A recent report found that Blue Cross Blue Shield plans’ administrative expenses amounted to 9.1% of premiums collected in 2011. For those that have been following the Affordable Care Act’s (ACA) effect on Health Plan Carriers’ business model, this report shines the spotlight on an increasingly important reality of what Health Plan Carriers are closely watching. Health Plan Carriers must continue lowering total administrative costs while adhering to the ACA’s Medical Loss Ratio (MLR) requirement that has already been scaled into effect. Solutions must be in place to address the Summary of Benefits and Coverage (SBC) requirement that so many carriers are struggling with at present. The bottom line seems to be that carriers must have the tools and the expertise (internal or external) to respond and adapt to this rapidly changing environment. These are some of the challenges that Customer Effective is helping address with the Dynamics CRM-based solution for Health Plans Administrators.
So Why Dynamics CRM?
Simply put, we leverage the power of the Microsoft Dynamics CRM platform to help our Health Plan Administrator customers automate business processes in a variety of ways. Sometimes this is as simple as introducing the very natural and intuitive user interface (web-based or Outlook-based) to a group of sales reps who need better access to customer and prospect data. Other times it involves the integration between back-office systems like claims and underwriting or modeling the CRM workflow engine to simplify the assignment and visibility tasks. Below is a screenshot of a Dashboard used by many of our Health Plan Administrators for managing the sales side of the business.
Sales Manager Pipeline Dashboard
…but it doesn’t end with Sales. Health Plan Carriers have a unique business model where the implementation of the sold product can be exponentially increased by the complexity of the customer’s needs. Inefficiencies with all of the tasks associated with bringing on a new group customer, for example, can quickly drive up administrative costs. Furthermore, the on-going administration of a large group can be a costly and time consuming effort that, if not done to the satisfaction of the customer, makes renewing that customer the following year more challenging. We have modeled CRM to address the typical needs of the post-sale implementation process and the on-going administration of a group.
Workflow Designer in CRM for Post-Sale Implementation Tasks
Workflow-Generated Task Assignments for a Group
Post by: Caldwell Warley, Customer Effective