Wipro’s Medadvantage360 platform delivers impressive outcomes for Medicare

The silver tsunami may have slowed down, but the volume of eligible seniors joining Medicare is still at record levels of more than 2 million annually (see Exhibit 1). Volume will continue to grow at approximately 2% CAGR despite the declining life expectancy in the US. The enablement of technology is critical to address the varied healthcare needs of our seniors, who will account for almost 20% of the US population in 2023.

A critical element of that technology is a core administrative process system (CAPS) that enables the end-to-end value chain of health plans contracted by the Centers for Medicare and Medicaid Services (CMS) to manage Medicare benefits. Wipro’s CAPS is Medadvantage360, which has served more than 100 health plans for more than 20 years and will touch about 23 million senior lives in 2023. Medadvantage360 has an enviable compliance record providing critical functional capabilities (such as member management, benefits, and claims) to ensure Medicare beneficiaries can access the care they need when they need it.

Exhibit 1: The senior population will grow at 2.5 times the rate of the broader US population through 2030, though aggregate numbers will decline as US population growth slows

Source: HFS Research, US Center for Disease Control and Prevention, and US Centers for Medicare and Medicaid Services, 2023

Wipro’s Medadvantage360 provides the flexibility of modular and reliability of an end-to-end integrated platform

Medadvantage360 is a ground-up modular platform that helps simplify Medicare operations for health plans. The platform has eight key modules:

• Sales and Brokers (e-Enroll360) supports e-enrollment, broker commissions, and health risk assessments.
• Eligibility (E&E360) checks eligibility and enrollment submissions in real time and supports CMS and state data exchange.
• Member Management (Member360) manages enrollment and membership and handles billing.
• Reconciliation (Revenue360) ensures demographic and financial harmonization.
• Encounters (EDPS-GT360) manages regulations, risk scores, and encounter management.
• A&G360 manages member and provider appeals and grievances.
• Connect360 allows for integration with third-party platforms and applications.
• Analytics360 drives insights and reporting.

While the modules reflect most CAPS capabilities, they lack some key capabilities like claims management and care management. Wipro has smartly developed strategic partnerships to address those needs, given the commodity nature of claims and care management in an overcrowded market.

Continuous legislative changes and policy updates are the norm in healthcare. Consequently, Wipro has built a culture of 100% compliance by embedding it in its software engineering and testing process and maintaining heightened awareness through training, a trait reflected in its engineers’ pride and the company’s outcomes. Another attribute that ensures a competitive edge is the continuous upgrading Wipro invests in the platform.

Outcomes matter in healthcare—I mean, they really matter!

America’s seniors are our parents, our neighbors, and us. We are obliged to ensure all have the best healthcare to ensure the highest quality of life. Wipro’s Medadvantage360 appears to deliver key outcomes consistently, which has a direct impact on health outcomes.

Member360 has had no outages over the last three years during the annual enrollment period (AEP), a critical period when seniors enroll in Medicare. Outages during this period could impact enrollment, delaying care that could cause irreversible harm to seniors. Similarly, it has achieved 100% SLA adherence over the last three years. A typical SLA includes service availability, response times, and efficiency and timeliness of function execution. It has also achieved an enviable NPS of 100 with a top 2 box score of 100%. Wipro is driving the triple aim of care (costs, experience, and health outcomes) in the right direction.

The Bottom Line: Wipro’s Medadvantage360 delivers what matters to ensure our seniors benefit from Medicare.

Technology remains a critical enabler of value in healthcare, particularly when the regulatory, legislative, and technological environment remains dynamic and the impacts are a matter of life and death. They are further accentuated when we factor seniors into the equation. Wipro has managed to navigate the challenges and deliver consistently on the backs of its IT services heritage. It continues to do so in its typical understated manner.