Health plans: Best practices for increasing agility in an ever-changing market

Amid the national health care debate, many health plans are focused on anticipating changes in regulations, membership populations and consumer needs. Nevertheless, leading health plans are also focused on enhancing operational excellence to enable their organization to quickly manage and distribute products that align with the ever-changing needs of their market and members.

Many health plans have made significant investments to keep up with state and federal regulations at the expense of internal process improvement. The reality is that time-consuming workflow redundancy and manual processes stand in the way of a better experience for consumers and health plan staff.  Maintaining disparate systems is a common challenge, and there is a clear need for health plans to reduce their IT ecosystems to alleviate the overwhelming maintenance burdens.

Sophisticated health plans realize the key to increasing speed to market, data integrity and operational excellence is leveraging automation from product ideation to revenue generation — enabling sales, product, actuarial and compliance teams to make quality decisions about new and existing products in a timely manner. Additionally, establishing a single source of truth for benefit data that can be shared with downstream-consuming systems removes silos and enhances compliance and operational efficiency.

Best practices for leveraging automation to increase operational agility include:

Find intuitive tools that support clear communication, management and dissemination of benefit information across systems, including built-in business rules to support changes in regulations and compliance, for more efficient sales and product configuration teams.

Utilize automated underwriting for centralized rate management, financial modeling and automated quoting to decrease sales turnaround time while increasing financial controls and operational agility.

Optimize the view for sales partners and consumers with online, self-service tools to streamline renewals and new member onboarding to shorten the sales cycle, reduce manual processes and improve consumer satisfaction.

You can begin simplifying the business of health care by leveraging automation in the design, deployment and distribution of products. When challenges are addressed, profitable membership growth, increased operational agility and improved financial performance are achievable.

For Viewpoints on the 2019 CMS Call Letter, click here

About the author

Jodie Dowd
VP, StepWise® Practice

As VP, StepWise Practice, Jodie has deep experience in health plan sales compliance and operational efficiency. She specializes in identifying opportunities to optimize workflow in the quote-to-cash continuum for health plans and has broad experience in product lifecycle management, individual and group sales, rating and enrollment processes.


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