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| Web based enrollment and customization
to facilitate consumer driven health plan |
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| Customer |
| The customer is consistently
ranked among the top HMOs in the USA for quality of care.
They offer health care in New England area, primarily
in Massachusetts. They offer an extensive network of over
24,000 affiliated providers, providers on staff, thousands
of independent physician and group practices and 140 hospitals. |
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| Challenge |
| Consumer
Driven Health Plans (CDHP) reduce health insurance costs
while improving the overall health of employees. Employees
take the role of educated health care consumers, a well-designed
CDHP can rein in skyrocketing health insurance costs while
providing employees with the appropriate level of quality
health care they need. To facilitate CDHP implementation
healthcare payers look forward to integration and enhancement
of the existing systems in claims processing, Decision
support and web based member enrollment and choice plans
selection aids. |
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| Solution |
| This portal enables the
employer community to enroll their employee’s online,
design benefits plan with respect to Annual deductibles,
Co insurance amount and stop loss amount, to structure
Health reimbursement and Health savings accounts. Enabled
members, flexibility of care to pick and choose services
and providers, Choice options to compare CDHP plan with
other plans with respect to out of pocket expenses. The
backend systems like Decision support, “Proact-employee
enrollment system “and claims were also enhanced
and integrated to support this portal. |
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| Benefits |
Reduction in Administrative
Costs
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Customer able to
pick and choose |
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Reduction
in sales effort |
Decrease in Medical Costs
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Cost Conscious Patients
with complete awareness on plan and benefits |
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Decrease
in Physician office Visit |
Increase in Productivity
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Process
time taken into account for semi automated and automated
process measured at 3, 6 and 9 months averaged out
to 30% for sales & marketing, enrollment and
benefits administration collectively. |
Increase in Customer satisfaction
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Quote Info time
reduced from 3 days to 1 day |
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Customer
was able to choose provider, see all benefit information
and take conscious decision |
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