Health Insurance Exchange

While governments and consumers are demanding that Payors and Providers do more with less, they, along with exchange administrators, are grappling with the ever-changing Healthcare landscape. There is greater demand for accountability, improved health outcomes, cost reductions and increased patient satisfaction as market forces and public policies converge. Public and private Health Insurance Exchanges (HIX) represent another wave of forces driving change.

How Wipro Helps

Wipro collaborates with Payors, Providers as well as public and private exchanges to uncover the potential market and implementation strategies. We leverage best-of-breed solutions for business process, application, integration and infrastructure management.

These include:

  • Health Insurance Exchange (HIX) Platform and Business Process Services
  • Consulting Services
  • IT Infrastructure Services
  • Application Modernization, Testing and Support Services

We offer a powerful combination of business, technical and clinical experts that include over a hundred domain experts, physicians and data scientists.

The evolving nature of the Federal Insurance Exchange implementation adds another level of complexity to the decision-making process of Healthcare organizations.

Given provisions in the law, Health Insurance Exchanges (public and private) will be the catalyst for innovation in areas of insurance product design. Consumers will need help to navigate through the exchange-driven purchasing experience. The Healthcare Insurance Exchange is designed to change the benefit purchasing model from a predominantly B2B place to a B2C market place and, thus, offer a new "retail-oriented" channel for Payors.

Our solution suite includes:

HIX Platform and Business Process Services

  • Member 360 platform (cloud-based platform) is easily extended to automate and support the individual member enrollment and eligibility verification for the health plans that are offering their products on the exchanges
  • HIX Business Process Services to drive efficiencies in enrollment, eligibility, claims processing, contact center, among others, to capture this unique "retail" market

Consulting Services

  • HIX IT Strategy, governance and regulatory reporting
  • HIX advanced analytics, data warehouse and reporting strategy
  • Advanced member analytics that can help health plan to predict total lifetime value of a member and monitor voice of customer

Application Modernization, Testing and Support Services

  • HIX integrating and Testing
  • Application integration, modernization, and support (Claims, Membership, Providers, Billing, among others)
  • Managed Testing Services
  • Configuration and release management

HIX IT Infrastructure

  • Technology infrastructure
  • Remote infrastructure management
  • Security and risk management

We help Payors assess, develop, implement and maintain business and technical operating environments to support insurance exchange activities.

Assess

Our expertise in strategy development, business process consulting, and technology consulting helps Payors:

  • Assess market potential
  • Understand the changes required to support the new market
  • Develop a plan that enables organizations to accommodate the new market

HIX Market Entrance and Sustenance

We help Payors enter an insurance exchange with limited products and/or market segments. Specifically, in a Partial Entrance scenario, we help in planning by:

  • Conducting systems and operations gap analysis
  • Creating and executing detailed implementation plans
  • Enabling operations of business process and information technology staff and systems
  • Enhancing, as needed, to meet changes in legislation and/or health plan policy
  • Providing advanced analytics to suggest new and better ways to manage and grow the business
  • Enabling strategic relationships with major software partners