Ambition
Independent Health, a not-for-profit health plan provider headquartered in Buffalo, New York, has been a trusted leader in delivering innovative, consumer-focused healthcare solutions since 1980. Serving over 350,000 members nationwide, the organization offers a diverse portfolio of products—including HMO, POS, PPO, EPO, Medicare Advantage, Medicaid, individual Exchange plans, and self-funded employer coverage—designed to promote holistic well-being and member engagement.
The recent passage of the Inflation Reduction Act in August 2023 introduced a transformative mandate for Medicare Part D plans: the Medicare Prescription Payment Plan (M3P). This program requires health plans to offer beneficiaries the option to pay out-of-pocket prescription drug costs through monthly capped instalments, shifting significant financial and operational responsibilities to payers.
For Independent Health, this regulatory shift presented both a challenge and an opportunity. The organization needed to:
- Pay pharmacies upfront for prescription costs.
- Manage member billing and collections over time.
- Ensure seamless member experience while maintaining full compliance with evolving CMS guidelines.
With CMS releasing phased guidance through July 2024 and requiring core functionalities to be live by October 2024, Independent Health faced a compressed timeline to design and deploy a scalable, compliant solution. The stakes were high:
- Contractual Risk: Failure to meet CMS standards could jeopardize Medicare contracts.
- Reputational Risk: Any disruption in service could erode member trust in a competitive market.
- Regulatory Risk: Noncompliance could result in substantial civil penalties.
Rather than viewing M3P as a compliance burden, Independent Health saw it as a strategic inflection point—an opportunity to modernize its systems, enhance member engagement, and reinforce its commitment to delivering accessible, affordable care. To meet this ambition, the organization sought a solution that would not only satisfy CMS requirements but also elevate operational efficiency and member satisfaction.
Action
To meet the aggressive CMS timelines and navigate the complexity of the Medicare Prescription Payment Plan (M3P), Independent Health partnered with Wipro to deploy MPPP360—a purpose-built, scalable solution designed to ensure full regulatory compliance while enhancing operational efficiency and member experience.
Wipro adopted a three-phase implementation strategy aligned with CMS timelines, beginning with foundational capabilities and key functionalities like election processes (opt-in/opt-out) and mandatory member correspondence. The second phase expanded operational components, integrating with Pharmacy Benefit Managers (PBMs) for claims information exchange, billing, and invoice generation. The final phase completed the rollout by delivering remaining functionalities, including payment gateway integration, ACH configurations, and enhanced correspondence generation. Throughout all phases, rigorous testing was conducted under evolving CMS guidelines to ensure full compliance and system readiness.
Throughout the engagement, Wipro demonstrated agility and strategic problem-solving to overcome several critical challenges:
- Evolving CMS Regulatory Requirements: With guidance shifting frequently, Wipro maintained continuous monitoring and rapid adaptation to ensure compliance at every stage.
- Complex System Integration: Seamless coordination across internal systems, external vendors, and PBMs was essential to resolve data discrepancies and maintain operational stability.
- Member Communication & Experience: Wipro developed dynamic, compliant communication templates and workflows to ensure Medicare beneficiaries received timely, personalized updates aligned with CMS standards.
In addition to technical execution, Wipro ensured cross-functional alignment across Independent Health’s internal teams, vendors, and stakeholders. This collaborative approach enabled proactive risk mitigation, resource optimization, and consistent progress tracking—critical to delivering a compliant, member-centric solution under dynamic regulatory conditions.
Ambitions Realized
Following the successful deployment of Wipro MPPP360, Independent Health now operates on a fully integrated, compliance-ready platform that aligns with both regulatory mandates and member-centric service goals.
Key outcomes include:
- Enhanced Member Experience:
A customizable, device-agnostic portal empowers over 68,000 Medicare members with intuitive self-service tools, improving engagement and satisfaction while maintaining brand consistency. - Operational Efficiency:
Wipro MPPP360 manages eligibility, enrolment, maintenance, and prescription billing—including delinquency tracking and retroactive invoicing—within a unified system. Automation has significantly reduced manual workload and errors. - Improved Interoperability:
Seamless integration via real-time APIs, batch processing, and secure file transfers ensures smooth data exchange with external systems, including Pharmacy Benefit Managers (PBMs). - Cross-Functional Enablement:
A role-based portal experience for agents and operations team has streamlined workflows, boosted productivity, and enhanced collaboration across departments. - Regulatory Alignment & Future Readiness:
Built-in compliance features support ongoing CMS readiness, minimizing administrative overhead and positioning Independent Health for future regulatory shifts.
These improvements are expected to contribute to higher Star ratings, a critical performance metric in the Medicare Advantage landscape.
“Independent Health is proud to be recognized as a top-performing Medicare Advantage Plan, having earned either a 4.5 or 5 Star rating for our HMO plan from the Centers for Medicare and Medicaid Services for 15 consecutive years,” said Dave Mika, Senior Vice President, Business Services and Operations. “Wipro’s innovative MPPP360 solution plays a critical role in helping us sustain these industry-leading results by enhancing operational efficiency and improving the overall member experience—ensuring timely access to essential, affordable medications for Part D beneficiaries.”
Note: Every year, Medicare evaluates plans based on a 5-star rating system
