Why CARE Matters in Healthcare

"Health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy"

Rick Johnson, senior director of the healthcare practice at J.D. Power
 
Six out of ten negative experiences are more likely to be remembered for longer in the provider industry compared to other industries, according to the Health Research Institute (HRI) of PwC.

Who We Are

The healthcare industry as we know it is rapidly changing. Cost-containment, radically new approaches to reimbursement, and healthcare consumerism are pressures that can strain your operations, and also your customer relationships. At HGS, we have the holistic lifecycle management expertise to build long-term relationships that engage, satisfy, and retain your members and patients. As partners in operational excellence, HGS has the healthcare domain knowledge and innovation to deliver optimized outcomes.

15,000

Healthcare Professionals

100 M

Members Served

1,100

Nurses

90

Healthcare Processes

HGS Health+CARE drives better payer and provider outcomes by:

HGS Health+CARE
  • Enabling a concierge approach, with 24x7x365 service to simplify the coordination of care and flow of information among patients, insurers, and physicians
  • Integrating the healthcare front office with the claims and healthcare management back office
  • Leveraging analytics and the HGS Digital Natural Assist to balance cost per member per month-all to make our payer and provider client partners more competitive by optimizing the healthcare consumer experience
  • HGS insurance market service delivery across 80 countries is seamless and consistent service from nearly 30,000 personnel in the U.S., U.K., Philippines, India, and Jamaica
Our Health+CARE solution is built on a foundation of empathetic support, operational excellence, and regulatory and compliance adherence.
 
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What We Can Do for You

As a client partner of 5 of the top 10 U.S. healthcare payers, multi-state health systems, and large provider groups, HGS brings transformational care management to these critical areas:

  • Nurse support - Our 1,100+ nurses are supported by a health information line and nurse triage, level-of-care assessments, and wellness solutions.
  • Integration of front- and back-office - HGS has proven success of $20 billion in claims payout, 12 million customer interactions, reduced rework, and increased NPS, for both payers and providers, supported by industry-leading compliance - HIPAA, GLBA , URAC, ISO 9000, ISO 27000, SAS 70.
  • Scale - HGS employs more than 15,000+ Healthcare professionals, to provide our expansive capabilities and solutions to 100,000,000 members served.
  • Global experience - HGS insurance market service delivery across 80 countries is seamless and consistent service from nearly 30,000 personnel in the U.S., Canada, U.K., Philippines, India, and Jamaica.
  • Consultative approach - We provide a cost-containment focus that comprises solutions across marketing, engagement channels, and CX strategy.
  • Wellness management - HGS specializes in health risk at enrollment, case and utilization management, and healthy products.

Unified Strategy

HGS Health+CARE Services

There are three foundational pillars to the HGS Health+CARE Services operating model and enabling technology platforms that ensure the best possible outcomes.

1

Optimizing
Experience

Building promoters with accurate, empathetic support to members

2

Ensuring Operational
Effectiveness and Efficiency

Care Expertise + People, Process, Technology

3

Creating Peace
of Mind

Addressing Regulatory Challenges and Compliance

Unified Engagement + Lower Cost = Better Member Experiences (Outcomes)

Impact

Can engaging with us improve your bottom line? Definitely. Consider this example. In 2015, HGS helped achieve significant savings and transformation for one of the top five U.S. payers, with 94.2% reduction in multiple reach-outs to brokers. Read about our partnership success here.

25% Turnaround Time Improvement

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Less than 5% Claims Denied

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40% Increase in Sales Productivity

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More Case Studies

Robotic Process Automation driving cost simplification and reducing time

 
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What the Experts Say

The HGS healthcare team believes in the spirit of community and information sharing. We provide thought leadership and insights as part of our commitment to making our clients more competitive.