Solution

Reduce costs by delivering 24/7 access to the right care at the right time ER and urgent care visits are costly. Members and payers alike need alternatives to care for common illnesses that reduce out-of-pocket and medical spend without sacrificing quality care. Powered by Teladoc®, the nation’s leading provider of telemedicine services, The Hx Telemedicine Solution offers your members a convenient, affordable alternative to care quality care, via desktop or mobile environment, right from the member portal. Telemedicine Solution Benefits: Affordable care that is often covered in-network by the member’s plan at rates that are comparable or less expensive than


Empower members to address unhealthy habits before they escalate into high-cost chronic conditions Optum™ Wellness Tools provide your members with online and mobile tools targeted to their needs and available from the member portal. They become engaged, motivated, and empowered to adopt behaviors and lifestyles that ensure that they become as healthy as they can be. That adds up to reduced costs for the payer. A Comprehensive Library of Personalized Wellness Content and Education 24/7 access to individualized wellness content and tools based on the member’s current health and health risk status Virtual coaching provides personalized guidance and motivation via


Reduce benefits administration costs with automated, paperless enrollment The Healthx Advanced Enrollment Solution provides all the tools in one place, on one system, to manage the entire benefits administration process from onboarding to separation, reducing costs and streamlining operations with fully automated benefits enrollment and management capabilities. Benefits Administration Capabilities Employees can self-enroll, make benefit changes, change benefit elections, compare options and pricing for themselves or dependents, add or remove dependents, access FSA and HSA information and balances, view employer contribution amounts, and view benefits history online or via phone Past benefit elections can be imported, allowing existing employees to


Empower members and providers to proactively improve member health The Gaps in Care solution integrates disparate member data to dynamically display alerts to both the provider and member at login when specific types of preventive care are needed. This helps members proactively seek care at and helps providers deliver care at routine intervals to detect and treat potential issues with early intervention. Gaps in Care Capabilities and Benefits Reduces costs and improves quality of care by encouraging the member to seek appropriate care at the right time and helping the provider to close gaps in care Displays gaps in care


Turn your portals into an engine that drives smart care decisions and reduces costs In today’s healthcare landscape, successful organizations are those that leverage complex data analytics to measure, track and predict consumer and provider behavior to identify opportunities to create more efficiency. The Healthx Analytics Solution Converts data gathered from the Healthx member and provider portals into information that helps improve healthcare delivery and outcomes, reduce costs and increase patient satisfaction. Analytics and Reporting Capabilities Easily tracks provider overutilization with reports highlighting deviations in provider care, provider pay versus peer groups and provider behavior patterns by hospital Identifies cost


A central point of care coordination for everyone involved in the member’s care When the member’s healthcare journey requires high touch acute or chronic care, it’s critical that the entire care team understand how care is being coordinated so that valuable information is stored, shared, and communicated with everyone involved in a member’s care. Hx Care Plans provide a single, centralized point of collaboration and care coordination to ensure that each team member is on the same page. Care Plans Features and Benefits Automates storage, versioning, alerts/notifications, review/commenting, and care collaboration Gives all providers (traditional and non-traditional) the ability to


Simplify the authorization process Not only does Hx Authorization Submission reduce costs and simplify workflows by automating authorizations, it also helps you stay compliant with regulations for faster, more streamlined prior authorization processes. Seamless integration and data collection puts eligibility, claims information, authorization submission and authorization status in one place, at the provider’s fingertips. Authorization Submission Capabilities Seamless transfer of data from provider to care management software (batch or real time) Inquiry updates automatically notify provider of status changes Batch or real-time outbound collection of required data for each authorization One-stop shop for eligibility and claims information and authorization submission,


Keep the benefits administration process focused and organized As benefits administrators, brokers juggle many administrative tasks to make business efficient and competitive. Broker portals make managing everything from enrollment to long-term planning a smoother, more organized process that eases workloads and automates workflows. Broker Portal Features and Benefits Permission-based rules govern which groups and super users can access different types of information Claims and eligibility views allow user to access files with varying personal health information suppressed depending on the user’s role and access permissions Access permissions can be segmented within human resources by division and department Benefit summaries provide


Get the right information to the right people at the right time Boosting customer loyalty is crucial to your success. To maintain a competitive edge, healthcare payers need effective and engaging analytics that help customers make informed decisions about benefit plan design, incentive programs, and other elements of their strategy. We offer a selection of customizable services to get the right information to the right people. Analytics and reporting capabilities Eligibility search – Ability to search across the entire member population in order to verify eligibility and coverage information (effective dates, primary care physician, member profile information), view and download