The Challenge
The Regional Health Plan faced significant obstacles due to its proprietary provider directory, which lacked the necessary functionality, scalability, and compliance to meet evolving state and federal mandates. This outdated system hindered sales, member engagement, and the health plan's ambitious business growth goals. Key challenges included:
- The inability to scale with new product launches;
- Limited support for online sales and broker-driven prospecting; and
- Gaps in compliance with CMS regulations, including the Provider Directory API mandate.
The Solution
To overcome these challenges, the Regional Health Plan chose Perspecta as its strategic technology partner. The decision process involved evaluating multiple solutions, but Perspecta’s comprehensive provider directory solution stood out for its scalability, compliance capabilities, and user-centric design. The project included:
- Replacing the outdated directory with a modern, scalable solution;
- Designing both public- and member-specific directories tailored to users’ needs;
- Integrating the member directory into the existing portal via SSO; and
- Enabling functionality to support future expansion and compliance needs.
The Results
After implementing Perspecta’s solution, the Regional Health Plan saw remarkable improvements. The new provider directory ensured regulatory compliance, including adherence to CMS interoperability requirements. Broker enablement and online sales increased, driving revenue and market share. Members experienced a more personalized and integrated directory access, enhancing their overall experience. Additionally, the health plan established a scalable and future-ready platform, positioning itself for ongoing product and business expansion.
Metrics supporting these successes include:
- 100% compliance achievement
- Increased broker enablement
- Enhanced member experience
- A future-ready scalable platform.
