Catalyst Solutions
Igniting a New Wave of Efficiency for Health Plans

The new government mandates coupled with the unprecedented rate of mergers, acquisitions, and partnerships in the healthcare sector pose significant challenges for the existing health plans. In addition, the legacy platforms fail to offer accuracy, speed, and low auto-adjudication rates. An abundance of custom code is often used to offset platform shortcomings, but these solutions sometimes create more problems than they solve – including a constant cycle of manual and costly upgrades and code remediation. Furthermore, increasing threats around cybersecurity are of great concern, given the sensitivity of PHI.

This is where Catalyst Solutions steps in.

With over two decades of experience in the healthcare industry, Catalyst has a deep knowledge of payer technology and payer operations. The company has commoditized the processes of what plans refer to as the back-office (e.g., claims, configuration, call center, enrollment) and the mid-office (e.g., Provider/Network Management, Clinical Management, Data/ Analytics, Information Technology). “This specialization allows us to perform these activities more cost-effectively and leverage our economies of scale to best meet the unique business needs of clients,” says Scott Martin, President, Catalyst Solutions.

Catalyst’s BPO services have been designed from the ground up to help healthcare payers enhance product offerings while increasing market share, improving outcomes for members, and eliminating talent shortages. On the back-office side, the company provides services pertaining to claims, member/ provider call center, enrollment, and print/mail/fulfillment/ document management.

In the clinical operations space, Catalyst’s BPO helps healthcare plans expand health management services, to prevent health issues from escalating through proactive identification, engagement, and management of at-risk individuals. This creates a foundation for health payers to meet larger strategic goals. Using a BPO frees up resources to focus on clinical innovation and establishing new outreach services that better engage consumers and providers to improve health outcomes.

Catalyst’s core focus is on providing commodity service, which allows it to achieve scales of economy that a plan cannot. With a higher volume of operational work, it has built workforce resiliency that addresses staffing shortages and turnover while negating the cost of shrinkage and downtime. Catalyst is also known for its talent acquisition capabilities to identify, recruit, and retain the right talent. The company offers highly specialized training functions that help create a level of expertise that a health plan cannot replicate. Its trainers are experts in adult learning theory, instructional design, and classroom facilitation. Catalyst also offers offshore/nearshore resources as offshore support can be beneficial for payers seeking lower costs.

Catalyst is driven by the philosophy that success in any BPO relationship is built on collaborative partnerships. That’s why the company strategically engages with clients and maximizes the performance of its health plan by taking a holistic view of people, processes, and technology. This enables Catalyst to deliver tangible results – hard dollar cost savings, cost avoidances, and enhanced revenue streams.

The company has also made a significant investment in Machine Learning to process claims faster with few errors, match authorizations to claims, maximize audit capabilities, and reduce fraud, waste, and abuse. In a clinical capacity, clients can use predictive algorithms of past claim activities to identify future risks, thereby minimizing health risks for members and preventing adverse medical events. “Our customers find that the initial cost savings are significant, but the benefits go beyond outsourced labor,” says Martin.

Catalyst has refined and optimized its processes to ensure repeatability and high-quality consistency. The company continues to deliver on this promise owing to its skilled team who have previously worked for healthcare payers. Their experience gives Catalyst a distinct advantage of comprehending the challenges health plans face and minimizing those issues via its BPO services.

“The Catalyst team is truly passionate about our mission to help plans focus on what really matters: making healthcare affordable and accessible, and improving lives by making people healthier,” concludes Martin.