Improving top-line and bottom-line value for a Payor in the Philippines.

In a nutshell …

A health maintenance organization (HMO) set out on a transformative digital journey to enhance operational efficiency, optimize health plan design, achieve competitive pricing, foster customer loyalty, and expand distribution, paving the way for significant growth. Seeking support, the client partnered with MiyaHealth and opted for our MiyaPayor platform.

This comprehensive solution offers workflow and claims adjudication automation, precise data capture, and insightful analysis of large datasets, while also combatting claims fraud, waste, and abuse. As an added benefit, MiyaHealth is providing a customized MiyaPatient platform as a value-added service to the client’s customers, cultivating loyalty and promoting other health plans.

The Problem

The client was facing the following key challenges:

  • High dependencies on manual processes throughout the journey (e.g. Manual LoG issuance, recon, etc.).​
  • Disjointed systems / processes resulting in delays and admin issues; poor data capture capabilities.​
  • Lack of operational expertise resulting in underutilized tech.​
  • Relatively undifferentiated product.
The Solution

To help the client achieve their objectives, we deployed the MiyaPayor solution to improve top-line and bottom-line value for their insurance line. In the future, we will collaborate to launch a customized, branded MiyaPatient & MiyaAvatar solution to drive customer loyalty and expand distribution for the client.

Why They Chose Us

The client chose to work with MiyaHealth as we provided a one-stop-shop solution – solving both the back-end issues and improving the member experience. They chose MiyaHealth because of our ability to improve the granularity of data capture for the client, and the ability of our products to drive both top-line and bottom-line value. They also chose us because of our team’s credibility and operational expertise.

How We Executed

Recognizing the complexity of the digital transformation required, we proposed a well-structured, two-phased approach for our enduring partnership.

Phase 1 prioritizes the deployment and utilization of Miya Payor, aiming to enhance the client's insurance operations and product offerings significantly.

Moving into Phase 2, we will develop a tailored Miya Patient platform, seamlessly complementing and adding value to the client's services. This platform will empower their customers with efficient chronic disease management tools and guidance for navigating healthcare decisions, including selecting appropriate and personalized health plans.

The Outcome

In Phase 1, within 4 months, we replaced existing systems with MiyaPayor digital capabilities. We expect administration costs to reduce by 30-40% and claims costs to reduce by 20-40%. We also expect the client to increase sales primarily by keeping its premiums low as a result of lower administration and claims costs.
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In Phase 2, we similarly expect the client to increase sales through the Miya Patient platform, which provides a good member experience, increases retail touchpoints, and drives personalized health offerings based on customer profiles and experiences.

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