Situation

A major health plan with more than 500k members serving multiple lines of business sought a transformative, data-driven solution to improve member satisfaction, engagement, and health outcomes. The client had amassed a variety of single-use systems, tools, and data to support efforts across the organization, but lacked the ability to centralize and coordinate their member-facing services.  

For the organization, this resulted in asymmetric adoption of digital applications, disparate data pipelines, and costly duplication of efforts. Members were frustrated by the slow and uncoordinated customer service experience resulting from team members having to navigate across 8 different tools or lacking access to insights to provide real-time support.  

The client engaged AArete to build a centralized and comprehensive digital platform powered by advanced analytics to enhance member experience and engagement while increasing operational efficiency. 

Approach

AArete partnered with the client to develop a new, single front-door supported by a Health Navigator Team to provide a guided, curated experience. 

Co-create a future vision of member service 

To get started, we designed a framework to understand the processes, people, and technology integral to all stages of a member’s journey. We employed a collaborative, member-centric approach to understand the current state, identify organizational and information gaps, and define future-state aspirations through a series of stakeholder interviews and UX/UI design workshops. 

Optimize data management and delivery through architecting an Enterprise Data Warehouse 

We enhanced the client’s in-house data engineering capabilities to provide automation and seamless data delivery through a centralized Enterprise Data Warehouse. This included architecting and optimizing how new and existing data was processed (e.g., claims, provider data, member data, prior authorization, SDOH, and point programs). Our team performed data integration with SSIS, T-SQL, SAS and Python to ensure optimal data availability to all consumers. This positioned the client to expand on new and existing data processes with Azure DevOps, facilitating, for example: 

• Seamless data exchange across the console, Health Navigators, and third parties like SWORD and Strive to boost accessibility and effectiveness of vital care. 
• Quality measurement and reporting of HEDIS measures from Cotiviti to improve the health plan’s overall rating. 
• IPD analytics to provide additional reference information for the medical pharmacy business, medical claims, and pharmacy analytics. 

Develop a member platform to serve up comprehensive insight  

AArete deployed a multi-disciplinary team of technologists, user experience experts, visual designers, healthcare experts, and data scientists to build an operationally efficient, member-centric platform. With newfound integrated data-driven capabilities, the console was positioned to play a key role in ensuring all information was consolidated pertaining to member notes, policy updates, and any member touchpoints across the organization.  

Empower Health Navigators to provide streamlined customer service 

To provide centralized, real-time service to members, we developed a new service design and operating model for the customer service team to adopt and to improve long-term outcomes​: Health Navigators. This role bridges the gap between customer service and healthcare services while providing more bandwidth for each team to focus on its core deliverables. Armed with a comprehensive member view and increased access to information, we reduced navigational inefficiencies to enable Health Navigators to serve as a “one stop shop” to solve members’ problems and take a proactive approach to address obstacles to care.  

Results

• Enhanced member satisfaction  
• Improved quality of care and care outcomes  
• Reduced total cost of care  
• Operational efficiencies  
• Plan growth  
• Reduced gaps in information  
• Increased engagement in plan offerings 
  

Learn more about our solutions:

Member Experience Solutions | Digital and Technology

About AArete
AArete is a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and advisory services. Our cross-industry solutions are powered by modern technology, market intelligence, and big data to drive purposeful change and actionable outcomes. 

Learn more about AArete’s Digital & Technology solutions