Top insurer strengthens member care with Microsoft Cloud for Healthcare and Dynamics 365

Adapting to meet the needs of patients

For more than 35 years, MVP Health Care has been committed to creating healthier communities in New York and Vermont by making high-quality health coverage more accessible and supportive. The not-for-profit insurer consistently rates among the nation's top health insurance companies. The organization was recognized by both Medicare and U.S. News & World Report in 2022 for the quality of its Medicare Advantage plans. Over the years, MVP Health Care has appeared on multiple 'best places to work' lists.

MVP cares for more than 700,000 members with a wide range of health benefit plan options and a dedicated team that provides personal and attentive service. Over 1,700 caring employees make a difference in patients' lives every day through their commitment to quality and customer satisfaction. As a group, they're driven by the MVP mission to have a positive impact on the complete well-being of the members and communities they serve.

Even with the ongoing recognition for their plans and work environment, MVP isn't resting on its laurels. The organization knows that the health care industry is rapidly changing, and so it’s making changes, too. MVP Health Care is committed to keep listening, learning, and adapting to the needs of its patients and employees—which means investing in new tools and technologies that make health care simpler. The organization was prepared to make changes when it recognized an opportunity to improve processes and provide care teams with a more complete and useful view of members.

Disconnected systems cause disconnected experiences

MVP had already begun its journey towards building a complete 360-degree member view by moving sales and prospecting processes into Microsoft Dynamics 365 Sales. However, processes and data related to member onboarding, care plans, and care management were still managed by separate applications and departments. This resulted in member information being available only via manually pulled reports or via custom integrations that didn't always provide real-time data. To see real-time information, employees would have to log into the separate systems, since member data resided in one system, while clinical data resided in another. 

The impact of the multiple integrations set up between CareRadius, Facets, and other legacy systems was that MVP employees couldn't quickly and easily access the up-to-date member and prospective member information they needed to provide the best customer service. The system had no connection to historical member data, which sometimes resulted in either history loss or duplicate member records. Additionally, employees had to manually validate eligibility of prospects and current members for state and federal programs, which resulted in delays in eligibility verification and in reaching out to eligible members. 

Also, due to the different processes and systems, MVP was unable to connect the steps of the member journey from prospect to onboarding to care management. The activity history for prospective members wasn't available to be tied to their member records if they later became members. MVP employees had no information available about any previous interactions, including who had previously spoken to the prospect and what was said. And without that previous history available, multiple members of the sales team might reach out to prospective members and cause confusion.

The Health Risk Assessment (HRA) survey process was also very manual. External databases were maintained and reviewed to determine which members needed to receive the surveys. Then the data was manually imported into CareRadius and sent to a third-party fulfillment center for physical surveys to be mailed out. A separate third party managed online surveys and the Optical Character Recognition (OCR) scanning for the completed physical surveys to make the information available in a digital format. 

MVP knew it needed to address these challenges and create a more unified view of their members, and it chose Microsoft Cloud for Healthcare to transform and modernize their way of working. From addressing the near-term need for better 360-degree member views and more efficient survey processes to addressing longer-term goals for improved interoperability with partners and providers, Cloud for Healthcare's trusted capabilities were the ideal solution.

Microsoft Cloud for Healthcare and Power Automate transform processes

With Cloud for Healthcare, MVP benefitted from the combined capabilities of Dynamics 365, Microsoft Power Platform, Microsoft 365, and Microsoft Azure. These trusted, integrated capabilities—along with Common Data Model—made it possible to build a comprehensive, centralized, and interoperable member engagement platform. With the addition of the Care management solution from Cloud for Healthcare, it was able to achieve the 360-degree member view that it needed. 

For the initial launch, MVP chose to transition a subset of their members from their legacy systems to Cloud for Healthcare, using the group as a model for future programs. The subset chosen was the member group for their Dual Special Needs Plan (D-SNP), a special type of Medicare Advantage plan. The D-SNP plan was selected because it was a new offering with only a few members in its current systems, so it could build an end-to-end process without having to worry about as many dependencies on those systems. However, choosing D-SNP had implications for the timeline due to Medicare signup periods. The project—which began in June, —would have to go live by January and include onboarding capabilities even earlier, by October. 

