Transforming healthcare brokers

with portal and mobile solutions

Healthcare payers typically interact with four key external

stakeholders: providers, employers, members and brokers.
Amongst these external entities, the brokers play a critical role to
generate and sustain new businesses for the payers. Until today, the
interactions between payer and brokers where primarily driven
limited to lead generation, quoting, commission processing and
renewals. However, with the universal healthcare reform initiatives
the role of brokers has been transforming into change agents with
the responsibility of not only educating the prospective members
but also fasten the process of insuring clients.
Internet and Mobile technologies for brokers will play a critical role
not only in increasing the customer base of payers, but also enable
to provide quick turnarounds to any form of member requests.

1. Current Scenario
Though the need for the cutting edge broker portals has been
increasing, many payers till rely on centralized quoting, paper based
enrollment and payer driven membership renewal processes. All of
these are time consuming, inefficient and manual in nature. In this
scenario, Broker portals for a healthcare payer can become an
important conduit to enhance and improve customer satisfaction
and generate more business.
To provide up-to-date information to clients and speedup the
process of lead generation into actual enrolment, brokers are
increasingly looking at technological avenues including internet and
mobile technologies. To meet this gap, healthcare payers also have
traditionally relied on internal home-grown applications or
products customized to their needs.
HCL healthcare team did a research on about 180 US healthcare
payers of various revenue sizes to verify the usability of broker
portals. Many of them still do not have a dedicated portal to meet
the need of the broker community. Amongst many payers with
existing broker portals, the functionality is typically limited to online
quoting and commission statements.

2. HCL Solution
HCL provides a comprehensive web portal and mobility solution
that will provide best in class and comprehensive features to enable
brokers in engaging sales end customers in efficient and cost
effective manner.
Our proposed framework formulates the solution by breaking
down the broker activities in the following 5 life cycle phases. Our
solution is unique in a way that it not only integrates all the
important life cycle activities for a broker to generate and sustain
sales leads, but also manages the member relationship via benefits
administration features.

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The proposed solution brings about the portal and mobile driven
functionalities that will automate and speedup many of the
standard broker activities. It will provide an all encompassing
resolution to enhance broker satisfaction, reduce costs and improve
sales efficiencies.

3. Solution architecture

Our solution architecture is designed for easy integration with

multiple backend administrative system and pulling relevant details
into the mobility or portal solution. The integrated data can then be
used by brokers using either of the two platforms to perform the
various functions.

4. Functional Modules
Product Selection
The product and quotes module helps the broker to select the plan
and provide preliminary quotes to individual prospective members
and groups based on multiple factors.
The product selection function is the first step in the above
framework lifecycle where the broker understands and evaluates the
various product options. The product selection will enable the
prospective members not only get a range of premium for products
but also get a detailed breakdown of the benefits for individual
plans. It will also enable the customer get a side-by-side comparison
amongst the available plans.
Quoting
Rate quote or quoting provides a preliminary quote to an individual,
family or small group based on various criteria such as
demographics, age, gender, deductible and coinsurance amount.

Enrollment
If the group/individual is satisfied with the preliminary quote, a
proposal for enrollment will be submitted. The proposal once
approved will enable the next process in the framework cycle, i.e.
enrollment. The broker will have the facility to track and follow-up
on the pending proposals with the payer.
Benefits Administration
In case the broker is going to act as the benefits administrator, this
module will provide an array of administrative functions that the
broker would provide on behalf of the account.
During the enrollment period, the broker will be able to add the
subscriber/member details, make initial PCP and OB/GYN
selections, request new ID cards and print temporary ID cards. In
addition, the broker would also be able to make membership
changes on an ongoing basis, such as, changing name, PCP, address
and phone number.
Account Management
The account management module will enable the broker to view
account benefits and premium payment information. In case of late
payments by an account, the broker would be able to remind
account representative to make the payment.
The commission module will help the brokers to verify the
commission schedules and check the commissions paid and to-bepaid in a given month. The agent can also view historical
commissions (for example: year to date commissions etc.).

5. Key Value adds

Broker Tools
The module on broker tools will enable agents to provide up-todate and supporting information inquired by customers. These
could be in the form of providers in the network, the drug
formularies, enrollment, renewal and risk assessment forms.
Knowledge Center
The dispersed broker community also needs to be frequently
trained, re-trained and provided with latest happenings and
information from the healthcare payers. These are catered in the
form of online trainings, guides, newsletters, FAQs and references

Benefits of the solution

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Reduce administrative costs to manage broker services such as

quoting, prospecting and renewals

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Ability to work on a mobile device in the absence of online
computer access
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Ability to track various updates, trainings, enrollment forms
from the payer side
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Reduce time to convert prospects into members with automated
processes
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Increase broker satisfaction with the ability to view leads,
members and personal data online
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Ability to manage various kinds of member requests in an
automated approach
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Workflow based approach to convert any lead into member
End to end portal solution - Though many payers have put web
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portal for brokers, but their solution is not complete as they look
at only specific functions on the portal such as quoting and
commission statements rather than facilitating the complete sales
process with the portal. There is also a significant amount of
manual intervention by broker administration team of the payers
to resolve broker issues. HCL portal solution is an end-to-end
solution for brokers, starting from prospecting to customer
acquisition, administration and renewals. It also contains value
added features including knowledge centers and extensive broker
tools.
Mobility solution The mobility solution provides base
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functions such as quoting, commissions, renewals processes that
do not take significant data entry but can easily provide results on
the mobile device. Thus enable brokers to do away with using
computers/laptops and the need to be online in order to perform
simple tasks.
Why HCL?
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HCL has experience with broker related processes in the
healthcare payer industry
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HCL is building strategic solutions for HIPAA 5010 & ICD-10
remediation backed by experts with X12 & clinical backgrounds
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PAHM, HIPAA and PMP certified professionals
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HCL has strong capabilities in web architecture & mobile
technologies
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HCL has developed a five-phased SOA-based proprietary
methodology for legacy modernization
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HCL has established practice in GRC (Governance, risk and
compliance) for healthcare clients
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6. About the Author

Anirban Mukherjee is Business Manager at HCL's
Healthcare Solutions group. He has worked extensively
with US healthcare payers and is currently engaged in
building solutions for payers.

Hello, Im from HCL!. We work behind the scenes, helping our customers to
shift paradigms & start revolutions. We use digital engineering to build
superhuman capabilities. We make sure that the rate of progress far exceeds
the price. And right now, 60,000 of us bright sparks are busy developing
solutions for 500 customers in 23 countries across the world.
How can I help you?

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