Member Experience Management Solution Framework by HCL


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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:

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Member Experience Management Solution Framework by HCL

  1. 1. Copyright © 2014 HCL Technologies Limited | HCL – Healthcare Payer Solutions Member Experience Management
  2. 2. 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
  3. 3. 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 Procedure Cost 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
  4. 4. Copyright © 2014 HCL Technologies Limited | www.hcltech.com4 Assess Member Data Health Records Premium Variables Provider Details Subscriber Demographics Claims History 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
  5. 5. Copyright © 2014 HCL Technologies Limited | www.hcltech.com5 Print/ Fax/ PaperOnline CHANNELS Call Center Kiosk Mobile BrokerVideo Chat MEMBER ACQUISITION MEMBER RETENTION MEMBER RECAPTURE Portals CRM Product Selection and Quotes EXPERIENCE Enrollment Member MaintenanceNeed Analyzer HRA SVoC Analytics Member Single View Business Rule Engine Care Management ENABLERS Customer Experience Dashboard Computer Telephony Interface AdaptersDigital Mail Room Campaign Management HCL’s Member Experience Management (MEM) Solution Framework Member Portal Prospect Portal CSR Portal
  6. 6. 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
  7. 7. 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
  8. 8. Copyright © 2014 HCL Technologies Limited | www.hcltech.com8 For Questions, Please Contact:
  9. 9. Copyright © 2014 HCL Technologies Limited | www.hcltech.com9