The BroadVision Blog

Galaxy Health – Collaborative Process Management

Galaxy Health is a US healthcare insurance provider. Galaxy has chosen Vmoso to  improve its membership acquisition and renewal rate as well as a number of collaborative business processes involving member enrollment and renewal, plan management, claim escalation and dispute resolution.

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With so many parties involved in these processes – employees, family members, employers, brokers, insurers and providers – they can generate a huge amount of time-consuming discussions. Galaxy are confident that by using Vmoso Collaborative Process Management they can improve the efficiency of these discussions, leading to a lower cost of service and happy customers.

It’s open enrollment time at Vision International. Sue is an employee at Vision, and she’s trying to work out the best plan for her family.

Her husband, Joe, works part time and look after the children, meaning the whole family is covered on Sue’s plan.

Sue and Joe like the plan from Galaxy Health but have a few questions. So Joe downloads the Galaxy app and joins the chat. Included in this chat is Galaxy’s chatbot which gives rapid answers to frequently asked questions, reducing the burden on Galaxy’s customer service team.

Joe wants to check that his primary physician is included in the plan.

This is something the chatbot can handle easily, quickly confirming that the doctor is indeed already covered under the plan by searching Galaxy’s database of providers.

Joe suffers with back pain, so also wants to check whether a chiropractor he sometimes uses is included in the plan.

This time, the chatbot says no. But it guides Joe towards the process for requesting inclusion of additional providers.

By using a collaborative process to request additional providers, both Joe and Galaxy save time. Joe starts by entering the chiropractor’s details.

So by the time it reaches Galaxy’s customer advisors for review, all the necessary information has been collected.

Joe can see the status of his request and is notified when it’s approved, and has a record of the conditions attached.

Sue’s now ready to sign up for her Galaxy plan. Again, this is performed using a Vmoso collaborative process, which is integrated with document processing and digital signature systems to streamline this type of customer engagement; a document created by QuickSilver and maintained by DocuSign details specific coverages, terms and conditions under her plan.

 

When she runs into any trouble during this sign-up process, she clicks into the collaborative process’s chat tab, where its built-in chatbot is able to answer all her questions interactively, guiding her through to completion.

A few months later, and Joe has suffered a recurrence of his back trouble

He initiates the policy’s coverage validation process by requesting authorization for treatment from his chiropractor

As the chiropractor is not on the list of approved providers, this is not automatically approved, but assigned to Shirley in the Galaxy customer advisor team to review

Shirley tells Joe that unfortunately his treatment can’t be approved

But Joe has the details of the previous conversation where use of his chiropractor was authorised, so simply links to this.

Shirley acknowledges her mistake and approves the treatment

After a short course of treatment, Joe is feeling a lot better

But Sue’s surprised to receive an invoice from Joe’s chiropractor that she thought should have been covered in full by Galaxy.

So Sue starts a process to query the bill that involves both Galaxy and the chiropractor’s admin. She includes links to the authorization process, and the earlier agreement to add Joe’s chiropractor to the plan

Jamie in the Galaxy billing team assesses Sue’s query and looks back through the previous discussions. What Sue has failed to notice that the earlier approval did point out that only 90% of the chiropractor’s bill would be covered, and that Sue would be billed for the other 10%

Sue & Joe realise that they have overlooked this, and the billing query is resolved.

A year has gone by, and it’s now annual health insurance renewal time at Vision International.

Sue and her family have been very satisfied with their Galaxy Health plan, thanks especially to its mobile-centric high-touch engagement experience empowered by Vmoso.

So when Sue receives Galaxy’s renewal alert, she immediately starts the collaborative process to complete the renewal, which normally involves just a few simple confirmation steps.

However, by taking advantage of Vmoso’s Big Knowledge and its integration with artificial intelligence predictive reasoning capabilities, Galaxy can now analyze Sue and her family’s health profile and actual care received over the past year, compare that to a vast database of similar cases, and recommend the most cost-effective plan coverages for Sue to consider.

Sue chooses a new option, as recommended by Galaxy, which not only increases her coverage but also saves her several hundred dollars per year, making her an even more satisfied customer.

Galaxy’s use of Vmoso benefits everyone across its entire ecosystem, making it easier for customers to get the information they need quickly, and reducing the burden on Galaxy’s own customer advisors as well as its network of brokers and providers.

Using collaborative processes for plan selection, claim authorization and billing query processes ensures that everyone knows what needs to happen next and reduces miscommunication.

Preserving previous discussions as a “single source of truth” for future reference gives a full audit trail and ensures rapid resolution of any queries.

With Vmoso at the centre of their customer engagement, Galaxy has been able to achieve its business goals very successfully by improving membership acquisition, increasing customer satisfaction and reducing their cost of customer service.

Galaxy Hospitals Medical Research

Galaxy Hospitals uses Vmoso to help medical researchers plan, prepare and execute their studies, Vmoso lets them engage with both the physicians who can benefit from research findings, and patients in the trial cohorts.

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Dr Sandra Baker is a young researcher at Galaxy Hospitals. She’s got plenty of ideas and lots of enthusiasm, but hasn’t published many papers yet, so she struggles each time she applies for a grant.

She’s planning a study about the relationship between the environment children grow in – including nutrition, physical activity, pollution and exposure to pesticides – and their growth. In addition to the statistical snapshot this study would provide, she believes that indicators can be found to help prevent environmentally-induced pathologies that develop unnoticed.

