Laying the foundation for a better member experience and patient engagement.
A new member portal and integration architecture for a joint venture between a health plan and a provider system.

The Challenge 

Delivering a new, integrated partnership to improve health outcomes

In response to market forces dominating the healthcare headlines, a mid-sized regional health insurer was looking for ways to improve health outcomes, decrease healthcare costs for consumers, and dive into a more meaningful partnership with providers.

The Solution

A new partnership integrating primary care and health insurance

To create greater access to primary care services and an easier experience for healthcare consumers, this regional health insurer partnered with a local health system to stand up a new clinic and related benefits plan. The plan delivers additional services outside of traditional primary care and zero out-of-pocket costs for services delivered in the clinic. The product is wrapped by more a conventional network for national coverage, while still prompting advanced primary care services as its core benefit for consumers.

To enable this partnership and advanced care experience, the insurer needed a new technology stack to serve the vertically integrated venture. West Monroe built an integration platform that would allow for the marrying of health plan data with clinical data. This involved the design and development of a micro-service architecture that enabled access to real-time data and provided flexibility for product enhancement in the growing and dynamic plan. The team also assessed the insurer’s internal QA processes to develop an automated solution that provides higher test coverage and requires fewer QA personnel to execute.

To bring the customer experience to life, the team partnered with the insurer to design the desired customer experience and core features needed for a new Member Portal. The team then developed the new Member Portal leveraging a component architecture and modern web frameworks, creating a seamless and intuitive user experience. The experience also laid the initial foundation for more precise care coordination and navigation and, ultimately, greater patient engagement.

The Impact

A new model that moves the industry toward value-based care

The West Monroe team ultimately helped the insurer develop the capability to integrate realtime data for more accurate and precise care coordination. From the consumer perspective, the team delivered a more seamless and intuitive experience via a new, modern Member Portal that is both adaptable and easy-to-maintain. 

  • Designed a Member Portal using advanced customer experience techniques
  • Developed a developer library that allows individual components to be integrated into any web application with minimal additional work
  • Created a micro-service strategy and architecture that enables higher performance and the ability to easily integrate clinical, health plan, and third party data
  • Fully automated UI and quality assurance capabilities developed using the latest open source tools that require fewer resources to execute and maintain test scripts

West Monroe continues to work with the insurer to build out future phases that will include rapid analytics, event stream logging, and work flow automation to better enable patient engagement and drive improved care outcomes. 

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