“We were in a rapid growth phase, and ikaSystems has acted as a very effective partner by helping us achieve this without increasing our staff strength, providing the seamless and efficient functionality of the portals.”

Chris O’Connor, CFO, Freedom Health, St. Petersburg, FL

ikaEnterprise for
the Medicare Market

One Integrated, Web-Based Solution
to Fuel Rapid Growth

Medicare growth and product development are among payers’ and policymakers highest priorities. The U.S. Department of Health and Human Services estimates that the number of Medicare-eligible beneficiaries will total 50.4 million by 2014, up from 43.1 million in 2008.

As they develop, market and service Medicare Advantage products, payers must constantly monitor and conform to regulatory requirements, improve operational efficiencies, reduce administrative costs, and ensure delivery of highly coordinated care to this demographically challenging population to contain medical costs.

Winners in this market must have systems that closely align with Medicare beneficiaries at all points in the continuum, from product design and marketing through sales and enrollment to proactive care collaboration between members, providers, purchasers and payers. Such systems must allow health plans to act with speed and agility to maximize the market opportunity while minimizing the risk of a demanding population and complex regulatory requirements.

 

Create a Highly Intelligent and Effective Organization

ikaEnterprise automates all key processes in the Medicare business cycle, combining business intelligence and transactional systems for sales automation, core claims adjudication, care management and proactive quality measurement and reporting with self-service portals for sales, administrative, employer, member and provider use. The result is an end-to-end, fully Web-deployed solution for process automation and intelligence management.

Using our agile, modular technology, payers can create a single intelligent ecosystem — comprising health plan staff, members, providers and brokers — that feeds on the same real-time information and fluidly responds in a way that benefits the ecosystem as a whole.

Build Your Own Solution

ikaEnterprise modules can be implemented one at a time or all at once, helping health plans better manage IT expenses and develop their confidence in ikaSystems as a technology partner while delivering increasing value. With ikaEnterprise, you can innovate at your own pace and create your ideal solution.

For the Medicare market, ikaEnterprise offers solutions in the following areas:

Sales
 		 ikaSales is a comprehensive suite of integrated marketing and sales force automation tools that also encompasses electronic billing and commission payment.
 
Portals
 		 ikaPortals provide self-service capabilities for sales, members, providers and health plan administrative staff.
 
Claims
 		 The ikaClaims solution suite empowers health plans to turbo-charge all of their claims administration activities or to extend their existing IT investments by adding on high-performance functionality.
 
Medicare
 		 ikaMedicare solutions automate the complexity of CMS data exchanges, delivering greater accuracy and speed to member enrollment, member/payment reconciliation, diagnostic reporting and care coordination. 
 
Medical Management
 		 ikaMM’s integrated medical intelligence and management solutions proactively measure and act to improve quality, utilization, satisfaction and regulatory reporting.