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With the implementation of the individual mandate clause of healthcare reform, it is estimated that 40 million new applicants will shopping for insurance from 2014.

In this evolving state of industry, payers need to figure out how to serve an influx of new members while keeping in mind that a majority of these applicants will be first-time shoppers for health insurance. To succeed, payers must adopt a customer-centric approach to deliver a consistent and differentiated experience to their existing and prospective customers across all channels of interaction.

In addition, the entry of 40 million members also will require the health plans to invest in augmenting their technology and infrastructure, in order to scale up to meet the increased demands on their IT systems.

This presents an opportunity to the health plans to transform their business & thereby Gain in this Change

HCLs Member Experience Management Solution Framework will help a plan to cater to the demands posed by the entry of 40 million potential new members. The componentized solution which is available on the cloud will help a plan to quickly scale up to address the demand on their IT technology and infrastructure while providing the flexibility to choose the modules that can complement their existing systems.

The solution provides the payers with:

  • Acquisition support – Through solutions like the
    • Need Analyzer to identify the insurance product that, based on customers inputs and predicted spending, meets the customer requirements
    • CRM Suite to drive segmentation and appropriate acquisition campaigns
    • Portals for information dissemination and member enrollment
  • Retention Support – Through solutions like the
    • Single View of Customer to understand the members behavior and preferences, which in turn can be used to determine retention campaigns
    • Member Switch Predictor that, based on an analytical data model, will identify triggers that could lead to the member to potentially switch to competitors
    • Cost Estimators that provide the cost of care for visits, diagnostic tests and procedures to help the member estimate their out-of-pocket costs and informed treatment choices
  • Multichannel Support – to help the plan leverage multiple communication channels like mobile, web, social media during the implementation of the plans outreach programs using HCLs proprietary campaign management platforms like Campaign as a Service (CaaS) & Member Engagement Program (MEP)

For example, the Payer could choose the cloud enabled CRM capabilities of the MEM solution. This gives the payer the access to an industrialized CRM platform and the necessary infrastructure to mount an acquisition campaign to target the 40 million new members

Additionally, the Payer could use the analytical capabilities of the MEM solutions to identify the members who could be on the verge of switching plans. This information can be used to formulate a retention campaign which also can be delivered using the CaaS platform.

Healthplans can execute the campaigns identified using HCLs Campaign as a Service (CaaS) platform. CaaS is HCLs cloud enabled end-to-end marketing technology platform which provides the technology, infrastructure and the personnel to quickly scale up and execute the marketing campaign on behalf of our customers. The CaaS platform can also act as the feedback loop as the response from the campaigns can beused as an additional input in the MEM analytical models to aid future segmentation efforts.

Key Features:

Pega frameworks - Pega ISPM and CPM have been integrated for developing HCL’s MEM solution.  The integration follows the member through quoting, fulfillment and maintenance process. ISPM Framework is the Pre-Enrolment module and is used to enroll a new member. Once the member is enrolled, these details are sent to CPM which is the member maintenance module.


HCL MEM Solution Architecture using Pega Solutions / Frameworks

Advantages to clients by using Pega

  • Process driven customer service using Pega CPM ensures appropriate interactions
  • Consistent experience across multiple channels
  • Ability of business users to make changes faster
  • Pega Next Best Action enables every customer interaction to deliver intelligent and coordinated communication and become an opportunity to improve experience
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