Building trust and enhancing experience through technology-enablement

US health plans continue to shapeshift as they merge, acquire, and consolidate to meet changing market conditions. When organizations grow inorganically, they tend to take on additional technology platforms, services, and processes. Technologies (platform, software) and processes have a direct impact operations and delivery capabilities, all of which reflect in the customer experience for members, providers, and other external stakeholders. While the contours of the situation are broad, they reflect the reality experienced by one of the three largest health plans in the US, with more than $100 billion in 2021 revenue and 17 million members across Medicare, Medicaid, and commercial plans. Brillio partnered with this health plan to innovate and transform its external stakeholder experience challenges.

A sub-optimum experience can have financial implications

In the conversation with the health plan, at stake was the experience of all external stakeholders, including members, doctors, nurses, employees, clients, and external partners. Experience manifests across the various operational areas of call centers, claims processing, and vendor management. While each operational area measures performance based on the type of delivery, the aggregate performance reflects in the interwoven experience of the stakeholders.

The health plan provides various services to clients and their employees, such as a provider directory for clinical care or claims management. The services rendered are supported across multiple channels, such as an employee portal and call centers. Given the propensity of consumers to use self-serve options, the use of portals typically comports to better experience instead of calling the call center. Experience is typically acknowledged to be a critical driver of retention of clients that impacts health plan financial metrics.

Similarly, the accuracy of claims adjudication is another important contributor to the stakeholder experience. Inaccurately adjudicated claims lead to inaccurate payments or the denial of care, significantly impacting stakeholder experience.

The health plan depends on various partners and vendors to deliver services. This ecosystem of thousands of partners and vendors is large and dynamic. There is an investment in developing and managing such an ecosystem and requires optimization. The speed and efficiency of onboarding are critical contributors to the experience of the partner community.

Deploying technologies laser-focused on the outcomes is the key to success

A large part of the health plans challenges impacting experience rested in the tech-debt (dated technologies, disparate systems etc.). At the heart of the solution that Brillio envisioned with the health plan was a modern, scalable, multi-cloud, and agnostic hybrid architecture to enable effective and efficient technology delivery and meet the experience objectives. The technology solution is a digital, cloud-native mesh architecture built on an interceptor approach for agile transformation and microservices API to integrate multiple applications and portals seamlessly with the vision interceptor. Microservices enabled plug-and-play solutions to optimize some of the legacy investments. Further, the solution enabled a more mature DevOps process to sustain the improved delivery.

…Meeting the delivery with the quality that we need is certainly the foundational first case component, but actually seeing improvement in the usage from a customer standpoint adoption…is huge.

—Health plan VP of IT Delivery

Outcomes are particularly important with transformational engagements, given the many bets typically placed on them. Recognizing that, Brillio took an agile approach to solution development and delivery. It has been regularly deploying incremental releases to shape the solution while mitigating the risks of large releases.

Brillio’s experience transformation engagement with the health plan has a long arc and many moving parts. Yet, interim results are encouraging when measured against the key performance indicators (KPIs) it collaboratively set with the health plan. One KPI is to reduce call-center call volume by 80%, which appears to be on target along with cost savings due to increasing accurate claims adjudication. The goal to reduce a KPI measuring the number of days required to complete partner onboarding and enablement from several weeks to 2 days also appears to be on target.

Picking the right partner is as important as the solution and the outcome

The health plan reflected on its positive engagement with Brillio, indicating several attributes it believes contributed to its success. It is appreciative of the fresh perspectives and challenger mindset Brillio’s deeper understanding of healthcare brought to the table to enhance the solution.

Another key differentiator the health plan found is that the same folks who developed the solution and sold the engagement are also the same folks involved in the delivery. This enhanced communications consistency and ensured there were no gaps in understanding the problem statement or delivery construct.

Brillio addressed the health plan’s skills gap effectively in the time of the great resignation. Its ability to bring to bear niche skills ensures the quality and timeliness of its deliverables always meet or exceed expectations. Consequently, it has been a force multiplier for the health plan to address its IT human capital needs.

The Bottom Line: Building trust through outcomes is critical to driving client engagement.

In a competitive market with hundreds of technology-solutions providers offering a stack of ever-evolving technologies, building trust with clients is nothing short of fundamental. This story highlights that trust is built incrementally with a full understanding of the challenge, deep domain expertise, technology skills, and capabilities and consistently delivering agreed-to outcomes. That is the story of a satisfied client who has improved the experience of its stakeholders.