Healthcare

Hindered by disparate and outdated systems and processes, this healthcare giant struggled with service excellence for its providers and lacked enterprise-wide visibility into their network. Discover how Hitachi Solutions stepped in, guiding them through a transformative journey to unify operations, standardize processes, and harness the power of their data. The result? A centralized solution that boosted productivity, provided valuable insights, and empowered the company to thrive in a competitive industry

Challenge

With millions of managed care members and tens of thousands of employees, this multi-national healthcare conglomerate is a major player in the highly commoditized Medicare Advantage market. Ensuring they attract and retain the best quality providers is how they stay on top in an intensely competitive industry.

However, the company was not operating on a standardized provider management platform and disparate business systems and antiquated processes made managing their more than 30 subsidiaries complicated and costly. Not only did this hinder the provider services team’s ability to offer quick and efficient service, it also prevented the parent company from having visibility into the network and from engaging with providers across all markets.

To better manage their network, the company knew it needed to be able to provide end-to-end service capabilities and ensure seamless communication and collaboration across the enterprise. This meant unifying operations, standardizing and automating processes, and harnessing the power of their data.

Why Hitachi Solutions?

The company had planned to work with a Hitachi Solutions competitor on this project because of an existing business relationship. However, a strategic shift occurred when Hitachi Solutions established our advisory expertise, demonstrated our depth of industry and technical knowledge, as well as showcased our proprietary industry IP. The decision was made to bring in Microsoft as the platform and switch to Hitachi Solutions as the partner of choice.

Our initial focus was on addressing the challenges related to provider services. However, as the project progressed, the company realized the broader potential of Hitachi Solutions’ capabilities. Our customer engagement and rapid solution delivery teams partnered with the customer to deliver a tailored solution built on Microsoft Dynamics 365 and Power Platform that addresses their unique business needs and enables them for future growth.

Solution

To provide a centralized platform for the company’s more than 2,000 users, we implemented Hitachi Solutions’ Engage for Health Plans and Microsoft Dynamics 365 Customer Engagement.

The solution was dubbed Provider 360 and is driven by integration and data. It consolidates data from various other systems and sources, streamlining the process for provider relations representatives and delivering near real-time updates. It also includes data processing, nightly refreshes, and dynamic visual representation of the data.

We also introduced a comprehensive account hierarchy that includes practitioners, groups (facilities), business entities (holding tax IDs), contract entities, and corporate entities. This hierarchy is crucial for managing relationships, affiliations, and data roll-ups, and provides a structured and complete view of all provider information.

Next, we concentrated on efficient tracking, management, and reporting capabilities. Provider 360 addressed the challenges faced by provider relation representatives who traditionally used disparate systems, SharePoint sites, and Excel spreadsheets for tracking. The solution encompassed visit tracking, issue tracking and resolution, performance management, account assignment, and territory management within a unified platform.

 Further enhancing capabilities, the system included Power BI reports and dashboards that provided valuable insights into active cases, aging cases, trends, and percentages. These dashboards were crucial for leadership to manage accounts efficiently and monitor employee usage of the tool. The ability to tier accounts based on health plan priorities and territory management enhanced the user experience and supported strategic decision-making.

Benefits

Leaning in on our advisory capabilities and industry expertise, we were able to increase productivity and efficiency for the customer with a modern end-to-end provider experience — from onboarding through service delivery and contract performance, to issues and complaints. The solution benefits include:

• Automated visit scheduling and improved visit readiness through a single window for data entry and scheduling
• Provided end-to-end visibility and tracking of all provider data and interactions including issue and request tracking
• Offered Outlook integration, mobile application enablement, and Portico lookups
• Improved data insights for enhanced visit readiness, solid visit agendas, and support management reporting of visits

Future

Our ability to guide and advise the customer as they realized their needs extended beyond the scope of a traditional business application was pivotal to the success of this project. Our expertise in advisory, data and analytics, and rapid solution delivery demonstrated the value of our diverse capabilities and ability to evolve as required. We were able to demonstrate we were a strategic partner that is ready for future collaboration.