Member Experience Management Solution Framework by HCL
9
Copyright © 2014 HCL Technologies Limited | www.hcltech.com HCL – Healthcare Payer Solutions Member Experience Management
-
date post
18-Oct-2014 -
Category
Business
-
view
293 -
download
0
description
The healthcare payer industry is in transition. Payers must deal not only with the rising costs of delivering care to their members but also with figuring out how to serve an influx of new members while keeping administrative costs below the appropriate medical loss ratio (MLR) thresholds. To succeed, payers must adopt a customer-centric approach, to deliver a consistent and differentiated experience to their existing and prospective customers across all channels of interaction. HCL has created a comprehensive analytics driven framework to help health plans offer a differentiated experience to their existing and prospective customer base. The componentized solution which is available on the cloud will help a plan to quickly scale up to address the demand on their IT technology and infrastructure while providing the flexibility to choose the modules that can complement their existing systems. Gain scalability with HCL’s flexible, adaptable and agile enterprise IT, Infrastructure & BPO combined “Campaign as a Service” program services for members. To know more, please visit: http://microsite.hcltech.com/gainwithchange/40-million-new-members.asp
Transcript of Member Experience Management Solution Framework by HCL
Copyright © 2014 HCL Technologies Limited | www.hcltech.com
HCL – Healthcare Payer Solutions
Member Experience Management
Copyright © 2014 HCL Technologies Limited | www.hcltech.com2
Healthcare Payer Market Drivers – Managing Member Experience is an Important Component
Adopt best practices from B2C industries like banking, retails etc
Customer segmentation
Risk identification and mitigation
Innovative product development
Update IT infrastructure to handle influx of members
Achieve operational efficiencies
Healthcare Reform
Consumerization Of
Healthcare
The Bottom-line for Health Plans
Influx of Member with Higher Risk
Profiles
Customer Experience
Management
Market expansion to include large pool of uninsured customers (approx 40 million)
MLR minimum of 80% (small group / individual) and 85% (large group)
Shift in responsibilities for financial & health management to individuals
Super consumers - seeking independent information
5% of population utilizes over 50% of healthcare spend
Over 50% of population utilizes only 3% of healthcare spend
Chronic diseases contributing to 65% of healthcare expenditure
Shift from B2B to B2C model driving focus on customer experience
Low CEM scores relative to other industries
Copyright © 2014 HCL Technologies Limited | www.hcltech.com3
Member Experience as we see it….
Mobile
Broker
Mobile
Call Center
Online
Online
Online
Call Center
Mobile
Social Media
Health Risk Assessment
ProcedureCost Estimates
Comparative Shopping
Cost/Utilization History
Interaction Tracking
Cost / Quality Data
Segmentation
Communication Participation
Patient ActivationSegmentation
Communications
Outcomes
Triggers / Alerts
Triggers / Alerts
Marketing
Need Analysis
Marketing
Health Literacy
ANALYTICS
Acquisition
Retention
Health and
Wellness
Care Management
Copyright © 2014 HCL Technologies Limited | www.hcltech.com4
Assess Member Data
HealthRecords
Premium Variables
Provider Details
Subscriber Demographics
ClaimsHistory
HCL Point of View: Member Experience Management
Retention Prospect
Recapture Prospect
Acquisition Prospect
Driving Focused Target
Programs through
Preferred Channels
MEMBER DATA ASSESSMENT
&CUSTOMER MANAGEMENT STRATEGY
HUC VALUE BASED MEMBER SEGMENTATION DRIVING MEMBER EXPERIENCE
Copyright © 2014 HCL Technologies Limited | www.hcltech.com5
Print/ Fax/ PaperOnlineCH
AN
NE
LS
Call Center Kiosk Mobile BrokerVideo Chat
MEMBER ACQUISITION MEMBER RETENTION MEMBER RECAPTURE
PortalsCRM
Product Selection and Quotes
EX
PE
RIE
NC
E
Enrollment
Member MaintenanceNeed Analyzer HRA
SVoC
Analytics
Member Single View
Business Rule Engine
Care Management
EN
AB
LE
RS
Customer Experience Dashboard
Computer Telephony Interface
AdaptersDigital Mail Room
Campaign Management
HCL’s Member Experience Management (MEM) Solution Framework
MemberPortal
ProspectPortal
CSRPortal
Copyright © 2014 HCL Technologies Limited | www.hcltech.com6
Multi channel communication for segmented population
Leverage the HUC score to group/segment members to enable
care and mass customization
Provides holistic information about individual members and acts as input for
HUC analysis
Based on the value derived from HUC, per member details on health risk,
utilization and cost is derived
Analytics to drive care and customer engagement
Stage 1 – Risk Assessment & Customer Identification
High Risk Profiles
Moderate Risk
Low Risk
Segmented member
information is fed into analytics
system
Customized Experience is enabled with
Segmentation
Stage 2 – Customer Segmentation
Per member HUC score is being used to define a population/group (members
with similar HUC scores will form a group)
Stage 3 – Facilitate Care Management for segmented population
Copyright © 2014 HCL Technologies Limited | www.hcltech.com7
HCL Solution – Key Differentiators
REDUCED TOTAL COST OF
OWNERSHIP
TECHNOLOGY AGNOSTIC
QUICKER GO TO MARKET
ENHANCED DECISION MAKING
SUPPORT
Analytical capabilities through Comprehensive Reports & Models
Considerable Reduction in Cost when compared to building the solution grounds up
Predefined metrics, reports, statistical models & dashboards
Predefined data model and computations
Adapters to adjudication platforms like FACETS
Being technology agnostic can be deployed on customers’ existing reporting and modeling tools/technology
Copyright © 2014 HCL Technologies Limited | www.hcltech.com8
For Questions,Please Contact: [email protected]
Copyright © 2014 HCL Technologies Limited | www.hcltech.com9
![2813. Hr Policies in Hcl at Hcl Cdc , Noida [Hr]](https://static.fdocuments.in/doc/165x107/577cc9911a28aba711a414a9/2813-hr-policies-in-hcl-at-hcl-cdc-noida-hr.jpg)
