enabling payor transformation

Copyright © 2020 Tech Mahindra. All rights reserved.

ENABLING PAYOR TRANSFORMATIONTech Mahindra PoV & Solutions

Aug 2020

2Tech Mahindra Confidential 2019

2ENABLING PEOPLE TO RISE SINCE 1945

2,40,000+EMPLOYEES

$21BILLION

100+COUNTRIES

22INDUSTRIES

11SECTORS

Aerospace & Defence

Aftermarket

Agri Business

Automotive

Farm Equipment

Financial Services

Hospitality

Information Technology

Partners

Real Estate

Two Wheelers

MAHINDRA GROUP

125,200+ EMPLOYEES $5.2 BILLION 90+ COUNTRIES

DELIVERING EXPERIENCES- OUR FAMILY

RECOGNITION TILL 2019Microsoft global

Supplier Leadership

Award on Climate Change-2019

Carbon Disclosure

Project-2018

Science based

Targets

Awarded byISS-oekom-

2018

DJSI Emerging Markets Index

2018

DJSI EMI

DJSI World Ranking 2018

RobecosamSustainability

Yearbook 2018

FTSE4Good Index 2018

TECH MAHINDRA


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11600+ employees based in Americas40 offices5 data centers

8700+ employees based in APAC21 offices8 development centersBusiness footprint spans more than 12countries

4400+ employees based in Europe + UK50 offices24 development centersBusiness footprint spans more than20 countries

INDIA81200+ employees 38 officesBusiness footprint spans more than14 States

AUSTRALIA1000+ employees 6 offices3 development centers

AFRICA90+ employees 6 officesBusiness footprint spans more than 5 countries

3:1 Gender Diversity 29 years average age 60 Nationalities

CONNECTING WORLD ACROSS REGIONS


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TechM Health & Lifesciences

Customer success

Focussed Sub Vertical Digital Ecosystem

Our aim is to touch 4+ billion lives by 2025 with the help of our customers by empowering them with NXTGen technology services.

LIFE SCIENCESPAYER MEDICAL DEVICEPROVIDER

200+Global Customers

6000+Associates across locations

$0.5 BN Revenue

28Delivery Locations

Delivering Future of Care across sub-verticals

Our Ecosystem


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Our Healthcare Payer Practice has been consistently ranked as one of the most matured practices in the industry, with over two decades of experience in serving several US Health Insurers and Blues plans.

22+YEARS

INDUSTRY EXPERIENCE 1500+ PROJECTS DELIVERED TO IMPLEMENT WaaSIN PAYER INDUSTRY

FIRST

2300+ person years ofexperience in solutions

Over 500+ projects delivered for a single customer over 7 years

Expertise on Core insurance products like FACETS, DIAMOND, Power MHS

Avg. 5 years of engagement with most Health Insurance customers

Presence in USA, Middle East and Australia

Served 2 of the top 10 US Health Insurance Companies

Clinical Based Solutions

Analytics Platform on Salesforce

Digital Member Experience Business IntelligenceData Activation Platform

to help Value based Care

Tech Mahindra has built a portfolio of capabilities & ecosystem partners to help our Customers


6Tech Mahindra acquisition of Provider focused HCigroup strengthens our Payer-Provider Integration capabilities

HCI is a high growth healthcare IT companyproviding clients with full service solutionsand proprietary products in advisory,implementation and support for complex ITsystems within healthcare. Now a part ofTech Mahindra.

Recognized as the fastest-growing privately held company in the healthcare sector

Increased client service capabilities with EHR Experience of HCI & Technology

Experience of Tech Mahindra

Trusted relationships with its 200+ health system clients

(covering 800+ hospitals)

Global Partner #1 for EHR Advisory & IT Managed Services2018 | 6 Consecutive Years 2018 | 6 Consecutive Years 2018 | 4 Consecutive Years

RPM CONSULTINGEMS HEALTHNxT EMRDIGITAL HOSPITALS

HCI has been heavily involved in over 100 Epic implementations;


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Customer Experience

Service Experience

Physical Experience

Operations Experience

DataExperience

NextGen ADMS

Data Analytics

Digital Assurance Services

Patient/ Member Experience (CX) and digital transformations.Design the customer experience

Enhance Physical DesignImpacting Star Rating for topline and bottom line

Creating Omminchannel Experience , world-class strategy, creative, content and commerce offerings with strong technology

Clinical Experience and Expertise – Deep Insights

As a Service

Smart Business process

Cloud

Security

WE DELIVER EXPERIENCE…


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01

02

03

04

05

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Provider Management

Complete Automation and Process improvement of Network Management function leveraging PEGA platform. Reduces the enrolment, administrative cost and improves Provider relationship time.

Virtual CareTechM Connectsense TM – a holistic patient support digital platform providing end-to-end patient engagement and remote patient monitoring services

Automated Audit Tracking

RPA(UI Path) enabled automated solution to validate regulatory compliance checks on member access data on web channels, and compare against existing member data.

Predict Group Cost using AI PlatformUsing Machine Language, Predict Group cost from historical data and realigning Product and cost strategy using Lumiata platform. The results are compared with Cost trends and group benchmarks

Digital Mailroom ServiceDigital Mailroom automates tedious back office processes with digital channels, artificial intelligence and machine learning. Helps secure confidentiality of information through mailroom.

