Personalized Care and Member Engagement

Value-based care encourages plans to provide engaging member experiences that support wellness and disease prevention or management. When members have a more positive experience they build trust in their plan and providers, leading to a more positive and cooperative relationship and resulting in more effective care. From member support to member engagement, our people, processes, and technology can help you develop effective, flexible consumer-focused programs that help you adapt at the same pace as the market. Our EHR integrated web services support price transparency for members at the point of care and help prevent time-to-therapy delays due to utilization management.

  • Membership and Billing – Employ a centralized, highly automated and flexible platform on which to enroll members and manage rating and billing – including cost-plus billing. The application is designed to support Commercial (Not-For-Profit, Medicaid, Medicare Supplemental) and Marketplace plans and is sufficiently flexible to meet rapidly changing regulatory requirements and market demands.
  • Call eCenter – Communicate with your members through our trained staff of professionals available at all times. With extra staffing available during surges, you can be sure your members have a ready line of communication whenever they need it.
  • Member Portal – Utilize a white-labeled customizable member portal using SS&C Health technology. You select the areas you want your members to see, including available pharmacies and medication pricing.
  • Real-Time Benefit – Provide drug price transparency at the point of care and greatly reduce time to therapy delays through our industry-leading solution.
  • Campaign and Engagement Coordinator – Help members become more engaged in their own personal healthcare journeys by reaching out to them with relevant, personalized messaging. This solution lets you send automated yet targeted campaigns that reach the right members, through the right channel, at the right time.
  • Case Management - This member-centric solution automatically creates cases and care plans based on risk-stratified population data, helping care teams focus resources on members who are in the greatest need of care.  Our comprehensive case, disease, and utilization management solution provides an overall view of a member’s care in a single, integrated platform to improve coordination of care across teams and departments. 
  • Wiseman 360PlatformTM - Deliver value-based analytics to providers at the point of care within their existing electronic health/medical record (EHR/EMR) system with this payer-agnostic platform. It features 360 RibbonTM, an intuitive application that provides smart, actionable and relevant insights embedded within the clinical workflow, including opportunities to close gaps in care.
  • Digital Experience Platform - Provide a digital front door for your members and bring together your health and wellness strategy, while engaging and motivating members to take charge of their health. Your members will have streamlined access to your health plan content, enabling a self-service experience any time on any device. By allowing members to own their connection to your health plan and encouraging an active role in their health, members will likely feel more satisfied with their plan choice and less likely to leave.

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