member-care-productivity-care-solutions

Increase Member Care Productivity with Hitachi Solutions’ Member Care Solution

A Health Maintenance Organization (HMO) faces daily challenges coordinating activities for their members. Providing the members with quality, affordable health options involves management and accountability for both your care team and the provider network. Hitachi Solutions is helping HMOs’ and Health Insurance carriers increase member care productivity and raising member satisfaction by streamlining the collaborative process required to serve members.

With Microsoft Dynamics CRM as the platform, Hitachi Solutions has configured a Member Care Solution that coordinates activities by providing insight and activity management for your two key constituents: Members and Providers.

Our Member 360 brings together all of the deliverables and data points regarding a member into one singular real time view and summary.

From a single screen, a member representative can:

  • Receive inbound calls and know which members are calling
  • See complete detail about the member/member household, including:
    • All member baseline and contact data
    • Plan detail including benefits, formulary, and provider network offerings
    •  Complete claim history in summary and individual detail
    • All case detail and history; including appeals and grievances
  • Real time activity view of outstanding tasks and to do lists
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Figure 1 Member 360 Form: Overview

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Figure 2 Member 360: General Information

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Figure 3 Member 360: Appeals and Grievances

 

The Provider 360 keeps your member care team up to date with all aspects of the provider network and their interactions with your members. The insight allows your care service team to:

  • Provider baseline contact details along with updated accreditation
  • Pro-actively manage the provider network and instantly understand:
    • Provider status, including performance measures
    • All provider activity with a given member or group
    • Status of appeals and grievances
  • Manage providers by specialty and delivery type
  • Build and improve your Health and Wellness network
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Figure 4 Provider Services Dashboard

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Figure 5 Provider 360 Form: Overview

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Figure 6 Provider 360: General Information

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Figure 7 Provider 360: Appeals and Grievances

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Figure 8 Provider 360: Claims

 

 The capabilities of the Member 360 and the Provider 360 provide a care solution that transform HMO management. The framework was developed to provide your organization with the foundation for improving the member experience. Client feedback, led us to consider the best methodology to provide a flexible collaboration platform to better meet the members health care needs. Flexible in that the views and screens are based upon the care role; and collaboration based on taking the data points from a numerous back office systems into a singular, aggregate view for your team.

For information on Hitachi CRM for Health Plans please contact us and visit our website!

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