Skip to main content


Modernizing the Health Plan Business Process

Health plan organizations must conquer mountains of data, increasing regulations, and escalating consumer expectations. The digital interactions happening beyond your industry shape customers’ expectations. 

That’s why your digital presence matters, so you can offer services to meet their needs wherever they are. 

Common Risks and Consequences for Health Plans Not Embracing Digital Transformation:

Digital transformation in regulated industries, such as health insurance, can feel daunting, to say the least. I spoke with a friend in the industry recently and she had a long list of barriers to driving change in her organization. To name a few: long-tenured employees who have “always done it this way,” limited appetite for risk, and tight budgets due to growing competition and demand from small group employers for bare bones, cost-effective plans. The transformation blockers my friend sees are not uncommon in the vertical, but it’s not stopping some brave leaders from doing it anyway. Across the sector, carriers are making big plays to create a digital business and experience – and their customers are noticing.

A norm among many carriers is manual, paper-based processes across the sales cycle, from quoting to group setup, enrollment, on-boarding, and renewals. Often, processes are only incrementally modified to account for new regulatory requirements and updated plan designs. While existing workflows may be “working,” it is not without consequence.

Our point of view is that by not embracing digital solutions to enhance the sales process, carriers are:

  • Increasing internal administrative costs through manual processes and information transfer
  • Losing critical time in turning leads into quotes to closed business
  • Missing out on the opportunity to capture additional context on customers

While some carriers have dipped their toes into automation by investing in building capabilities themselves, homegrown solutions are time-consuming, add risk, and increase technical debt in an organization. This, along with the barriers noted above, often cause insurers to pull back rather than push ahead. Does any of this sound familiar?

Modernize Your Health Plan Business Processes with Salesforce Industries:

Perficient is recognized as the 6th largest healthcare IT consulting firm and a key leader in the space in the Modern Healthcare’s 2020 survey. We have extensive healthcare experience and support many of the largest health insurance organizations in the US including 5 of the 5 largest health insurance plans and 16 Blue Cross Blue Shield organizations.

Our experts are working with health insurers to leverage front and middle office automation using Salesforce Industries (formerly Vlocity). There are numerous benefits to this cloud-based technology. It is modular, declarative, and built on top of Salesforce allowing users to seamlessly integrate with CRM (Sales Cloud, Service Cloud, or Health Cloud). Salesforce Industries has incredible depth in and features for the health insurance industry, eliminating the need for complex customizations.

To join the brave organizations modernizing their business and the experience they offer brokers, employers, and members, consider these six steps to start digitizing your workflow:

Step 1: Start with the “Why” by Determining Your Pain Points

Collect as much information as you can around the pain points through each step of the sales, quoting, group set-up, enrollment, on-boarding, and renewal cycles. Talk to brokers, employers, members, and your sales and marketing teams to gather this intel. Where does most of the pain exist?

  • From small group employers, you may hear that they feel pressure to make a renewal decision quickly and wish they had more time to understand their plan options.
  • Large group employers may tell you that plan information isn’t easy to digest, and they wish they could compare plans, their differences, and costs more easily.
  • Brokers may complain that there aren’t enough self-service tools.
  • Your sellers might feel that the underwriting and manual census process is too slow and that they keep employers and brokers waiting on a quote too long – making them look bad and damaging relationships. They may have similar feedback around the administrative setup tasks that take place once an opportunity has closed, as well as around the member enrollment and on-boarding processes.
  • In the case of my friend, who leads a B2B health plan marketing team at her organization, her pain points revolve around not having insight into the clients currently receiving a quote or approaching renewal. Her team uses a cloud-based automation tool, but it has no connectivity to their on-prem CRM. And even if it did, meaningful information about the status of an opportunity is captured inconsistently based on the seller. This leaves her team resorting to “spray and pray” mass marketing versus personalized outreach using contextual information about where the group is in their journey.

Step 2: Quantify the “Why” and the Consequences for Not Changing

What is the opportunity cost of not addressing these pain points and can it be quantified in terms of efficiency, administrative cost, speed to market, lost business (new and renewing), net promoter score, or through another metric? These will become the measures of your program’s success. If possible, work with your SI partner or technology provider to calculate a return-on-investment analysis.

Step 3: Define Use Cases and Prioritize Them

After building out a strong “why,” decide where to start by determining the initial use cases your organization needs to focus on. The “why,” measures of success, and use cases will form the foundation of your program. Here are some examples of use cases that can be solved by using Salesforce Industries:

  • Automate screener process and census capture, and store data on employer’s account.
  • Implement self-service quoting and plan comparison tool for small group fully insured employers, with lead capture and quote to cart capabilities.
  • Create a self-service large group quoting engine and plan comparison tool that is dynamic based on geographic location and includes core medical offerings with ancillary benefits (such as critical illness or hospital indemnity).
  • Digitize the group set-up workflow when business has closed. Replace paper-based processes for submitting tax forms, providing payment, and collecting signatures.
  • Gain the ability to send messages in the broker/employer portal or via email with enrollment status and next steps. Create marketing automation based on where a broker/employer is in their sales cycle to keep them moving on their journey.

Step 4: Get Others on Board

If you’re in an organization like my friend, this will be challenging. But the time and thought you put into the steps above will take you far. It’s hard for people to argue with numbers. Communicate transparently and frequently, continuously reinforcing your why. Involve stakeholders in demos of the solution you are building to instill confidence and collaboration. Be willing to accept feedback along the way.

Step 5: Build a High-Performing Team

Identify the technologists within your organization that will contribute to the project, as well as who will represent the voice of the customer and business needs. Adopt a project metholodogy to streamline project delivery and optimize the team’s velocity. At Perficient, we are Scrum enthusiasts and live by the methodology. We think our clients should, too.

Step 6: Leverage a Strong Partner, like Perficient, to Fill Gaps

As a global digital consultancy transforming how the world’s biggest brands connect with customers and grow their business, Perficient has the vertical and technical expertise to fill internal gaps and help health insurance clients on their journey. As mentioned above, 5 out of 5 of the largest health insurers in the U.S. count on us. With more than 400 Salesforce certifications held by members of our tight-knit team, our consultants’ expertise helps clients identify the technology that is “just right” for their needs, implement, and scale. Having the right partner can mean time and money saved trying to recruit, hire, and train resources from within, faster speed to market, and the ability to demonstrate ROI.

Join courageous leaders across the industry and start taking action to digitally transform your organization’s front and middle offices.

If you need more inspiration, watch this overview of Humana’s journey.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.