Flexibility to respond quickly as price transparency and competition evolve healthcare

Member expectations for digital-first, self-service tools are becoming more pronounced. The need to update and share updates and adjustments to plans details and member benefits increase accordingly. Our administrative tools continue to grow and expand to enable plans to respond with increased speed and precision.

Manage

Update plan data and information for members with greater publish frequency

Through initial implementation the data needed to power our solutions is organized into a master data structure that can be used to update and republish the data and information to keep members current on changes to benefits, networks, and offers available to them.

  • Updating the master configuration data set, plans can update and republish network, provider, and product details to display through our platform.
  • With our growing content editing and scheduling capabilities, items including disclaimers, member facing messages, and network participation status can be edited and updated and republished. Robust disclaimer settings let you format the content and allow you to embed dynamic numeric content or hyperlinks.
  • Our reporting tools make utilization details available to help plan leaders gather insights about what is driving member care discovery and selection.
  • Our proprietary member and provider data warehouses create a 360⁰ data-rich profile of a member or a provider across multiple disparate systems, enables SmartMatch comprehensive matching technology, and delivers enhanced performance reporting and program savings.
  • We combine a demographic, rule-based recommendation system with a machine learning (AI/ML) approach to identify and close data gaps.

Partners

Care access, data, and implementation support partners help keep best-in-class shopping experiences best-in-class

Frictionless, digital-first engagement drives customer satisfaction—in healthcare and everywhere. Most point solutions solve only one problem at a time and compete for member focus but a healthcare shopping platform can bring them all together. A well-built provider directory understands the details of a member’s network, current liability, estimated costs, and sentiments throughout the journey. As the central tool for helping the member find care, S365 is the ideal destination to coordinate care access solutions.

  • Access Partners: From easy online scheduling to medical opinion to virtual care to transportation, integrating access partners directly increases use and outcomes.
  • Data Partners: With the increased focus on interoperability and cost transparency, ensuring the right data is flowing through your shopping portal helps ensure members can find what they are seeking quickly and easily and that their information is accurate.
  • Implementation Support Partners: For organizations who need additional support in organizing enterprise data for use within the S365 platform, we have a number of vetted implementation and data aggregation partners to help efficiently get your provider directory online.

Services

Engaged the support of our subject matter experts to guide digital shopping, engagement, data, and implementation strategies for healthcare shopping

Healthcare is changing rapidly in an already fast-paced digital world. Your clinical data, your unique networks, and your innovative care programs set you apart. Sapphire is your trusted partner to execute your strategies and maintain your edge in market.

  • Data Consulting: Our team of data experts have decades of experience with health plan data infrastructure and can advise on everything from the tactical to the strategic.
  • Implementation Services: Our implementation project managers know our expansive configuration suite inside and out. They can help you configure the platform functionality to your member goals and your data, networks, benefits, and messaging to a tee.
  • Digital Strategy: Our product, design, and engineering team are true partners to the most innovative ideas your employer groups are seeking. We rapidly prototype, gather data insights and feedback from real users to validate and bring the most innovative market ideas to fruition.

Intelligence

Get smarter about your members and drive better engagement

Provider directories and incentive programs have gained importance as the healthcare world has moved towards a digital-first member experience. Over the past decade, we have seen other service-based industries like retail, cable, auto insurance, and finance orient to a highly personalized service experience. They orchestrate a combination of technologies and channels through a well-understood journey to deliver specific and relevant interactions at the anticipated point of need. Through continuous learning and tuning, these tools continue to refine the experience for users as their needs, wants, and expectations are more understood through consumer preferences, usage data, and AI-backed prediction. And through that refinement, the value is optimized for both the business and consumer.

  • Work with Client Engagement Managers to optimize SmartShopper Program Performance with proven marketing campaigns and support.
  • Engage with our product team as a strategy partner to consider audience and segment analytics as we work to continuously optimize experiences for all members and households in each of their unique healthcare journeys.