Sales and marketing effectiveness



Shifting consumer behavior, evolving regulations and nuanced market dynamics raise the stakes for sales and marketing teams to innovate. MA plans also must win broker mind share and differentiate themselves in a commoditized market.

Bringing science into decision-making



Many MA plans use more art than science to make critical growth decisions such as market expansion, benefit design updates and marketing budget allocation. Plans need to learn from other industries and use data and analytics to make key growth decisions.

Product differentiation



The competitive MA market has eroded distinctiveness among health plans. Many now offer features and benefits that often are differentiated only by pricing and network options. MA plans must cut costs while adding attractive supplemental benefits.

Sustaining quality performance



Regulatory changes related to the Star Ratings program, including an increased emphasis on member experience measures, and continuously increasing benchmarks present significant challenges for MA plans to maintain and improve their quality scores.

WHAT WE DO

Challenges we solve



Geography expansion strategy



Determine which geographies to enter and simulate enrollments based on predictive modeling. Identify emergent trends in those geographies and model how expansion will perform against the expected competition.

Benefit insights and analytics



Design a differentiated benefits package by understanding its competitiveness, alignment with market trends and customer needs. Using ML-based models, simulate plan performance for different benefit design scenarios.

Broker targeting and engagement



Maximize broker engagement with advanced modeling using different data types including agent, enrollment, benefits and social drivers of health data.

Marketing mix



Simulate budget scenarios and estimate marketing impact to make objective spending decisions and optimize budget across channels.

Star Ratings analytics and advisory



Use data and analytics to maximize Star Ratings by prioritizing underperforming measures and analyzing performance drivers for individual measures. Run a successful program with targeted interventions and real-time performance monitoring.

Digital annual enrollment period (AEP) command center



Overhaul AEP dashboards to reduce the time to insights, provide a next-best action recommendation with each insight and formulate a clear structure for your teams to follow through. Estimate the impact of actions via what-if scenario modeling.

HOW WE DO IT

ZS’s approach





Next-Best Plan (NBP) solution



NBP helps plans solve design challenges with a single data repository and AI/ML-driven insights. It identifies performance drivers, recommends supplemental benefits that drive enrollments and offers county-level insights on market trends.

Next-Best County (NBC) solution



NBC uses predictive modeling to help plans determine which geographies to enter by simulating potential enrollments and identifying emerging market trends. It also allows plans to assess how expansion will perform against the expected competition.

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