Health Plans & Providers

Meet Steve

He is a member services representative who is the trusted face of the company. His role as the go-to for all member questions helps ensure satisfaction, retention, and revenue. But Steve’s members expect a robust, personalized experience focused on their convenience. If he is unable to show them this value, they will go elsewhere, and the call center ends up being a cost center instead of a revenue generator.

Steve wants to create a trusted and personal connection with members
He juggles up to 10 different applications and tools while trying to stay focused on answering questions and creating a personalized engagement. It makes him inefficient, disconnected, and unable to be proactive to member needs. Steve’s leadership needs to modernize technology to automate the call center and empower him with a single, complete view of his members so he can gain the insights he needs to improve interactions across all touchpoints and channels. Speaking of channels, Steve handles inquiries across multiple, which makes it challenging to manage the volume of questions he receives and respond to things in a timely manner. To ensure that each member receives the care and attention they’ve come to expect, Steve needs a more efficient approach — ideally, one that enables him to offload low-level inquiries and dedicate his focus to solving more complex challenges.

Digital transformation is the key
Technology such as Microsoft Dynamics 365, Power Virtual Agents, Power Apps, AI, and analytics give him the visibility he needs to get to know members better and help him predict their needs and wants.

Meet Susan

She’s a health plan sales manager who wants to enable brokers to do what they do best — sell her products and grow the business to better meet the members needs. But the company’s disparate systems and manual processes are costly and slowing them — and her — down. They can’t easily access the information they need to provide their clients with timely and accurate quotes. So, instead of focusing their energy on quoting her offerings and finding her new clients, they help her competitors.

Susan wants to empower brokers and improve the quote-to-card-experience.
But to do this she needs to ditch her old legacy systems and implement a single cloud-based sales and service automation solution for connecting, communicating, and collaborating with her agents. This technology transformation is the most cost-effective way to modernize the quote-to-card experience for small group insurance, large group insurance, ASO, individual insurance and more.

Modernization drives success
Centralizing systems, automating processes, providing self-service portals, and moving to the cloud will simplify and speed operations and improve data accessibility, consistency, and accuracy. Now, with her team more informed, independent, and responsive, Susan is free to focus on other revenue-generating tasks.

Meet Jay

Jay is a director of provider management who’s dedicated to ensuring that providers have a positive experience with his insurance company so that they’ll renew their contracts. This involves staying on top of ever-changing plan policies, codes, regulations, and contracts to reduce unnecessary billing, denied claims, grievances, and administrative complications.

Ultimately, Jay’s job is all about helping providers work with carriers to service members in a frictionless way. However, not having the right tools to access high-quality provider and member data; optimize credentialing, onboarding, and other management processes; and easily communicate with the network makes his job a struggle.

Jay wants to be more efficient and cost-effective
Modernizing core systems into a single cloud-based solution with centralized data, automated workflow, collaboration tools, and provider portals will give him the continuous transparency he needs to manage accounts and enhance communications and knowledge transfer between his team and the network, thereby creating a better overall provider experience.

Game-changing technology
Through digital transformation Jay will be able to simplify and speed processes, have easy access to comprehensive data, increase collaboration, and improve communication with providers. He’ll also be able to track and manage his team’s performance and activities in real time — all from a personalized dashboard. Optimizing credentialing, onboarding, and other management processes will increase efficiency, reduce costs, and improve the relationship between carrier and provider.

Meet Taylor

As the Digital Transformation Officer of their company, Taylor is tasked with identifying opportunities to enhance efficiency and streamline business operations using digital solutions. They’ve been given a sizeable budget to devote to digital transformation initiatives but needs to find a way to spend it wisely so that their company receives the greatest possible return on its investment.

Taylor wants to move their company into the future.
But they sometimes struggle to find the right approach. While certain projects, such as member service initiatives, have an immediate and apparent value proposition, they know that they also offer marginal returns relative to the size of the investment. In order to make smarter, more impactful decisions when allocating spend, Taylor needs visibility across the entire organization — something they currently does not have.

Data shows the way
By choosing to invest a small percentage of their digital transformation budget n data science, Taylor can access valuable insights into everything from what pain points different departments are experiencing and where there are hidden operational inefficiencies to which market opportunities are most lucrative and where their company stands relative to competitors in the field. Armed with this information, Taylor can make more informed decisions, identify high-impact opportunities, and strategically invest in initiatives that optimize existing business processes, deliver competitive advantages, and enable their company to adapt to the ever-changing industry and technological landscapes.

Meet Martha

She’s a home health provider who is charged with helping patients recover where she is most comfortable, at home. But because her hospital’s systems are not connected and processes are manual, she wastes a lot of time checking her schedule, reviewing appointment details, traveling, and documenting her tasks.

Martha wants to be more responsive
By replacing its disparate systems and manual processes with intelligent healthcare management, Martha will now have optimized scheduling and routing, access to real-time patient data and communications, and visibility into the entire process — all from her mobile phone.

Ripe for digital transformation
Transforming home health operations, processes, and scheduling with CRM, connected field service, advanced analytics, and other modern solutions provides a huge opportunity for Martha to boost her efficiency while reducing costs. Analytics provide her with insights about the patients so that she can offer a more personalized experience.