Overview

The client is a large payer national healthcare organization that needed to maximize the application of the member engagement dollar. This challenge created the need for the company to establish a Member Interaction Center (MIC).

This initiative also required that the current member engagement process be optimized to ensure the engagement dollar is spent to create the largest possible impact on the health of members. This had to be accomplished through the most effective channel, deploying the right sequence of engagement. The goal was to ensure that teams and care agents were able to productively engage members and were performing at their best.

We discovered this problem existed after a team of architects, business analyst and functional experts met with health management executives and IT leaders from the client team. These leaders were interviewed to identify the existing process and operational issues, resulting in the discovery of the need for requirement elicitation in conjunction with the customer team. The requirement was to develop a MIC.

The client needed to solve numerous problems, including:

  • Inability to effectively utilize the data sets available and monetize them
  • Existence of a fragmented process flow and inconsistent collection of member engagement data
  • Excess administrative costs due to lack of integration between member interaction function and other departments, such as eligibility and enrollment
  • Absence of insight concerning ROI on investments and effectiveness of member engagement initiatives
  • Lack of centralized repository for PHM analytics

We realized that numerous successful end results needed to be accomplished:

  • Developing a 360-degree Member-Engagement Analytics Platform
  • Transforming a seamless integration of heterogeneous systems into an analytics platform
  • Conducting data profiling to determine data availability and usage
  • Evaluating various off-the-shelf tools and other technologies based on the data and functional requirement along with client infrastructure and technology, from which the solution was determined

Solutions

We developed several effective solutions that significantly enhanced the client’s MIC. Four primary solution pillars were considered – efficiency, quality, maximization ROI realization and cost management. Efficiency solutions included sustaining technology with the existing infrastructure and optimizing the Netezza platform to power the analytics warehouse. Quality solutions centered around the structured processing of data and developing a configurable and tool-agnostic solution. Maximizing ROI realization consisted of developing a quicker time to market and the standardization of the data operation process with maximum automation. Cost management solutions involved minimizing operation and engineering expenses and reducing infrastructure costs.

Results

Our successful functional and technical solutions met the client’s goal of maximizing utilization of the member engagement dollar. We saved millions of dollars on member engagements and optimized channels for outreach.

Functional solutions

The MIC solution integrates data from various streams like Wellness and Preventions, Care Management, Disease Management, Member Management, Agent Productivity, CCC, Preferences and Campaign Effectiveness into the Member and Health Management Data Mart to provide insight to business leaders in understanding agent effectiveness and productivity through a well-crafted dashboard.

Technical solutions

The proposed MIC solution architecture will involve data extraction from hetrogeneous data feeds (internal and external), data processing and loading data to the Federated Warehouse and Data Marts (DM). The newly built data marts will provide the KPIs for creating Tableau-based dashboards.

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