Avnet Services:IBM

Eastern Healthcare Payor

Eastern Healthcare Payor

The Challenge

In 2008, an East Coast Healthcare Payor was running a member portal site that was putting it at a competitive disadvantage in the marketplace.  The old portal had poor utilization rates, awkward navigation, and relied heavily on paper correspondence in solving problems for both its current and potential new members.  The system led to an increased reliance on expensive customer service calls rather than direct use of the portal to gather information and manage a members experience and needs.

Requirements Gathering

States on the East Coast of the US led the nation in 2006 with statewide implementations of Healthcare Reform that was successful in insuring 97.4% of the population.  While overall insurance coverage was greatly improved, the cost of health insurance was not directly addressed by the initial reform laws, leading to cost overruns, incorrect use of services, and questions on how services were to be paid.  The Payor needed a solution that would help explain both costs and the insurance process without negatively impacting the health of their members.  To achieve that goal, the Payor had to rethink and retool their delivery system, with the goal to develop a new model of business-through-communication with customers and Payors that included a personal experience for those constituents.

Key priorities identified in the requirement gathering process included:

  • Identify priorities in terms of health, service, communication and billing.
  • Allow processes to be driven by behavior of users
  • Align with business goals to control costs and compliance
  • Socialize internal adoption and communication
  • Plan to evolve, imagine possible and probable scenarios
  • Ensure collaboration and buy-in with both business and IT
  • Test thoroughly with Users
  • Throughout the implementation, various high-level goals were documented, including:
    • Benchmark and increase member satisfaction.
    • Increase customer retention.
    • Reduce business cost in the short- and long- term.
    • Allow members to access and choose Payors who deliver the highest quality care at a cost effective rate.
    • Better educated health consumers.
    • Empower users to make the best decisions about their care.
    • The site also had to roll out in stages - members and visitors first, followed by other constituents; Brokers, Payors and Employers.

    Technical Solution

    IBM Websphere Portal

    The solution implemented at the Payor centers on an IBM WebSphere Portal platform.  This foundation, both stable and easily upgradable for current and future needs, created an environment that leveraged both user-centered design and specific customization requirements.  The technical solution also involved the establishment of a vision document based on competitive and strategic analysis and utilized a customer experience quality measurement framework.

    Implement Lotus Content Management

    Using IBM Lotus Web Content Management software allowed maximum flexibility and personalization to satisfy creative and marketing departments, without sacrificing the power of automation of template design.  Tight integration with IBM WebSphere Portal allowed the Payor to take advantage of a configurable and re-useable workflow model, tracking changes and approvals without impeding content managers in the creation of rich media. 

    The Result

    The new Member Portal was delivered within nine months of signing the contract.

    Ascendant and the Payor’s personnel were successful in creating an enterprise level strategic objective design, utilizing IBM WebSphere Portal and IBM Web Lotus Content Management as the fundamental base to the solution.  A new, rules-driven personalization engine also increased automatic customization, all delivered using the agile development process in tandem with the Payor team.

    Notable results from the implementation include:

    • Improved task completion success rate from less than 30% to greater than 80% for all features prototyped.
    • Reduced time on task from an average of 3.5 minutes to less than 2 minutes.
    • Reduced calls to customer support based on simplified navigation and streamlined tools.

    The end result is a fully designed and activated WebSphere Portal that is easy to use and understand, allows for individual personalization, increases action and utilization, and prepares the way for future upgrades.

    The details matter

    • Dynamic web 2.0 menus using AJAX
    • Personalized content based on member info
    • Mouseover text and help
    • Visualizations and High Fidelity Simulations using iRise to validate requirements and provide user training
    • Animated promotional sliders based on plan type
    • Marketing messages based on plan and member demographics
    • Information based alerts