Dan Jimmerson

Director of Marketing

Wag-the-Dog: Cloud Players to BPO Patrons – Yes, You Can In-Source Your Claims Processing

PACE Organizations of All Shapes and Sizes Have an Affordable Option to Conduct Their Business and Technical Operations Efficiently and Cost-Effectively

Ashland, Oregon, October 12, 2012 – Business process outsourcing (BPO) can very effectively lower operational costs or quickly achieve scale in response to market or regulatory changes through the use of shared infrastructure and labor arbitrage. The problem lies in the hidden expense of giving up native control and use of meaningful information – among other things, says Mace Wolf, CEO of Cognify, Inc. With cloud solutions coming into their own, healthcare software product companies such as PLEXIS Healthcare Systems of Ashland, OR, are partnering up with boutique tech players like Cognify of Laguna Beach, CA, to deliver comprehensive claims processing infrastructure available by cloud.

Through a recently formed partnership, PLEXIS and Cognify together will offer the world class PLEXIS Claims Manager (PCM) application to Programs of All-inclusive Care for the Elderly (PACE – a unique Medicare capitated managed care benefit program for the frail & elderly provided by a not-for-profit or public entity), via Cognify’s cloud services and specialized consulting. “We are enamored by the prospect of building an extremely affordable high-tech solution set for PACE plans, and by the rapid onboarding that will be available for these groups as a result”, says Bart Rupert, COO of PLEXIS Healthcare Systems. By outsourcing only the technology component to Cognify’s cloud, any sized PACE company – large or small, can now achieve scale, reduce costs (especially those related to up-front hardware and software procurement), and meet compliance requirements for years to come.

Outsourcing is a well proven strategy used by management to achieve a wide range of business goals with the pull of one lever. The question is, do you outsource the entire process or do you acquire on-demand, automation tools to retain control and flexibility while still greatly reducing the effort and thus, the cost of the process? Cognify says, the latter and they call it Strategic IT. PLEXIS’ PCM product is a key ingredient for PACE programs to automate their claims administration and ensure proper provider reimbursement while achieving a 360-degree view of services rendered to the participant/patient. What’s more, adds Wolf, ”We can mash-up that information with cost and quality data from other sources to provide a sophisticated view of the entire business that is rarely achieved at most Fortune 500 companies.


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