Business Challenge

Meeting unique member needs can be complex and costly for health plans. How could HMHS help health plan partners compete by shaping personalized member interactions?

Transformation

HMHS created a cost-effective, enterprise-class health platform, enabling its health plan partners to gain deep insight into member needs and deliver customized digital experiences.

Results

Brings

enterprise-class digital marketing capabilities to health plan payers

Nurtures

long-term loyalty by enabling personalized member experiences

Improves

outcomes by helping members make better-informed healthcare decisions

Business challenge story

Facing tough competition

Health plans find it increasingly challenging to compete—and building and maintaining technology platforms can send costs skyrocketing. As a result, many health plans are unable to invest in technologies to optimize their services and create member engagement and loyalty.

HM Health Solutions recognized the opportunity to help health plans team up to compete effectively with commercial carriers. Elizabeth Bivens, Manager – Product Marketing, Commercial Markets, at HM Health Solutions, explains: “We see that many health plans across the country face similar challenges, including boosting enrollment, driving retention and controlling costs—all while keeping up with a continually evolving regulatory environment.”

Tina Satterfield, Vice President, Marketing, at HM Health Solutions, continues: “Technology is crucial to running a competitive health plan, but staying current with advances in the marketplace can be extremely complex and costly, particularly for small and medium-sized health plans. For example, even superficially simple changes, such as updating systems to use the latest diagnostic codes, require substantial amounts of time and investment.”

HM Health Solutions leaders realized that enabling health plans to pool their resources could unlock economies of scale, and free them to focus on developing value-added services to differentiate themselves in the marketplace. Bivens explains: “Every partner contributes to the development of the platform, and HM Health Solutions is able to offer advanced capabilities that would otherwise be too complex or costly to develop in-house. Our health plan partners jointly invest in changes that are needed to evolve the platform in response to broad industry trends. By partnering with us and leveraging their investments and economies of scale, our partners are better positioned to address each of their unique market needs.”

Running on security-rich, highly available IBM® z Systems® servers, HM Health Solutions’ cloud platform augments back-office, middle-office and marketing functions—empowering plan payers to compete more effectively. Bivens remarks: “We provide a flexible set of tools and capabilities, which our health plan partners can configure and deploy based on the specific needs of their market. By collaborating with IBM, we have created a platform that our partners can use to shape relevant and compelling member experiences.”

Thanks to our IBM solutions, we help plans to deliver personalized, high-quality experiences to more than 10 million members across the country.

—Elizabeth Bivens, Product Marketing, Commercial Markets, HM Health Solutions

Transformation story

Shaping personalized services at scale

To support the marketing component of its cloud-based enterprise health system, HM Health Solutions uses IBM Watson® Customer Engagement solutions. Bivens comments: “Our marketing solutions are a key part of our end-to-end service offering, and we saw IBM as a natural fit to deliver the digital capabilities we needed. IBM is a proven provider in the customer experience space, and we felt that IBM’s product development roadmap was perfectly aligned with our own vision—particularly their commitment to cognitive solutions.”

HM Health Solutions uses IBM WebSphere® Commerce to deliver a customizable web experience for its health plan partners, who are then able to offer their members online tools to manage their care. From a single, personalized dashboard, every member can use search tools to find nearby doctors, providers and specialists, compare the fees for medical procedures, and explore new insurance and healthcare products.

By integrating cognitive search capabilities from IBM Watson Explorer, HM Health Solutions enables members to use natural language to surface information and services online. By designing a search experience around the “bite, snack, meal” model, the company can present large amounts of data in a highly accessible way. For example, if members search for a care facility, their first click takes them to a list of potential locations, the next click shows them basic information such as opening hours, ratings and whether the clinic is accepting new patients, and the final click shows all the remaining information available.

As increasing numbers of members choose to access healthcare services from their smartphones or tablets, it is more important than ever to deliver a seamless journey on every device. Using IBM Digital Analytics, HM Health Solutions helps its health plan partners obtain in-depth insight into the way members move across their digital sites, enabling them to identify and remove sticking points where members struggled or even left the site.

Crucially, HM Health Solutions’ digital marketing offering empowers health plan partners to execute highly relevant, personalized wellness campaigns based on plan members’ unique healthcare needs and preferences—an important source of competitive advantage.

With IBM Campaign, HM Health Solutions enables plans to analyze numerous small pieces of member information, such as content preferences, demographics and locations, to gain a 360-degree view of every member. Using this insight, health plans can build fine-grained segments for targeted wellness campaigns. By reaching out with relevant messages, health plans can inspire members to use the site to access online healthcare tools, read articles or sign up for meetings with medical practitioners.

For example, when a health plan releases a new product via the member site, it can reach out to the members most likely to benefit. These members receive an email with links to a landing page with information about a new product on the member site. And utilizing the reporting tools in IBM Campaign, health plans can determine how many people opened the email, logged into the site and used the tool—helping them to learn valuable lessons and improve the effectiveness of future communications.

Results story

High-quality experiences nurture loyalty

By helping health plan payers to manage their front-to-back operations cost-effectively, HM Health Solutions is enabling its partners to focus on innovation and service quality—driving their competitiveness.

“Today, we work with health plan partners across the country,” says Bivens. “We provide the combination of people, processes and a cloud platform that enables our health plan partners to spend less time and resources keeping the lights on, and more time delivering value to members. Our service is backed up by more than 3,000 experienced professionals with deep expertise in healthcare best practices, and cloud-based tools that support multiple lines of business—including marketing.” 

Satterfield adds: “Many health plans are focused on minimizing per-member per-month [PMPM] costs—and by replacing on-premises systems with our offering, our health plan partners can shrink their spend on foundational technologies and redirect their investments into market development.”

Bivens concludes: “As the healthcare marketplace becomes more competitive, it’s easy for providers to lose ground. Thanks to our IBM solutions, we help plans to deliver personalized, high-quality experiences to more than 10 million members across the country.”

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About HM Health Solutions

HM Health Solutions (HMHS) delivers business solutions to health plan payers so they can run their organizations efficiently in a competitive and ever-changing market. By offering cutting-edge technology and unparalleled industry knowledge, HMHS meets the many operational needs of health plan payers. A wholly owned subsidiary of Highmark Health, HMHS is partnered with eight health plans serving 10 million members. Headquartered in Pittsburgh, Pennsylvania, HMHS has more than 3,500 employees.

Solution components

  • Digital Analytics
  • IBM Digital Analytics
  • IBM Marketing Center
  • Marketing Operations
  • Watson Campaign Automation integration with IBM Campaign
  • WebSphere Commerce as a Service

Take the next step

To learn more about IBM Watson Customer Engagement solutions, please contact your IBM representative or IBM Business Partner, or visit the following website: ibm.com/watson/customer-engagement

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