What should health plans be doing to prepare for 2015 after the launch of Heath Insurance Marketplaces? Delivered at AHIP Operations and Technology Forum, November 20th 2013, by Andy Arends, Managing Principal, Dell Services.

1. After Exchange Launch—
Preparing for 2015
November 20, 2013

2. What Does Dell
know about
Health Plans?
2
Services

3. Dell’s Solutions for Health Plans
Applications
Business Process
Outsourcing
Claims Platforms
CRM
HIX Connector
Member Portals
Health Plan Informatics &
Data integration
(Quality Measures,
Operational Metrics,
ACOs)
• Mobility and Social Media
• Operations
(Claims/Enrollment/
Customer Service)
• Claims Administration
• Health Insurance
Exchange (HIX)
• System Conversion
(Selection/Implementation
/ Data Migration)
• ikaSystems BPO Practice
•
•
•
•
•
Strategic
Services
Consulting
3
Confidential
• Commercial Insurance
Exchange Support
• ALR/MLR Compliance
Strategies
Infrastructure
Security
• IT and Data Center
Outsourcing
• Infrastructure Consulting
• Hosting Services in Cloud
(Claim System, Analytics,
Virtual Desktop)
• IT Modernization
(Infrastructure
Consolidation, IT Portfolio
Rationalization, Application
Re-engineering, Platform
Migration etc.)
•
•
•
•
•
• Data Quality Assessment
HIPAA Security
HIPAA Privacy
Credit Card Security
Penetration Testing
Disaster Recovery
• ICD-10 Assessments
• HIX Assessment
• Business Process Optimization
Services

4. Planning for
2015
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Confidential
Services

5. Heath Plans Have a Lot On Their Plates
Reduce
Administration and
medical cost and
achieve Medical Loss
Ratio
5 Star…
Achieve
Best-in-Class
Member and Provider
Engagement
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Confidential
Consumerism
Medical
Management
Mobility, Web Stores,
Call Centers, Retail
Outlets…One view of
the customer
UM/CM/DM strategies
and tools that drive
best in class member
wellness
Incentivize
Outcomes based compensation
for the providers
Revenue
Optimization
FWA, Coding review, ICD 10 COB, Subrogation
Services

6. No. 1 Social
Brand on the
Social Brands
100 List.
ITSMA Marketing
Excellence Award
for Generating /
Nurturing Leads
and Marketing
with Social and
Interactive
Red Cross coMedia.
won the 2012
Digital PR Team
of the Year
from the PR
News Digital PR
Awards for their
social media
humanitarian
and digital
fundraising
efforts.
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Services

7. What is “health care consumerism?”
“a movement that encourages individuals
to become more involved in and take more
responsibility for making smart health care
decisions, managing their health benefits
dollars and maintaining their overall health
status.”
http://www.planforyourhealth.com/resources.dyn/glossary.html
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8. 2013 Has Been a Disaster for Health Care
Consumers…
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9. …Or Has It?
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10. The front end
…it’s the back
should be easy… end that’s hard
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11. The Front End Should Be Easy…
…But It’s Not
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12. Consumer Engagement Today…
Traditional
Brick &
(phone /
Mortar
paper / HR
Retail
(Service) / Agent
Portal)
Etc.
Claims
Care Mgmt
Membership
CRM
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13. …And Tomorrow
Traditional
Retail
• Full
• Temporary
• Kiosks
•
Digital
• Portal
• Mobile
• Social Media
Applications / CRM
Integration
•
• Agent/HR
• Phone
• Paper
Business Operations
IT Operations
Security & Compliance
Testing
Hardware/Devices
Infrastructure / Cloud
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Services
Analytics / BI
Single view of the member
Greater member engagement
Increased self-service
Enhanced health and wellness
experience
Initial sales & cross-selling of
additional products (e.g., voluntary)
Future-proof platform
•
•
•
•
Consumer

14. Digital Tools—Portals, Mobile, Social
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Services

15. Health Plans’ Growing Retail Presence
Basic Retail
General inquiries
Purchasing Individual and MA products
Enhanced Retail
Voluntary products (dental, vision, life, etc)
“Pop-ups” targeted at specific venues, etc.
Cultural/linguistic-tailored support
Customer Service
Enrollment changes (family adds, etc.)
Claims questions, premium payments
Health & Wellness
Health risk assessments & screening
Individual/group education classes
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Services

16. Retail & Remote Health—Meeting Members
Where They Are
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17. The front end
…it’s the back
should be easy… end that’s hard
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18. A Consumer Driven System, But With No
Connected Systems
Medical
Management
Membership
Incomplete &/or
inaccurate
information
Incoherent
timing
?
Inconsistent
messaging
Chaos &
confusion
Core Administration
Web Portal /
CRM
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19. Integration Is the Key
Web Services/API
DEVICE Web Services/API
Member Portal
CSR
KIOSK
Web Services Layer for Mobile Apps
Employer Portal
Patients
MEMBER App
Tablet
Android
iPhone
iPad
Provider Portal
PROVIDER App
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Tablet
iPhone
Android
iPad
Services

20. Where Do We
Go From Here?
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21. Step 1: Begin With the End in Mind
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22. Step 2: Leverage What You Have
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23. Step 3: Extend Beyond Your Control
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24. Imagine…
A member
engagement strategy
that provides a
consistent experience
and door for
everyone to come
through
Actionable insights
to know when to
offer the right
product(s) at the
right time while
driving retention &
healthy outcomes
A solution that easily
adapts to reformdriven changes
The right partner that
provides a unified
roadmap – an endto-end solution – to
provide sustainable
transformation to
you
Dell: The power to do more
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25. Thank you
Andy Arends
andrew_arends@dell.com
630 708 2521
@Andy_Arends