified by AWS.

The product supports the following AWS services:

1. AWS EKS
2. AWS ECR
3. AWS VPC
4. AWS RDS
5. AWS EMR
6. AWS S3
7. AWS EFS
8. AWS SES
9. AWS API Gateway
10. AWS Cloud IAM
11. AWS Lambda
12. AWS RDS
13. AWS Route53
14. AWS Cloud ALB
15. AWS Cloud Watch
16. AWS Guard Duty

• Payors want to leverage their provider network as an asset of differentiation for membership growth. On the other hand, patients seek high-quality & timely services at affordable cost that are also easily accessible. Balancing such competing objectives to achieve an optimal network configuration that meets stakeholder expectations is a continuous process. However, with operational activities related to contracting and credentialing dominating the Provider Network Management (PNM) services, improving the efficiency of the networks has taken a backseat.

• AI/ML technologies provide an avenue to holistically analyze provider & aggregate claims data for valuable business insights that can help in increasing network efficiencies. TCS Customer Intelligence & Insights™ for healthcare on AWS is a modular and scalable AI-driven analytics solution that provides optimization and performance management of provider network. The platform enables continuous optimization and performance monitoring that ensures provider networks remain responsive and adaptive to changes, consistently delivering high-quality, cost-effective, and accessible care.

• To increase the coverage of their members, Payer organizations typically create a country wide network of providers that meet varying needs of its members (e.g., from primary care to specialty treatments to home care etc.). Building a network that satisfactorily serves its members and its own business objectives (e.g., competitive challenges, revenue management) even while meeting government and regulatory requirements is a complex task. With thousands of hospitals in network and multiple objectives, it becomes complex to identify the most optimum network for a specific purpose. And this is a continuous process because of the changes that keep happening in the network and business priorities & objectives may change. With time taken in traditional systems, by the time business can conclude regarding optimized network, the data already becomes outdated.

• TCS Customer Intelligence & Insights™ for healthcare on AWS with its AI-enabled provider adequacy model helps payers shift to a high-value network by ensuring the required number of high performing providers is maintained. The provider adequacy model helps reduce both medical costs and the administrative costs of managing the network.

• While Payors are generating tremendous amounts of data, be it claims or provider related, the use of this data for taking critical decisions for optimized provider network requires much to be done. Instead, the PNM teams are saddled with operational activities on contracting & credentialing. Using this data coupled with AI/ML, there is scope for better network performance and continuous optimization through advanced modeling. Particularly with the integration of multi-objective NSGA-II algorithm, that enables the simultaneous optimization of multiple conflicting objectives by generating a diverse set of Pareto-optimal solutions, allowing decision-makers to choose the best trade-offs according to their specific needs. Such a model supported by asset grading and scenario modelling can help asset managers (e.g., Network Manager) take the right decisions in the interest of members.