CRM for Managed Care 

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Creating Member Value: A Rx for Success 

Combat Disenrollment by adding Value

Database integration offers providers a centralized customer-service vehicle

Build physician loyalty with Value

Beef up the business value of CRM by getting back to basics

Disparate applications: an opportunity for agility

Embrace CRM by implementing the full suite of offerings

Implementing these IT initiatives moves payers toward automation

Payers seize opportunities to manage, forecast sales

Technology purchases must be effective, not just efficient

Medicare HMO Marketing in the Information Age

Squeeze Play. HMOs faced with profit losses, tight finances

TeleMagic, Act, SalesLogix, HMOZ

HMOZ CRM System

HMOZ Amisys Integration

Managed Care Marketing Needs

1. Creating Member Value: A Rx for Success 
Eric Reidenbach & Gordon McClung                                                                                                                                                                                             “No longer can managed care continue to rely on the current thinking that produced the cost cutting initiatives that dominated HMO strategy. New thinking is required – thinking that focuses on the creation of value for the different key constituencies that it serves.”

2. Combat Disenrollment by adding Value
R. Eric Reidenbach & Gordon W. McClung                                                                                                                                                                         “Globally, two elements drive managed care choices made by employee benefits managers: quality and price. Taken together, these two components define a critical dynamic that most managed care providers are not monitoring. That dynamic is value, customer value to be specific.”

3. Database integration offers providers a centralized customer-service vehicle
Comprehensive data warehousing can streamline medical management and improve customer loyalty, satisfaction.
By Dorinne Hoss                                                                                                                                                                                                                                   “In order to build loyalty among existing customers and attract new prospects, many providers are turning to customer relationship management (CRM) initiatives. CRM involves understanding and meeting customer needs across all customer-facing functions, including sales, marketing, and customer service.”

4. Build physician loyalty with Value
R. Eric Reidenbach & Gordon W. McClung                                                                                                                                                                         “The issue of physician retention is critical to the ongoing quality of service and patient care provided by HMOs. Retention is made even more difficult because many physicians are not particularly enamored with what they consider to be the intrusive nature of HMO management.”

5. Beef up the business value of CRM by getting back to basics
Managed Healthcare Executive                                                                                                                                                                                     “Customer relationship management (CRM) is a business strategy designed to optimize profitability, revenue and customer satisfaction. With the many technical attributes required for CRM transformation, HMOs are especially concerned about ROI, including tangible and intangible benefits. As HMOs pursue CRM strategies, they are realizing that the benefits and costs of those strategies can be significant.”

6. Disparate applications: an opportunity for agility
Managed Healthcare Executive                                                                                                                                                                                               “Having disparate applications in an IT environment forces a degree of independence between applications that can provide a high degree of flexibility (business agility) if appropriately designed and managed. Health plans that try to eliminate heterogeneity by standardizing on single applications may gain IT efficiency but at the loss of critical business effectiveness.”

7. Embrace CRM by implementing the full suite of offerings
By: Joanne Galimi
Managed Healthcare Executive                                                                                                                                                                                               “Industry pressures have created an impetus for a new transformation of consumerism in which consumers are empowered and accountable for their healthcare. This transformation has required payers to shift thinking toward customer relationship management (CRM). CRM is a business strategy designed to optimize profitability, revenue and customer satisfaction.”

8. Implementing these IT initiatives moves payers toward automation
By: Joanne Galimi
Managed Healthcare Executive                                                                                                                                                                                                “The past 18 to 24 months have been the trial-and-error period for payer automation. The implementation of e-transactions between payers and providers, consumers and purchasers has been slow because of the challenges of integrating them with back-end applications, historically poor data management, slow trading-partner adoption and a volatile and relatively young vendor market.”

9. Payers seize opportunities to manage, forecast sales
By: Joanne Galimi
Managed Healthcare Executive                                                                                                                                                                                                 “Every healthcare payer organization needs the ability to manage sales opportunities. Payers also are facing changing business models, additional product offerings in new geographies with new sales distribution channels, the need for member retention capabilities and the need to be more effective and efficient.”

10. Technology purchases must be effective, not just efficient
Managed Healthcare Executive                                                                                                                                                                                                 “How much should a managed care organization invest in information technology? How can an MCO ensure that IT is making a worthwhile contribution to its business? The answers to these questions will be central to business success in the 21st century as MCOs must balance effectiveness (getting the business done well) with efficiency (getting it done at minimal cost). Current IT benchmarks and measurement systems are failing to demonstrate business value.”

11. Medicare HMO Marketing in the Information Age
A REPORT BY MEDICARE RIGHTS CENTER                                                                                                                                                                       “HMOs spend millions of dollars on marketing their Medicare products. One study found that marketing has a major influence on an individual’s decision to join a Medicare HMO. Some marketing practices can mislead and result in misinformed or poorly informed enrollments.”

12. Squeeze Play. HMOs faced with profit losses, tight finances
By Alexandra Matisoff-Li                                                                                                                                                                                                             “Although HMOs transformed the way most Americans get their health care, the industry has suffered from growing pains in recent years, experts say. In the face of recent steep drops in profits and perceived consumer discontent, healthcare policy experts agree HMOs are at a crossroads.”

13. Telemagic, Act, SalesLogix, HMOZ                                                                                                                                                                             “According to the last HMOZ Customer Relationship Growth Forecast report, the most profitable MCOs have between 10 and 950 sales and marketing reps. Gartner Group observers named SalesLogix to be the market leader in Customer Relationship Management with over 25% market share and the best fit for this size Managed Care Organizations…”

14. HMOZ CRM System                                                                                                                                                                                                            “HMOZ Customer Relationship Management (CRM) system is uniquely customized and built for Sales and Marketing departments of Managed Care Organizations (MCO).”

15. HMOZ Amisys Integration                                                                                                                                                                                                   “HMOZ is setting a new standard for the health plan industry, providing sales and marketing solutions integrated with Amisys that manage sophisticated processing requirements, including consumer-directed healthcare products. It offers small, medium and large payers a comprehensive, robust and flexible way to meet their information needs.”

16. Managed Care Marketing Needs                                                                                                                                                                                         “Needs of marketing departments in Managed Care Organizations are often overlooked. MCO management believes sales and marketing has the lowest priority when it comes to internal investment and technological advances. Marketing reps lack the ability to argue this situation with management and need support from HMOZ CRM system to be able to present a solid business case backed up with reports.”