Sandra has published a short abstract of her project in Vmoso, inside a public space which can be read by anyone from Galaxy Hospital who’s interested in pediatric research. A few physicians have answered her message, giving her a few extreme examples of children affected by pathologies which, they suspect, could be related to their lifestyle.

One of them, Dr Felz, has also contacted her in a private chat to share some data about cases which could help Sandra refine her research topic. His message includes his findings in an attached file, and a reference to Sandra’s original post, making it clear why he is contacting her.

From the data shared by Dr Felz, Sandra is able to see a pattern, but of course that’s just a suspicion. In the hope of discovering more supporting data, she comments on her original post, asking readers to point her to any data that could confirm or deny her initial findings.

Shortly afterwards, she gets an email from Dr John Martinez, from another research institute. John is currently trying to push forward a very similar project, and he’s been given Sandra’s details by Dr Felz. John is interested in joining forces, so that they can present a more robust project for a grant application. An abstract of his project is attached to the email.

Sandra decides to grab the opportunity and transforms the email into a Vmoso chat. As she does this, John receives a notification email, which is also an invitation to join Vmoso to gain full access to the chat. He registers, and becomes an external member. He can now collaborate with Sandra, but doesn’t yet have any access yet to the data shared only with Galaxy Hospitals.

John and Sandra work together to refine the abstract. Sandra creates a Vmoso space to share all the related documents, and gives John access to the space. They collect data which they either upload to Vmoso, or simply share from existing Galaxy Hospitals data already present in Vmoso.

After a few weeks of work, Sandra and John feel that their project is very solid, but still lacks some details regarding the recruitment of subjects for the clinical trials. Neither of them is very experienced on this topic, so they decide to gather some knowledge about it.

Sandra navigates the Vmoso posts and finds a couple of topics about cohort recruitment. She quickly gets lost in all the explanations she reads, so decides to look at the connections between those topics and users. For that, she switches to the knowledge map of the posts, which show relationships between discussions, documents, and users.

She quickly finds a researcher who is involved in many cohort selection discussions. Dr Victoria White is a recognized expert on this topic so Sandra invites her help in her study. That’s done very simply by adding her into the discussion already taking place with John.

By going through the discussion, Victoria is able to quickly understand the research topic, which she immediately relates to. She suggests a cohort recruitment process which is added into the grant application documents.

Finally, the application is ready to be sent to the granting body that they have decided to apply to.

The grant application has been well prepared, and shortly afterwards the team receives the approval and is able to start the research.

In order to organize the collaboration necessary for the project, Sandra creates a spaces in Vmoso to share documents and discussions with relevant and authorized participants.

A company-wide space is created to share status announcements about the project, and build up traction inside Galaxy Hospitals.

A restricted space is created, shared only with the core team, for all the discussions and documents which the team need to keep private.

Other private spaces are created to collaborate with individual physicians helping with the cohort selection and management, and also with the patients families to share instructions, news and advice with them.

In order to find potential patients, Vmoso is integrated with the electronic medical records system. A query is done through Vmoso and the results are returned to the selected Vmoso thread from the records database. This avoids the need for Sandra to switch between multiple tools and automatically makes the data available to all project researchers.

Because each patient has Vmoso access through Galaxy Hospitals, the potential trial patients will be notified about the research project through both Vmoso and email, allowing them to choose the communication channel they prefer.

Once enrolled, the patients’ families can interact with the research team through either the Vmoso-enavled MyGalaxyHospitals app, or directly through Vmoso.

In addition to the news and advice pushed to the patient families through their Vmoso app, the families are also asked to complete questionnaires relating to the lifestyle of their children. For example, how much time their child spends exercising, how much fruit and vegetables the child eats, etc.

The questionnaire results are made available to the physician following the child, and to the research team. The physician has the opportunity to double check with the family whether the answers are correct, and to correct them if needed, before the data gets fed into the study database.

Whenever physicians have doubts or need to discuss specific aspects with the research team, they can use either the global post, or one of the private chats each of them has with the team.

After 5 years of research, the study delivers interesting results, but Sandra’s objective is to have at least 15 years of data. Sandra and her team are able to use the data recorded in Vmoso to quickly build a grant extension application, and they succeed in obtaining a 5 year extension.

If a researcher requires a test using specialized medical equipment during the course of the project, they can book a time through Galaxy Hospitals’ equipment rental portal, which is integrated with Vmoso. A Vmoso task is created including both the equipment booking team and the equipment operator.

The researcher can then communicate with the equipment team through Vmoso with any questions. When the test has concluded, the results are added to the task.

Dr Felz is also very satisfied with the outcome of this study. Thanks to the communication channels he has with the research team, he is able to get early access to the study results. This helps him advise families in the best way possible to improve the health of their children.

Vmoso helps the research team plan, prepare and carry out their studies. It improves the communication and collaboration between the research team, the patients, and interested medical professionals, resulting in faster, more accurate results.

Galaxy Health

Galaxy Health is a US healthcare insurance provider. Galaxy’s new CEO made it his personal mission to overhaul the way Galaxy communicates with its partners and customers so that it can deliver the best care and service to its policy holders, medical providers, agents and brokers.

See how Galaxy and their major partners have chosen Vmoso to streamline the communication involved in claims, thereby lowering costs and speeding up resolution.