Leaders of healthcare organizations who must adhere to Medicare or Medicaid regulations face an important decision: manage member issues in a single Member Experience Platform or buy several separate case tracking systems and seamlessly integrate them.

The choice seems obvious. Why cobble together multiple systems when a single platform can optimize workflows, lower costs and improve member experience? Yet many health plan IT departments default to multiple systems.

As such, it’s important to know all the key benefits of a single Member Experience Platform, since some can easily get overlooked. In this blog, we’ll explore six key benefits which should help simplify the decision for leaders of healthcare Appeals and Grievances departments.

1) 360-degree View of Member Experience

Team members need visibility into all member issues and a single Member Experience Platform will deliver that. These insights can help team members provide a much richer and comprehensive customer experience in a single call.

For example, members often call into the Call Center asking for a status on existing cases. The status update could be about any case type, such as:

  • Inquiries
  • Grievances
  • Initial medication requests
  • Initial medical requests
  • Appeals

Not having to bounce around between multiple systems — or rely on a fully functioning integration — is going to be extremely helpful and very member friendly. In addition, having access to all the member issues will help when assessing customer sentiment. If there are a lot of open issues, and they have been open for a while, the team member will be able to assess how much extra effort they should apply to the customer interaction to get the member back on a happy path.

2) Decreased Total Cost of Ownership

Cost-conscious senior leaders always look at ways to deliver the most appropriate technology at the lowest possible cost. Platform solution providers will tell you that paying for an entire platform (versus point solutions) is going to deliver the desired results at a fraction of the cost because of the “like” functionality will only be paid once. The cost saving categories are listed below:

  • Single platform price is less than the price of two case-tracking systems
  • Integrations reduced by 50% for (Member, Provider, Auth, Claims)
  • No integration required between Member Services and A&G
  • Less maintenance because only one system requires updates

3) Faster Implementation Time

Implementations are the bridge to a better future, yet we have all been in implementations which have taken way too long. There are all sorts of reasons for implementation delays and several areas tend to drag out the timelines.

One is around domain knowledge. If the vendor is completely new to the industry — and requires expedited immersion to gain the knowledge needed to start building in customer requirements — it will require several iterations until the system is designed correctly.

Another cause of delays is around integrations. Multiple teams must get together to discuss, and then co-develop the communication tunnel between systems, which necessitates a back-and-forth process that cannot happen overnight.

Too many meetings can also extend an implementation and, when you have multiple vendors, that is exactly what you are going to get. The schedules for the healthcare organization will also be much more challenging due to all the competing meetings.

However, a single Member Experience Platform will accelerate the implementation time because:

  • A single integration for one system versus multiple connected systems
  • A compliance-driven platform include compliance reporting right out of the box
  • Fewer vendor meetings lead to reduced scheduling conflicts

4) Frictionless Cross-Departmental Communication

Interdepartmental communications within healthcare organizations is nothing new. In fact, the de facto method is often through email or fax. However, this is not efficient, which is why companies have relied on homegrown access databases and other similar systems to create a global communication tool.

The reality is, for a platform company that understands industry requirements, it will already have a solution for this challenge. They would offer a built-in tool that is very user friendly that would allow for the initiation, receipt, housing of communications and operational-level turnaround times.

5) Increased Operating Leverage

In the end, gained efficiency is one of the key reasons healthcare organizations adopt new technology. Systems should be able to reduce manual processes and eliminate workarounds as well as other time-consuming efforts.

For example, when the same data needs to move from one department to the next, the ideal scenario would be for a single data-entry process. In addition, it would be important to have visibility of all customer data to eliminate opening more than one case for a member who calls in multiple times regarding the same issue.

In a single Member Experience Platform these issues go away, and efficiency increases. The primary reasons for increased operating leverage are:

  • Reduced data-entry mistakes when recording multiple cases for the same member
  • Eliminated double data entry for issues that are initiate in member services and resolved in Appeals and Grievances
  • Misclassified cases can be reclassified and reassigned
  • Comprehensive and quick reporting for all cases

6) Higher Compliance Adherence

When member issues require multiple departments to participate in the resolution process, it requires effective coordination. The importance of managing regulatory due dates is a key driver in compliance adherence.

Cases that sit in one area and need to move to the next area will be difficult to spot in a disparate system environment. Even if the systems are integrated, there will be limitations.

There are four primary reasons that a Member Experience Platform can deliver higher compliance:

  • Improved turn-around times.
  • Real-time notifications of misclassifications.
  • Internal urgent alerts on aging cases.
  • Visibility over all cases for greater oversight.

Inovaare has been delivering a compliance-driven Member Experience Platform to Healthcare Organizations since 2008. We can work with your organization to uplift your technology suite to ensure you are following all the right steps and complying with all regulatory guidelines, including those related to Appeals and Grievances. Please contact us to explore how we may be able to support your healthcare organization’s compliance processes!