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CGI - Healthcare Payer BPS

Vendor Analysis

by Sven Lohse

published on May 16, 2019

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Report Overview:

CGI is a public, global IT and BPM company headquartered in Montreal, Canada. The company generated approximately $8.6bn ($11.5bn Canadian) in fiscal year 2018 (ending December 2018).

Who is this Report for:

NelsonHall’s profile of CGI’s Healthcare Payer Business Process Services (BPS) is a comprehensive assessment of service offerings and capabilities designed for:

  • Sourcing managers monitoring the capabilities of existing suppliers to deliver business process services to healthcare payers
  • Vendor marketing, sales and business managers looking to benchmark themselves against their peers
  • Financial analysts and investors specializing in the support services sector.

Scope of this Report:

The report provides a comprehensive and objective analysis of CGI’s offerings, capabilities, and market presence in support of business process transformation through the application of healthcare payer BPS including the company’s:

  • Offerings and key service components
  • Delivery organization
  • Customer base, including the company’s targeting strategy and examples of current contracts (where available)
  • Revenue estimates for healthcare payer BPS
  • Strategy, emphasis and new developments in support of healthcare payer BPS
  • Strengths and weaknesses.

Key Findings & Highlights:

CGI is a public, global IT and BPM company headquartered in Montreal, Canada. The company generated approximately $8.6bn ($11.5bn Canadian) in fiscal year 2018 (ending December 2018).

NelsonHall estimates that CGI payer BPM revenue from commercial clients in calendar year 2018 was approximately $66m. NelsonHall estimates that revenues from government clients over calendar year 2018 were approximately $20m.

Distinctive elements of CGI’s payer BPS practice:

  • Claims administration, especially document management
  • Payment integrity/FWA (CGI combines software IP and service capabilities in its Protect the Payer offering)
    • Appeals, recovery audit, third party appeal review for other services, reimbursement consulting, and benchmark analysis
    • CGI’s ProperPay rules engine (with HotScan filtering software and cybersecurity solutions) was initially developed to identify fraud, waste, and abuse in U.S. federal government, but is now also offered to U.S. commercial clients
  • Population health management – CGI’s CGI CommunityCare360 supports home health monitoring, care planning, and workforce and ambulance dispatch
  • Health information exchanges – customer service and enrollment
  • Healthcare analytics - Healthcare Enterprise Optimization is an innovative modeling and analytics solution supported by services.

Table of contents:

Table of contents:

  • Introduction and Strategy
  • Offerings and Capabilities
  • Delivery Network
  • Clients
  • Strengths and Challenges

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