With Cloud for Healthcare solutions powered by Dynamics 365, the organization created end-to-end processes for prospecting, onboarding, and managing the D-SNP member population. For the initial launch in January, MVP implemented specific requirements that were in scope to get members onboard. After the initial launch, the team added more features to meet regulatory compliance and other requirements.

During implementation, MVP quickly realized the benefits of using Power Automate to streamline and simplify processes and started using it to manage more integrations. For example, data that previously would be dumped into Excel files for manual processing can now be ingested into the system more efficiently using Power Automate, which automates monthly member eligibility queries. 

Additionally, Power Automate automatically generates the lists of members who need to be sent the HRA survey, replacing the former manual process. Dynamics 365 Customer Voice was also implemented to streamline the survey process, using out-of-the-box functionality to distribute mail surveys. For members without emails on file, a customer process was built to send physical surveys via postal mail. There are also plans to create an automated process to read the responses from the physical survey documents so that they can easily be added to the member records. 

Because of the complex nature of the project, the change management, training, and testing plans took longer than expected—but MVP was able to refine the plans by incorporating best practices shared by the Microsoft FastTrack for Dynamics 365 Solution Architect and the Customer Success Manager. Due to the combination of the rich out-of-the-box features and the MVP team’s knowledge of Dynamics 365 and Power Automate, the organization managed the implementation with in-house talent—only adding staff augmentation during the final phases to meet the accelerated timelines. 

Being an early adopter of Cloud for Healthcare, MVP provided valuable feedback to the Microsoft product team during the project. When the team encountered a few bugs, they were able to quickly resolve them with support from the product team. MVP also provided ideas about product improvements, some of which were included in later updates.

“Microsoft Cloud for Healthcare allowed us to extend our current Dynamics 365 implementation and place a focus on helping our customers achieve their best health. In doing so we were able to streamline data and processes from multiple systems, providing improved visibility and efficiencies all with the end result of providing exceptional service and care to our customers,” says Craig Heier, Director Dynamics Functional Implementation at MVP Health Care.

Dynamics 365 and automation lay groundwork for cost and time savings

Over time MVP expects cost and time savings due to the standardized and simplified processes, which will allow them to focus even more of their efforts on their continuing mission to create healthier communities. Since Microsoft Cloud for Healthcare now manages more of the data and processes, MVP was able to eliminate some of the integrations and the overhead associated with those integrations.

With both member data and clinical data now in Dynamics 365 and with automation-driven improvements to business processes, MVP has achieved real time 360-degree member view it needed to best serve their members and employees. Employees have increased visibility into member activity throughout their care journey, with a much simpler way to access that history. Care teams no longer have to log into multiple systems or rely on integrations or reports that might contain outdated information—they now simply access the Care management app. 

The onboarding process for new members has also been consolidated into Cloud for Healthcare, with one solution that now manages survey distribution via both email and physical mail. The new process saves time and money and allows Care Coordinators to access newly submitted surveys within minutes. Plus, Care Coordinators receive notifications when risk assessment surveys have been received via Customer Voice. The structured flow also makes it easier to meet deadlines without requiring manual intervention. 

Moving to a single system also simplified member communications, as anyone on the care team can now easily see a member's history and the communications they've had with other team members. For prospective members, the experience has improved because there is no longer inadvertent duplicate outreach since the activity history is now more accessible and complete. 

Plus, due to the connection of sales and clinical data in Dynamics 365, the clinical staff can forecast their upcoming caseloads better now. Previously, members could only be assigned once their insurance policy was active, but now pending members in the pipeline who aren't yet active can be included in the forecasting (reducing a two-week to three-month gap to near real-time for inclusion). 

Cloud for Healthcare brings scalability for future migrations and enhancements

For the foundational solution the organization has built for the D-SNP member population, MVP plans to keep refining the Care module features and adding enhancements for member management and knowledge management. Once all the features have been released, it will monitor the system for a period to determine if it needs to make any additional changes.

MVP expects to have up to 5,000 D-SNP members within three years, and once it reaches that target limit, the organization plans to move their current population from the CareRadius legacy system. Then, in a multi-year project, the member populations for all product offerings will be migrated from the legacy system to Microsoft Cloud for Healthcare.