EXL leads health and wellness corporation’s innovation transformation

A large organization in the health and wellness industry recently wanted to generate and implement innovative ideas for its clinical program services in full alignment with its new corporate vision, mission, and goals. To do so, the company asked EXL to carry out a process of discovery, due diligence, and course-of-action recommendation.

The starting position

The organization identified specific objectives within its overarching goal that it wanted to achieve in three areas.

  • Building a global shared services organization enabling the client’s clinical workforce to operate at the top of their license without losing focus on administrative costs.
  • Accelerating a scalable shared services model while simultaneously minimizing risk.
  • Identifying and deploying digital capabilities that enhance member experience and drive efficiency.

Discovery: Detailing EXL’s role

EXL deployed a specialist team to be on-site at the client’s headquarters for an eight-week period. These eight weeks allowed EXL to carry out a deep discovery and design phase as part of the wider due diligence process. The EXL team was comprised of five domain experts in clinical operations, quality, training, case management, and project management.

The team executed a number of critical tasks. These included observing and learning about end-to-end processes and nuances regarding the client’s products, lines of business, and processes; conducting gap analysis on new and existing process documentation; and identifying opportunities for transformation across care management workflows.

The EXL team also created scope mapping documentation in collaboration with client’s operational and process SMEs, and designed an all-new comparative process flow of current versus potential capabilities. This eight-week discovery and design stage positioned EXL to understand the client’s situation and how to achieve the desired objective at a deep, granular level.

Recommendations and client feedback

EXL recommended an exceptional transformation of the member engagement process, utilizing EXL PHRNs as clinical care management support specialists to perform enhanced member outreach and enrollment activity. The five-member EXL taskforce also leveraged their own clinical experience in designing a collaborative, solutions-focused approach to member engagement.

EXL’s transformational solution was designed to bring high-value outcomes to the client’s clinical case management team through several key activities.