After Exchange Launch--Preparing for 2015
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After Exchange Launch— Preparing for 2015 November 20, 2013
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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.
Transcript of After Exchange Launch--Preparing for 2015
After Exchange Launch—Preparing for 2015
November 20, 2013
2 Services
What Does Dell know about Health Plans?
3 Confidential Services
Dell’s Solutions for Health Plans
Applications
• Claims Platforms
• CRM
• HIX Connector
• Member Portals
• Health Plan Informatics & Data integration (Quality Measures, Operational Metrics, ACOs)
• Mobility and Social Media
Business Process Outsourcing
• Operations (Claims/Enrollment/ Customer Service)
• Claims Administration
• Health Insurance Exchange (HIX)
• System Conversion (Selection/Implementation / Data Migration)
• ikaSystems BPO Practice
Infrastructure
• 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.)
Security
• HIPAA Security
• HIPAA Privacy
• Credit Card Security
• Penetration Testing
• Disaster Recovery
Strategic Services Consulting
• Data Quality Assessment • ICD-10 Assessments
• HIX Assessment
• Business Process Optimization
• Commercial Insurance Exchange Support
• ALR/MLR Compliance Strategies
4 Confidential Services
Planning for 2015
5 Services Confidential
Heath Plans Have a Lot On Their Plates
5 Star… Achieve Best-in-Class
Consumerism
Medical Management
Reduce Administration and medical cost and achieve Medical Loss Ratio
UM/CM/DM strategies and tools that drive best in class member wellness
Revenue Optimization
FWA, Coding review, ICD -10 COB, Subrogation
Member and Provider Engagement
Outcomes based compensation for the providers
Incentivize
Mobility, Web Stores, Call Centers, Retail Outlets…One view of the customer
6 Services
No. 1 Social Brand on the Social Brands 100 List.
ITSMA Marketing Excellence Award for Generating / Nurturing Leads and Marketing with Social and Interactive Media. Red Cross co-
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.
7 Services Confidential
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
8 Services
2013 Has Been a Disaster for Health Care Consumers…
9 Services
…Or Has It?
10 Services
The front end should be easy…
…it’s the back end that’s hard
11 Services
The Front End Should Be Easy…
…But It’s Not
12 Services
Consumer Engagement Today…
Brick & Mortar Retail (Service)
Traditional
(phone / paper / HR / Agent
Portal)
CR
M
Me
mb
ersh
ip
Care
Mg
mt
Cla
ims
Etc
.
13 Services
Infrastructure / Cloud
Hardware/Devices
Applications / CRM
Business Operations
IT Operations
Testing
Security & Compliance Inte
gra
tio
n A
na
lytic
s / BI
Retail Traditional
Digital
Consumer • Full • Temporary • Kiosks
• Agent/HR • Phone • Paper
• Portal • Mobile • Social Media
• 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
…And Tomorrow
14 Services
Digital Tools—Portals, Mobile, Social
15 Services Confidential
Health Plans’ Growing Retail Presence
Customer Service Enrollment changes (family adds, etc.) Claims questions, premium payments
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
Health & Wellness Health risk assessments & screening Individual/group education classes
16 Services
Retail & Remote Health—Meeting Members Where They Are
17 Services
The front end should be easy…
…it’s the back end that’s hard
18 Services
A Consumer Driven System, But With No Connected Systems
Medical Management
Core Administration
Membership
Web Portal / CRM
?
Chaos & confusion
Inconsistent messaging
Incoherent timing
Incomplete &/or inaccurate information
19 Services
Member Portal
Employer Portal
Provider Portal
Patients
We
b S
erv
ice
s L
ay
er
for
Mo
bil
e A
pp
s
Web Services/API
DEVICE Web Services/API
KIO
SK
CSR
MEMBER App
Tablet iPhone
iPad
Android
PROVIDER App
Tablet iPhone
iPad
Android
Integration Is the Key
20 Services
Where Do We Go From Here?
21 Services
Step 1: Begin With the End in Mind
22 Services
Step 2: Leverage What You Have
23 Services
Step 3: Extend Beyond Your Control
24 Services Confidential
Imagine…
The right partner that provides a unified roadmap – an end-to-end solution – to provide sustainable transformation to you
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 reform-driven changes
A member engagement strategy that provides a consistent experience and door for everyone to come through
Dell: The power to do more
