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Member 360 for healthcare

The challenge

Healthcare in crisis? Make a strategic investment.

Employers and members, frustrated with the rising costs of healthcare benefits, are looking for alternatives to maximize their investments in benefits payments, including shifting more costs onto the employee and personal health savings plans. Employees, bearing much more of the burden for healthcare costs, are making increased demands for service, value and personalization. The Member 360 solution for healthcare from IBM can help healthcare organizations deliver a highly personalized experience by providing a single, complete and consistent view of the member across all service touch points, while meeting tactical cost-of-care reduction goals, and strategic overall health and financial wellness goals.

 


The solution

Gain a bird's eye view of your members

Due to the nature, magnitude and method of health data and information capture, healthcare organizations have long struggled to advance their knowledge of member needs beyond the analysis of claims data. To remain competitive and relevant, healthcare organizations need to understand members at an intimate and individual level, and be positioned to coach and consult members based on their specific needs. To achieve this, healthcare organizations must develop a single view of their members and their clinical, utilization, behavior and wellness goals. The Member 360 solution takes advantage of IBM’s leading healthcare best practices, consultants and technologies to integrate member information and deliver an enterprise-wide, member-centric analytics and knowledge management information environment.

The Member 360 solution aggregates information from a single or federated repository and provides analytics capabilities to help health payers use patient information in new ways for clearer insights, better decisions and optimized operations. The solution can also help you make smarter decisions by delivering insight into member health and provider performance, enabling greater collaboration with business partners in the area of recovery and fraud detection, and improving management of claims, medical costs and more.

 


The benefits

A member-centric view can lead to lower healthcare costs

By creating a single view of the truth across disparate systems, you can dramatically streamline analysis, care and product development processes. The Member 360 solution can help you:

  • Gain a single, enterprise-wide view of member information.
  • Present operational and financial data across multiple channels.
  • Optimize data to deliver information as a service.
  • Track outcomes and effectiveness while managing and monitoring the business.
  • Modernize analytics and metrics with strong reporting tools.

 


The specifics

Comprehensive data governance components

The Member 360 solution can include:

  • IBM® Global Business Services®—to deliver the analytics solution, reference architecture, data integration, process optimization, implementation and support.
  • IBM InfoSphere™ Master Data Management Server—to manage multiple data domains and relationships, along with pre-built services to garner a greater understanding of partner relationships and reduce system integration costs.
  • IBM InfoSphere software—to build and manage your master data environment, including InfoSphere DataStage®, InfoSphere QualityStage, InfoSphere Information Analyzer, InfoSphere Change Data Capture, InfoSphere Metadata Workbench and data governance software and services.
  • IBM WebSphere® Process Server—to increase efficiency and productivity by automating complicated processes that span people, partners and systems.
  • IBM Health Plan Data Model—to cover claims handling, adjudication and recovery, disbursements analysis, member service and retention, provider performance and quality, disease management, utilization management, pharmacy benefits, underwriting and profitability visibility.

 


 

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