Transforming healthcare brokers with portal and mobile solutions

Transcription

1 Transforming healthcare brokers with portal and mobile solutions

2 Healthcare payers typically interact with four key external stakeholders: providers, employers, members and brokers. Amongst these external entities, the brokers play a critical role to generate and sustain new businesses for the payers. Until today, the interactions between payer and brokers where primarily driven limited to lead generation, quoting, commission processing and renewals. However, with the universal healthcare reform initiatives the role of brokers has been transforming into change agents with the responsibility of not only educating the prospective members but also fasten the process of insuring clients. Internet and Mobile technologies for brokers will play a critical role not only in increasing the customer base of payers, but also enable to provide quick turnarounds to any form of member requests. 1. Current Scenario Though the need for the cutting edge broker portals has been increasing, many payers till rely on centralized quoting, paper based enrollment and payer driven membership renewal processes. All of these are time consuming, inefficient and manual in nature. In this scenario, Broker portals for a healthcare payer can become an important conduit to enhance and improve customer satisfaction and generate more business. To provide up-to-date information to clients and speedup the process of lead generation into actual enrolment, brokers are increasingly looking at technological avenues including internet and mobile technologies. To meet this gap, healthcare payers also have traditionally relied on internal home-grown applications or products customized to their needs. HCL healthcare team did a research on about 180 US healthcare payers of various revenue sizes to verify the usability of broker portals. Many of them still do not have a dedicated portal to meet the need of the broker community. Amongst many payers with existing broker portals, the functionality is typically limited to online quoting and commission statements. 2

3 2. HCL Solution HCL provides a comprehensive web portal and mobility solution that will provide best in class and comprehensive features to enable brokers in engaging sales end customers in efficient and cost effective manner. Our proposed framework formulates the solution by breaking down the broker activities in the following 5 life cycle phases. Our solution is unique in a way that it not only integrates all the important life cycle activities for a broker to generate and sustain sales leads, but also manages the member relationship via benefits administration features. Product Selection Quoting Renewals Account Management Enrollment The proposed solution brings about the portal and mobile driven functionalities that will automate and speedup many of the standard broker activities. It will provide an all encompassing resolution to enhance broker satisfaction, reduce costs and improve sales efficiencies. 3

4 3. Solution architecture Our solution architecture is designed for easy integration with multiple backend administrative system and pulling relevant details into the mobility or portal solution. The integrated data can then be used by brokers using either of the two platforms to perform the various functions. 4. Functional Modules Product Selection The product and quotes module helps the broker to select the plan and provide preliminary quotes to individual prospective members and groups based on multiple factors. The product selection function is the first step in the above framework lifecycle where the broker understands and evaluates the various product options. The product selection will enable the prospective members not only get a range of premium for products but also get a detailed breakdown of the benefits for individual plans. It will also enable the customer get a side-by-side comparison amongst the available plans. Quoting Rate quote or quoting provides a preliminary quote to an individual, family or small group based on various criteria such as demographics, age, gender, deductible and coinsurance amount. 4

5 Enrollment If the group/individual is satisfied with the preliminary quote, a proposal for enrollment will be submitted. The proposal once approved will enable the next process in the framework cycle, i.e. enrollment. The broker will have the facility to track and follow-up on the pending proposals with the payer. Benefits Administration In case the broker is going to act as the benefits administrator, this module will provide an array of administrative functions that the broker would provide on behalf of the account. During the enrollment period, the broker will be able to add the subscriber/member details, make initial PCP and OB/GYN selections, request new ID cards and print temporary ID cards. In addition, the broker would also be able to make membership changes on an ongoing basis, such as, changing name, PCP, address and phone number. Account Management The account management module will enable the broker to view account benefits and premium payment information. In case of late payments by an account, the broker would be able to remind account representative to make the payment. The commission module will help the brokers to verify the commission schedules and check the commissions paid and to-bepaid in a given month. The agent can also view historical commissions (for example: year to date commissions etc.). 5. Key Value adds Broker Tools The module on broker tools will enable agents to provide up-todate and supporting information inquired by customers. These could be in the form of providers in the network, the drug formularies, enrollment, renewal and risk assessment forms. Knowledge Center The dispersed broker community also needs to be frequently trained, re-trained and provided with latest happenings and information from the healthcare payers. These are catered in the form of online trainings, guides, newsletters, FAQs and references 5

6 Benefits of the solution Reduce administrative costs to manage broker services such as quoting, prospecting and renewals Ability to work on a mobile device in the absence of online computer access Ability to track various updates, trainings, enrollment forms from the payer side Reduce time to convert prospects into members with automated processes Increase broker satisfaction with the ability to view leads, members and personal data online Ability to manage various kinds of member requests in an automated approach Workflow based approach to convert any lead into member End to end portal solution - Though many payers have put web portal for brokers, but their solution is not complete as they look at only specific functions on the portal such as quoting and commission statements rather than facilitating the complete sales process with the portal. There is also a significant amount of manual intervention by broker administration team of the payers to resolve broker issues. HCL portal solution is an end-to-end solution for brokers, starting from prospecting to customer acquisition, administration and renewals. It also contains value added features including knowledge centers and extensive broker tools. Mobility solution The mobility solution provides base functions such as quoting, commissions, renewals processes that do not take significant data entry but can easily provide results on the mobile device. Thus enable brokers to do away with using computers/laptops and the need to be online in order to perform simple tasks. Why HCL? HCL has experience with broker related processes in the healthcare payer industry HCL is building strategic solutions for HIPAA 5010 & ICD-10 remediation backed by experts with X12 & clinical backgrounds PAHM, HIPAA and PMP certified professionals HCL has strong capabilities in web architecture & mobile technologies HCL has developed a five-phased SOA-based proprietary methodology for legacy modernization HCL has established practice in GRC (Governance, risk and compliance) for healthcare clients 6

7 6. About the Author Anirban Mukherjee is Business Manager at HCL's Healthcare Solutions group. He has worked extensively with US healthcare payers and is currently engaged in building solutions for payers. How can I help you? Hello, I m from HCL!. We work behind the scenes, helping our customers to shift paradigms & start revolutions. We use digital engineering to build superhuman capabilities. We make sure that the rate of progress far exceeds the price. And right now, 60,000 of us bright sparks are busy developing solutions for 500 customers in 23 countries across the world. 7