Transcript Document

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Confidential
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Copyright © 2014 TriZetto Corporation
Stars and Marketing Automation
Making the Most of Your Distribution Channel
Margo Carp, TriZetto, Strategic Partnerships
and Business Development
Mark Poling, Colibrium, CEO
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Copyright © 2014 TriZetto Corporation
Market Trends
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Copyright © 2014 TriZetto Corporation
Time of unprecedented change
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Growth in Medicare
Shift to Retail Model
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Massive influx of members over the
next decade (baby boomers &
expanded disability clients)
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Growing individual market segment
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Blurring lines between group and
individual markets
Insufficient reach as captured agents,
leads are not necessarily dedicated to
the carrier
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More technically savvy individuals
shopping combined with influx of ill
informed purchasers
Higher agent involvement in sales &
Medicare sales hierarchy (FMO, MGA,
SGA & Agent)
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Open enrollment volume – accordion
staffing
Moving to defined contribution as
compared to defined benefit in the
group world
Reform
Agent Community
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Medical Loss Ratio (MLR)
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Insufficient reach
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State & Federally run exchanges
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Open enrollment volume
Commission levels becoming a
challenge
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Path of least resistance is to sell the
cheapest policy – not necessarily
yours
Confidential
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Copyright © 2014 TriZetto Corporation
2013 to 2020 Projected Membership Shift
 Medicare Advantage
 + 30.3% (19,550,000 lives)
 Managed Medicaid
 + 54.3% (58,930,000 lives)
 Duals Managed Care
 + 400% (5,500,000 lives)
 Exchanges
 + (46,000,000 lives)
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What does this mean for payers?
• Shift of membership to Individual and Government lines
of business and evolving expectations (all LOB)
• Swing to more retail, consumer oriented experience
(online, mobile, phone, 24x7)
• Increased cost pressures from reduced Medicare
Advantage reimbursements and growth in duals
• Emphasis on driving healthier behaviors through
better member compliance
• New competition from Health Systems, consolidations,
etc.
• Focus on new capabilities, managing compliance,
speed to market, and growth
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Spotlight on Medicare Advantage
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Evolving Challenges
• CMS Compliance
• Ongoing audits and risk of sanctions
• Competition
• More enrollees are now in 4 or 5 star plans
>50% !
• Maximizing star ratings
• Only 4 or 5 star plans get bonuses
• Successful member engagement
• Multiple sales channels, member satisfaction drives
retention
• Internal Customer Relations tools
• Multiple systems prevent full view of member and impact
productivity
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Engagement Drives Lead Generation and Sales
• Increase conversion
• Capture and track direct leads (reduce commissions);
broker management; internal sales support
• Drive sales
• Upsell ancillary products; improve margins
• Positive initial experience
• Sets the tone for member experience; improves survey
results and star ratings
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Copyright © 2014 TriZetto Corporation
(Engagement Drives Everything After a Sale Too)
• Drive member compliance and healthy behaviors
• Improved quality; lower medical costs; better stars
(Controlling Blood Pressure, Medication Adherence, etc.)
• Full view of member for Customer Service
• Increased productivity of staff; better survey results (better
stars - Customer Service, Getting Needed Care, Rating of
Health Plan, etc.); Upsell and cross sell
• Healthier members are happier members with lower
costs – Need to retain them!
• Better survey results; better stars; increases desired retention
segments
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The ROI of Engagement
“Patients who were more knowledgeable,
skilled and confident about managing their
day-to-day health and health care had health
care costs that were 8% lower in the base year
and 21% lower in the next year... These savings
held true even after adjusting for patient
differences, such as demographic factors and
the severity of illnesses.”
– Hibbard and Greene, Health Affairs, Feb 2013
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Solution Overview
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Medicare Sales – Individual/Agent Flow
Tuo Modules
Tuo
Service
Tuo
Wellness
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Copyright © 2014 TriZetto Corporation
Facets/QNXT
Tuo Sales
&
Marketing
Internal Agent User Experience - CRM
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Confidential
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Copyright © 2014 TriZetto Corporation
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Preconfigured for Health
Insurance
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Public Exchange Integration
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Sales For All Market
Segments
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Call Center and Service
Automation
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Performance Dashboard
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CTI/IVR Integration
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Membership Integration
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Lead Management
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Marketing and Campaign Mgt.
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Cross Sell / Up Sell
Integrated, Multi-Channel Service
Online & Mobile Self Service
 Shop & Enroll
 Health Risk Assessment
 Consumer, Broker, Group,
Member
 Change / Add / Delete
Transactions
 Targeted wellness
participation
 ID Card Replacement
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Tuo Mobile – Engagement Through Every Channel
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CRM – Building Deeper Relationships
• Marketing campaign
automation
• Member segmentation
• Provider segmentation
• Automated workflow &
escalation
• Context sensitive
messaging
• Service agent automation
• Communication
preferences management
• Integrated quoting &
enrollment
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Drive
Focus
Efficiency
Focus
and&Efficiency
Navigation & Outlook
Integration
By Drug & Condition
Prevention Campaigns
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Non-Compliant
Members
Point
Click Design
Design
Pointand
& Click
• Rapid configuration &
customization
• Create dashboards, forms
and workflows
• Campaign management
• Communication
management (phone,
mail, email, text
• Template management
(email, letter)
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Business Intelligence & Reporting
By product & household
By source
All market segments &
demographics
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Business Intelligence & Reporting
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Copyright © 2014 TriZetto Corporation
Workshop Survey
We would like to extend you an
opportunity to provide candid feedback.
During the workshop you should’ve received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time, we would
greatly value your feedback. For your convenience, the survey will be
available throughout the remainder of the conference should you not
be able to complete immediately.
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Thank You!
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