Establishing a member-centric circle of care
Health plan members and care providers are increasingly frustrated in their search for an integrated, seamless experience that offers clear communication and guaranteed confidentiality. Without it, they are hindered in making informed healthcare decisions. Here are some of the obstacles that aggravate dissatisfied members and providers:
- Inability to access the information they need, when they need it, from any location, on any device
- Difficulty in performing simple tasks on web-based or mobile platforms
- Inaccessibility of crucial claims, benefits and prescription information
- Numerous calls with call center agents that do not resolve issues or provide answers
- Continual delays and confusion regarding claims, payments and benefits
Understandably, members and care providers have increasing expectations when working with health plans. It is vital to overcome these challenges and provide a better-than-expected experience. This will ensure health plans retain members and care providers.
Historically, patient data has resided in separate systems, so medical history, claims and payment records have not been available in a single view. However, it is now possible to obtain a 360-degree view of each health plan member — from lifestyle to medical and payment history — and health plans can dramatically tap the value of this rich data to improve both the member and provider experience.
A digital BPaaS solution integrates disparate systems to boost a health plan's agility and efficiency by consolidating IT and customer management processes on a single platform. In addition, automating workflows solves burdensome claims backlogs by enabling faster, more accurate claims processing for members and more immediate payment providers.
NTT DATA's Digital Member and Provider Engagement Platform offers a flexible architecture that can adapt to future technology. The infrastructure, platform, and applications of this improved technology ecosystem then drive better business outcomes by helping health plans easily access and use data that formerly resided in separate silos, enhancing the plan's operations' speed, accuracy, and efficiency. In addition, the tight integration of people, processes and technology drives the member and provider experience and delivers better customer service by:
- Enabling better member and provider communications
- Improving overall data management
- Streamlining payment processes
- Stabilizing and strengthening the plan's provider network
Optimizing and modernizing applications and automating processes to improve accuracy and reduce claims processing time helps health plans achieve goals, such as:
- Increased membership growth
- Enhanced competitiveness amongst health plans
- Dramatically increased savings on application support and maintenance
- Quality-based reimbursement to care providers
Our solution's fully integrated core platform, which is driven by data analytics, AI and best-in-class business processes, empowers health plans to:
- Increase operational efficiency
- Drastically reduce administrative costs
- Maximize ROI
- Reduce penalties
- Increase rating scores
- Proactively reduce fraud
- Identify leakage
- Improve member engagement
Members love the support
Our Digital Member Engagement Platform starts with making the enrollment process easy for new members and eliminating frustration and friction at the outset. Once enrolled, members can communicate questions and concerns in a secure communications pathway that timestamps each notification. Members receive a timely acknowledgment and, shortly after that, a status update in the same secure environment, which alerts them when the issue is resolved or specifies the need for more information. Often no follow-up phone call is required, reducing calls to the call center and saving costs.
Members also receive news, as well as targeted content embedded with a Mayo Clinic-sourced educational element. For example, a pre-diabetic member can be tied to FitBit via the member mobile app, and their FitBit data is automatically conveyed to their provider. In addition, the member feels reassured by a custom-tailored plan when the plan recommends health-supporting suggestions, such as walking 10,000 steps a day. The plan can even offer gift certificates for valued items as rewards for healthy behaviors.
If a member requires surgery, their PCP can flag a referral for a specialist in the system, and the plan reaches out with names of high-quality specialists so the member can compare costs or get a second opinion. Our Engagement Platform also includes treatment calculator functionality that enables members to see the impact on benefits and the average cost of treatments with specific care providers and specialists.
Members also benefit from the latest analytics and AI capabilities in a mobile app that offers chatbot convenience. For example, the chatbot automatically recognizes when to redirect a member to a customer service representative, if necessary.
NTT DATA's Member Engagement Platform also considers social determinants of specific member populations. For example, identifying members who rely on public transportation or live in food deserts helps the plan offer bus passes or referrals to food pantries to reduce the incidence of skipped appointments and eliminate barriers to healthful dietary changes. Our solution creates a persona using empathy mapping that encompasses the member's living circumstances, background, age, education and economic situation, so the plan can also offer telemedicine alternatives when appropriate. As a result, members feel supported rather than frustrated.
Providers love the convenience
Healthcare providers have historically been reluctant to adopt health plan portals because they can be difficult to navigate and cumbersome for staff to use. However, our Digital Provider Platform is easy and intuitive and serves as practical support for the clinical practice: it securely integrates claims submission, eligibility, authorization, and referral information. It requires fewer "clicks" from busy clinical staff.
Our solution also enables staff members to update information originally entered by others on the healthcare team. As a result, they can easily access the information they need while feeling confident about its accuracy. This "user friendliness" ensures that they will actually engage with the solution and work more collaboratively with the health plan to benefit the plan members.
Providers have felt the frustration of slow-pay issues, so they love the added efficiencies of a solution that pays them faster. Additionally, our solution ensures that a provider can quickly become credentialed with the health plan, smoothing the onboarding of new physicians. Doctors can also keep their information current, ensuring that the plan's provider directory is reliably up to date.
In short, the same information can now be available to all constituents — the health plan, members and providers. Access to accurate, updated information is faster than ever before, creating efficiencies that were never possible until now. Both members and providers feel a higher level of satisfaction with the health plan.
Learn more about the 360-degree delivered by NTT DATA's Digital Member and Provider Engagement Solution.
Post Date: 6/29/2021