What We Faced
Challenge
People today want convenience, quality, and a positive experience from brands, and this also applies to people’s expectations for their healthcare needs. In response, a prominent New York-based healthcare plan provider sought to elevate and enhance the way they connect with their members and providers by offering a personalized digital portal where each group could access important plan information.
Currently, members and providers did not have access to a self-serve digital portal. The readily available online resources were insufficient, so members and providers relied primarily on physical mail and customer service calls, making information updates an unnecessarily time-consuming process.
The company determined that they would offer two tailored portal experiences: a member portal and a provider portal. By creating two separate experiences, the health plan provider could prioritize and organize information that was most important to each audience in an intuitive, easy to navigate manner. The portal would be built on Salesforce Experience Cloud because it would integrate seamlessly and securely with Salesforce Service Cloud, which had been recently implemented for the customer service team.
What We Did
Solution
MRE designed and implemented a Member Portal and a Provider Portal powered by Salesforce Experience Cloud. For design, the team started with the customer, first determining what was important to a member vs. a provider to inform the data that would need to be accessible within the portal and the actions that each user would need to be able to perform.
The top challenge was data. The necessary data was fragmented across many internal systems and all data usage needed to adhere to HIPAA regulations to ensure proper data protections. Data was integrated from 5 systems to Service Cloud using MuleSoft and real-time API calls. To maintain data integrity and privacy, the portal virtualized data at the point of access. This meant that at the moment a user loaded specific information, the system would grab and display the data so that it was not stored unnecessarily, minimizing data exposure and access.
The digital brand experience needed to reflect the company values which emphasized compassion and inclusiveness. This was accomplished by incorporating accessibility considerations into the user experience. To accommodate alternative input methods, such as keyboard navigation, we incorporated specific functionalities to better facilitate a smooth and efficient interaction with the portal. To improve visibility, particularly for users with visual impairments, we implemented high-contrast color schemes. To support most devices, so users could conveniently access health plan information on their device of choice, we designed a mobile responsive experience.
Below are some highlighted features of the Member Portal and Provider Portals:
Member Portal:
- Access to Unified Health Records: View claims status, authorizations, plan benefits, eligibility, and more in one place.
- Secure Communications: Secure messaging with customer service for timely resolution of health plan-related inquiries.
- Personalization & Multi-language Support: Customized portal views for each health plan, with the ability to toggle among English, Spanish, and Chinese.
- Health Education Resources: Library of educational materials, empowering members to proactively manage their well-being.
Provider Portal:
- Centralized Member Information: Single-point access for healthcare professionals, streamlining access to past claims, authorizations, and more.
- Support-Related Case Management: Enabled ability to create support-related cases, such as authorization submissions and data requests, reducing call center volume, and optimizing workflows.
- Analytics and Reporting: Utilized Salesforce Service Cloud and 3rd party tools for real-time analytics, tracking portal utilization, and optimizing operational processes.
What We Delivered
Results
The Health Plan provider was pleased to offer an enhanced brand experience through the member portal and provider portal, powered by Salesforce Experience Cloud. There has been great user adoption. In the first 6 months, the company saw nearly 3k member and provider portal users with 20k logins.
The digital touchpoints are transforming the way they do business and how they interact with their members and providers, leading to:
- Enhanced Member Engagement: Improved management of plan benefits and access to health plan resources. The messaging feature for member communications has reduced call volume.
- Improved Collaboration: Facilitated collaboration among members as well as providers and their staff, such as administrators and billing agents, for easier access to needed information and visibility of historical communications and comments.
- Data-Driven Insights: Real-time analytics empowered executives and the member and provider relations teams to make informed decisions and identify areas for continuous improvement.
The successful launch of this digital portal experience is one component of the client’s digital engagement strategy. The team is already looking at how to expand digital touchpoints, lifecycle communications, and additional self-serve capabilities.
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