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HealthRules® Payer Horizons: Improve Member Engagement and Satisfaction

To stay ahead in the constantly evolving healthcare sector, payers are adopting digital solutions that put automation and accuracy at the core of every workflow. It’s critical that your Core Administrative Processing System (CAPS) delivers the most up-to-date data available so you can improve automation rates and streamline processes. Our five-part blog series, titled HealthRules® Payer Horizons, demonstrates how our CAPS solution empowers payers to adapt to meet new market opportunities.

Read the entire series at the links below:

Leverage a single solution to improve the member experience

The healthcare industry is shifting toward a value-based care approach, pivoting away from traditional fee-for-service models to focus on improving healthcare outcomes and patient experiences. This transformation is powered by cutting-edge technology and innovative platforms—including HealthRules Payer. Our CAPS solution leverages the latest in AI enablement and cloud-based agility, simplifying the transition to VBC for health plans and elevating member engagement.

1. Provide superior customer service with first-call resolution

Nobody has time to be bogged down by playing phone tag or sitting on a call with slow customer service—especially members trying to navigate their healthcare options. HealthRules Payer recognizes this critical need for speed and efficiency. The platform boasts a Contact Center with a first-call resolution rate of more than 90%. This not only reduces member frustration but also boosts confidence in their health plan. By leveraging HealthRules Payer, health plan leaders can ensure their members are not just satisfied but genuinely pleased with the level of service they receive.

2. Make decisions at the point of care with real-time data

Healthcare decisions are too important to be delayed or based on outdated information. HealthRules Payer empowers health plans to make informed decisions at the point of care by providing real-time member data. This ensures that care providers can access the most up-to-date member information, enabling them to make the best possible decisions for patient care. Access to the most current member information streamlines the process and significantly improves clinical outcomes.

3. Enable self-sufficiency for members seeking cost transparency

One of the most significant barriers to satisfaction and improving member engagement in healthcare is the lack of cost transparency. Members often feel left in the dark about potential costs, leading to frustration and a decrease in trust. HealthRules® Payer addresses this issue head-on by enabling self-sufficiency for members looking for accurate cost information. Through the use of intuitive tools and features within the platform, members can easily compare prices and understand their cost-sharing responsibilities prior to receiving health services. This empowerment leads to a more engaged, informed, and satisfied member base.

4. Improve member satisfaction with faster and more accurate claims payments

The timely and accurate processing of claims is a backbone of member satisfaction. Delays or errors can lead to considerable dissatisfaction and can lead to dissatisfied members. By leveraging HealthRules Payer, health plans can drastically improve both the speed and accuracy of claims payments. The platform’s cutting-edge technology reduces manual processing demands, ensuring that claims are handled efficiently and correctly the first time around. This not only improves the operational efficiency of the health plan but also greatly enhances member satisfaction.

As the healthcare landscape continues to evolve toward a more member-focused, value-based care model, the need for innovative solutions like HealthRules Payer has never been more critical. By providing superior customer service, real-time data for point-of-care decisions, enabling member self-sufficiency, and ensuring faster, more accurate claims payments, HealthRules Payer is transforming the member experience. Health plan leaders looking to stay ahead in this dynamic environment will find HealthRules Payer an indispensable ally in their mission to improve member engagement and satisfaction.