Making it easier for healthcare members to find, select, and access care.
By highlighting quality, cost-effective providers and facilities with personalized search, S365 helps 65M+ members make better healthcare decisions.
Health plan members are increasingly aware of rising healthcare expenses and are seeking solutions to help them make sense of the costs they are likely to face. At least 88 percent of adults living in the US lack the health literacy required to navigate the healthcare system and promote their well-being, according to the Milken Institute.
These consumers need easy-to use tools that help them better address and manage household healthcare spending. They expect these tools as part of their health plan service experience.
For most health plans and TPAs, collecting and maintaining the data while managing the business rules, configurations, and regulations required to deliver this capability is both cost prohibitive and not a core capability of the organization. S365 provides a white-label search experience to help customers find accurate estimated costs of care from in network providers and facilities while removing the administrative burden for health care organizations.
100+ new market validated capabilities including 5 partner integrations, 1 major multi-year regulation, dozens of continuous improvements, and WCAG 2.1 AA compliance.
Sapphire (now Zelis I&E) built and developed the S365 platform as an efficient alternative to the homegrown provider directory. Built using an Elastic Search framework, the solution provides various discovery tools including browse, recent searches, and personalized next best actions to support members in finding the care they need using their preferred discovery model.
The easy-to-use and personalized care shopping platform helps members search for, evaluate, and select high-value healthcare. S365 also delivers on the federal Transparency in Coverage (TinC) requirements by allowing members to easily access cost estimates and empowering them to address and manage household healthcare spending.
Since 2020, S365 has launched a number of new capabilities and continuous improvements as part of a structured release management and product management process, including:
Search for Virtual Care Alternatives and Search by Service Area
Integrated Medication Finder in partnership with RxSavings Solutions
Integrated Rx Coupons with Single Care
National Provider Quality Display and Rewards with Embold, and Health Corum
Member Profile and Next Best Actions
Propel Health Action Platform integration
FHIR API support for Provider Directories
Always planning at least two releases ahead, the product and engineering teams work to optimize the work of teams to deliver the highest value new capabilities while keeping an eye on technical investments and validated continuous improvement opportunities.
Embracing mobile-first members.
Healthcare consumers don’t plan healthcare the same way anymore.
They are digitally fluid and often on the go
They understand data and the value of data
They increasingly consider healthcare “shoppable”
They operate in two modes: “In the chair” and “on the go.”
In the Chair: More detail for deeper evaluation of account and care mostly using the S365 desktop experience
On the Go: Answers and actions in a hybrid of phone and web based experiences.
The S365 platform is designed and maintained to provide a similar experience that optimizes the user experience to the device.
A shopping platform for healthcare
The S365 platform is a B2B2C solution. To deliver successfully, it must deliver flexible, high quality solutions at three distinct layers in the consumer healthcare shopping model—the member experience, the shopping cycle, and the data & decision layer. This reference model outlines the layers driving product and engineering decisions.
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Some clients want to own the omni-channel experience and some want us to handle the experience.
We provide options for both with a white label user experience rooted in WGCAG 2.1 AA compliant user experience and RESTful API catalog to enable clients to build using our services.
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The member journey is primarily a shopping journey. There are specific capabilities available along the shopping cycle to help a member make good healthcare decisions.
With an integrated incentive solution, we provide members with cash rewards to make better healthcare choices and measure the conversion to ensure program ROI and realize value for all stakeholders: the health plan, the employer, and the member.
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Healthcare is incredibly complex. Data management and business rules must be meticulously ingested and maintained to ensure accuracy in everything from provider search to cost.
The S365 solution has provider and member data warehouses that store all client supplied and third party sourced data used in processing business rules and decisions that power the experience.
Embracing Healthcare Cost Transparency
As a result of the Transparency in Coverage Final Rule (CMS-9915-F) enacted in October 2020, health plans and TPAs are required to make personalized out-of-pocket cost information and the underlying negotiated rates for all covered healthcare items and services available to members (and their authorized representatives) through an internet-based self-service tool.
Over the course of a three year regulatory timeline, S365 underwent significant upgrades to user experience and underlying data management to comply with the regulation.