Workspace-as-a-Service (WaaS Nxt)Allows organizations to experience workplace virtualization and simplify the whole process for customers. It brings flexibility, agility and secured environment for users to operate anywhere, anytime and any device

FOCUSED SOLUTIONS


TechM Payor Experiences


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Indicative projects and the value delivered

§ Disease Identification § Pharmacy claims integration

§ Employer Group Reporting § Digital Health Initiatives

Value Delivered1. Improve disease identification & stratification process 2. Save cost by decommissioning third party analytic tool 3. Increase accuracy of predicting emergency visits due to

hypertension

CARE MANAGEMENT Data extraction, validation submission for:§ BCBS Axis Cost Data (NCCT) § Value Quest § FEP CMDM Data Exchange § PDR (Provider Data Repository)§ ITS (Interplan Teleprocessing Service)

Value Delivered1. Perfect score for the timely submission and data quality 2. Supported Consortium Health Plan for projected discount

analytics with timely data submission3. Stay compliant with required BCBSA mandates

BCBS ASSOCIATION MANDATESEnd-to-End management and support § Provider Portal § Employer Group Portal Support § Member Portal § Agent Direct Enrolment Tool

Value Delivered1. Improved self service capabilities 2. Stay compliant with HIPAA and CMS mandates3. Help agents renew/view/update plans for subscribers

CUSTOMER EXPERIENCE

End-to-End management and support§ Enterprise Web Service (Eligibility, Benefit, Claim) § Provider & Other Payer Web Service § X12 Healthcare transactions § Trading Partner Manager (TPM)§ Missing claims reconciliation § Member Touch Point Measure (MTM) Audit

Value Delivered1. Consistent and current information about plan 2. HIPAA / Blue Exchange SLAs for X12 transactions 3. Reduced claims administration cost 4. Help with annual claims audit & MTM audit resolution

CLAIMS AND BENEFIT OPERATIONS Support § HEDIS Audits § DOI Audits § Plan Performance Audits

Value Delivered1. Audit reports for various business stakeholders 2. Identify possible audit points

PLAN AUDIT § On-board ACO and setup data exchanges § Maintain Population Health Management platform§ Value based health plan reporting

§ Efficiency Score § Attributions § Risk Scores

Value Delivered1. Helped plan for alternate payment settlement (Shared

Savings/CPC+) and reconciliation 2. Helped Plan in CMF payments , Member Analytics and

deriving Quality Measures

VALUE BASED HEALTH PLAN

15+ Years of Partnership journey

OUR EXPERIENCES WITH SOUTH CENTRAL BCBS COMPANY


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Not startedQ1 CY’19 Q2 CY’19 Q3 CY’19 Q4 CY’19 Q1 CY’20 Q2 CY’20 Q3 CY’20

Performance Engineering Services

Salesforce App. Development | ServiceNow Support Services | Sharepoint Support Services | Liferay Portals Development

Care Coordination Portal App. Dev. Services | HEDIS & CM App Dev. Services and L2/L3 Application support

Journey began

Projects in-flight16 7

Outcome based

9T&M based

Relationship Highlights

70%Consultants working on Data management, BI & Analytics Programs

US based delivery100%

Consultants from TechM Delivery Center in Plano, TX

60+ Production Releases

20+

Analytics Transformation

CCP and HEDIS & CM App Support (Production support)

Major BLUEs Plan in North America – TechM Journey

Supporting 5.4 million Federal Employees, retirees and their families


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Digital ServicesWorkspace

As a Service (WaaS)

2013

Apr’2017

Office 365 & Win 10

Oct’2017

Service Deskand EUC Operations

Jul-2018

Architecture

Feb’2019

• Provide L1 & L2 support for

end users

• Serving 85,000+ users globally

from 4 different locations

• Handling average 68 K calls

per month, additionally 5 K

through Chat, Email and

Service requests

• Handled end to end project

management, end user

training and communications,

OCM, Onsite & Phone support

• Migrated 28,000+ machines

successfully

• Developed a tool that

integrated 60+ APIs from

multiple domains such as

Claims, Benefits, Enrolment,

Health Actions and Nurse

messaging

• Enables business users and

support agents to accelerate

their validation in much easier

way

• Strategic Unified End User

Computing Platform

• As A Service model with always

ON and scalable platform

• BYOD enabled workspaces in

compliance with healthcare

security

• 60,000+ VM’s with 99.999

availability

• 100% SLAs, 5 years in a row

• Provide Enterprise Architecture

Services in multiple Business

domains

• Information Architects,

Salesforce Architects, Integration

Architects and Solution

Architects

TechM Services Landscape – Leading Top 5 Global Health Insurer


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Some past experiences with Blues

DEEP & WIDE RELATIONSHIP WITH BLUES OVER A DECADE

Data Consolidation, Data Migration and Enterprise Data warehouse

Creation of Data Store (PDS)

Development of Enterprise data warehouse (EDW)

EDI support and SAS reporting

Production support services

• Application Development Maintenance and support, HIPAA gateway enhancements, maintenance and support

• Data Consolidation and Data Migration

• HIPAA5010 Implementation

• CRM Enhancements

• Care Management Analytics

Benefit Design Consulting and support Pega Product

Configurator Implementation

IT Conversion Project, Solution accelerator development

Y2K support, Application Development Maintenance and support, Data Consolidation, Data Migration and Enterprise Data warehouse

Application Development to DW Applications, Commercial and Corporate Applications

Application Development and enhancements (Claims)


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80K Workspaces as a Service

RPA for Enterprise functions

Chat bot based Patient Engagement

850+ Million People in India have access to Emergency Service

10,000+ Cancer Patients on our Patient Support Program

Digital Supply Chain for Specialty Care

AI based Digital Pathology

1 Million Farmers to be touched with Tele Health

92% Adherence to Therapy

BOT enabled Emergency access for Differently Abled

13k Ambulances, attending 240K Calls and 25K Emergencies per day

AI lead Drug Discovery

Expertise in using technology to improve health outcomes

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