The healthcare payer industry is in transition. Payers must deal not only with the rising costs of delivering care to their members but also with figuring out how to serve an influx of new members while keeping administrative costs below the appropriate medical loss ratio (MLR) thresholds. 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. HCL has created a comprehensive analytics driven framework to help health plans offer a differentiated experience to their existing and prospective customer base. 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. Gain scalability with HCL’s flexible, adaptable and agile enterprise IT, Infrastructure & BPO combined “Campaign as a Service” program services for members. To know more, please visit: http://microsite.hcltech.com/gainwithchange/40-million-new-members.asp

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HCL – Healthcare Payer Solutions
Member Experience Management

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Healthcare Payer Market Drivers –
Managing Member Experience is an Important Component
 Adopt best practices from B2C industries like banking, retails etc
 Customer segmentation
 Risk identification and mitigation
 Innovative product development
 Update IT infrastructure to handle influx of members
 Achieve operational efficiencies
Healthcare
Reform
Consumerization
Of
Healthcare
The Bottom-line for Health Plans
Influx of Member
with Higher Risk
Profiles
Customer
Experience
Management
 Market expansion to
include large pool of
uninsured customers
(approx 40 million)
 MLR minimum of 80%
(small group / individual)
and 85% (large group)
 Shift in responsibilities for
financial & health
management to individuals
 Super consumers - seeking
independent information
 5% of population utilizes
over 50% of healthcare
spend
 Over 50% of population
utilizes only 3% of
healthcare spend
 Chronic diseases
contributing to 65% of
healthcare expenditure
 Shift from B2B to B2C
model driving focus on
customer experience
 Low CEM scores relative to
other industries

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Member Experience as we see it….
Mobile
Broker
Mobile
Call Center
Online
Online
Online
Call Center
Mobile
Social Media
Health Risk Assessment
Procedure
Cost Estimates
Comparative
Shopping
Cost/Utilization History
Interaction
Tracking
Cost / Quality Data
Segmentation
Communication
Participation
Patient ActivationSegmentation
Communications
Outcomes
Triggers / Alerts
Triggers / Alerts
Marketing
Need Analysis
Marketing
Health Literacy
ANALYTICS
Acquisition
Retention
Health
and
Wellness
Care
Management

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Assess Member
Data
Health
Records
Premium
Variables
Provider
Details
Subscriber
Demographics
Claims
History
HCL Point of View:
Member Experience Management
Retention
Prospect
Recapture
Prospect
Acquisition
Prospect
Driving
Focused
Target
Programs
through
Preferred
Channels
MEMBER DATA ASSESSMENT
&
CUSTOMER MANAGEMENT STRATEGY
HUC VALUE BASED MEMBER SEGMENTATION DRIVING MEMBER EXPERIENCE

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Print/ Fax/ PaperOnline
CHANNELS
Call Center Kiosk Mobile BrokerVideo Chat
MEMBER ACQUISITION MEMBER RETENTION MEMBER RECAPTURE
Portals
CRM
Product Selection and
Quotes
EXPERIENCE
Enrollment
Member
MaintenanceNeed Analyzer HRA
SVoC
Analytics
Member Single
View
Business Rule
Engine
Care Management
ENABLERS
Customer
Experience
Dashboard
Computer
Telephony
Interface
AdaptersDigital Mail
Room
Campaign Management
HCL’s Member Experience Management (MEM) Solution Framework
Member
Portal
Prospect
Portal
CSR
Portal

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Multi channel communication for
segmented population
Leverage the HUC score to
group/segment members to enable
care and mass customization
Provides holistic information about
individual members and acts as input for
HUC analysis
Based on the value derived from HUC,
per member details on health risk,
utilization and cost is derived
Analytics to drive care and customer engagement
Stage 1 – Risk Assessment &
Customer Identification
High Risk
Profiles
Moderate
Risk
Low
Risk
Segmented
member
information is fed
into analytics
system
Customized
Experience is
enabled with
Segmentation
Stage 2 –
Customer Segmentation
Per member HUC score is being used
to define a population/group
(members with similar HUC scores will
form a group)
Stage 3 – Facilitate Care Management
for segmented population

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HCL Solution – Key Differentiators
REDUCED TOTAL
COST OF
OWNERSHIP
TECHNOLOGY
AGNOSTIC
QUICKER GO TO
MARKET
ENHANCED
DECISION
MAKING
SUPPORT
 Analytical capabilities through
Comprehensive Reports & Models
 Considerable Reduction in Cost when
compared to building the solution
grounds up
 Predefined metrics, reports,
statistical models & dashboards
 Predefined data model and
computations
 Adapters to adjudication platforms
like FACETS
 Being technology agnostic can be
deployed on customers’ existing
reporting and modeling
tools/technology

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For Questions,
Please Contact: contact.lsh@hcl.com

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