At a glance
Client
A top-five health insurance payer headquartered in California.
Goal
A single solution to generate, update, and edit, regulated CMS documents in house, increasing efficiency and growing the business.
Scope
Full scale integration of personnel, software, and workflow processes from multiple regions and subsidiaries– to enable in-house, self-service customer communications.
Solution
A center of excellence (CoE)—using the Elixir® platform—to unite the client’s multiple stakeholders and subsidiaries and manage their workflow needs.
Result
A Center of Excellence for Medicare communications, centralizing and streamlining all the systems in the document ecosphere—translation, 508 compliance, accessibility, data. A full transition to in-house CMS document production and management. Continued yearly growth of 30% – 70% in new plan documentation.
The Elixir® platform empowers efficient, scalable, and sustainable regulated CMS document generation and management.
Introduction: Growing pains
Business was booming for a leading health insurer. They were providing premier coverage for one in eight Americans. Growth had come through hard work, innovation, and ambition. It had also come by way of mergers and acquisitions.
Now they were experiencing growing pains.
As a result of their growth, many of their internal processes were fragmented. Subsidiaries had their own unique ways of doing things. This was especially troublesome for member communications, particularly regarding Medicare and Medicaid plans. The Center for Medicare and Medicaid Services (CMS) has strict regulations on member communication documents.
Generating and updating CMS documents is mission critical to any company providing plans to Medicare/Medicaid users. The company had been outsourcing the production of its member communications. This system was expensive. Then each subsidiary had its own process for managing, updating, and approving the documents. This was inefficient.
The company’s continued growth was stunted by a lack of cohesion.
To improve operational efficiency the company needed to consolidate business units and introduce shared services across the enterprise. They wanted to empower their teams and bring document management in-house.
They needed technology to unite their people around in a common process.
They needed a new solution.
Challenges and goals
The insurer needed more than a software upgrade. They needed a digital transformation. These were the challenges they were facing:
- Expensive, outsourced document management system
- Manual workflows
- Multiple and redundant systems
- Siloed business units across the organization on different pages
- Far-too-regular compliance issues
These issues were leading to workflow bottlenecks, stagnation in growth, and ultimately to customer turnover and attrition.
These were their goals:
- Enable internal teams to take ownership of outsourced document production
- Centralize control and decision-making for the documentation process
- Create clear and efficient systems and best practices across the enterprise
- Expedite the entire document lifecycle and time-to-market through automation technology
Meeting these goals would maximize the effectiveness of their human resources, slash communications costs across their enterprise, and ultimately enable efficient growth and expansion through the production of more plans.
Finding a partner
The insurer chose to partner with Elixir technologies and use the Elixir platform for their digital transformation. The team at Elixir provides 37+ years of experience in modernizing member communications in regulated industries like health insurance. Elixir’s successful partnerships with top healthcare payers make them a valued consultant and resource in the health insurance space.
They chose Elixir because the product and the team behind it provided a solution built for growth. Here’s what Elixir offered:
- Customizable automation to generate, update, and approve documents
- A scalable, cloud based ComOps platform that manages complex workflows
- Built in transparency and governance across the enterprise to handle regulated communications
- Seamless integration with existing technologies like Adobe Experience Manager and Microsoft Office/ Microsoft 365
- In depth user training for new teams and users
- Task driven interfaces that empower non-technical users to work effectively
This organization used Elixir to move to automated self-service for CMS documents. The Elixir platform centralized the payer’s entire document lifecycle and enables its teams to establish best practices across the entire enterprise.
Solution: A Center of Excellence
The insurer correctly realized that their previous approach to regulated documents treated member communications like a cost center. At the heart of their digital transformation was a redefining of customer communications as a growth driver. Generating regulated plan documents generated new plans, new members, and further expansion.
Together with their new partner, the insurer began building a Center of Excellence to direct and control their future member communications.
Gartner describes a Center of Excellence (CoE) as “a physical or virtual center of knowledge concentrating existing expertise and resources in a discipline or capability to attain and sustain world-class performance and value.”In other words, a CoE is the war room where a company gathers its top decision makers and experts to direct an aspect of its business. A CoE draws together complementary technologies, well-defined scalable processes, and experts in the field to achieve the most effective outcomes.
This enterprise built its CoE on Elixir, a ComOps platform. Elixir uses automation to unite stakeholders and assets from across a company. It enables real-time workflow management, information sharing, and technological integration. It centralizes decision making by cataloging and organizing workflow data from its many individual users.
The move to a modern ComOps platform both enabled efficient self-service from individual team members, and better oversite from decision makers.
Developing a CoE to manage CMS member communications provided the health insurer with self-service capabilities to enable and support users across their organization. Their automated ComOps platform immediately started maximizing efficiency and generating returns.
Implementing success
Implementation of the Elixir platform and CoE began in 2018. Major growth was seen within the first two years. (See the case study). Mutually assured success is the hallmark of every CoE project on Elixir.
Elixir commits to making new infrastructure meet their partner’s business needs. They conducted regular training to ensure new users gained hands-on experience on the platform. The teams at the health insurer learned how to successfully use their new tool and took ownership of the in-house customer communications process.
It was essential that all the pieces of the tech stack worked well together. The Elixir platform integrated the payer’s existing tech and chipped away at technology fragmentation.
By connecting Elixir to other technologies —for example, an automated translation tool—the company consolidated their workflow. From there the payer’s teams moved on to an integrated approval workflow, and the process advanced. The new CoE with Elixir collapsed disparate workloads into one solution and removed redundancies in technology. It streamlined workflow across all the organization’s teams and subsidiaries.
A roadmap for growth
The first regulated documents that the health insurer tackled with their CoE were: Medicare Annual Notice of Change (ANOC) and Evidence of Coverage (EOC). Their goal was to take ownership of the process, improve efficiency, scale growth, improve governance, and minimize risks.
As planned, the CoE centralized and managed the company’s processes for documentation.
Every team member now has a defined role and uses the same technologies and workflows. The first year’s success created a roadmap to effectively scale operations and bring additional documents onto the Elixir platform from every part of the business.
Their CoE with Elixir is scalable, sustainable, manageable, and efficient. “The CoE provides a powerful competitive advantage: Their new plan documents are growing by 30% to 70% each year.”
The CoE provides a powerful competitive advantage: new plan documents are growing by 30% to 70% each year.
Your next steps: Building a CoE with Elixir
Elixir’s comprehensive software-as-a-service (SaaS) platform scales with your business’s communication needs. It’s even more powerful supporting teams across your enterprise through a CoE. Elixir’s award-winning customer service provides the consulting and support your team needs to move from managed or outsourced services to a model of self-service (Gartner Customer Choice Vendor: Customer Communications Management (CCM) 2020).
While the benefits of reduced costs and timeto-market from a ComOps CoE are clear, it can be a daunting project to begin. Luckily, we’re experts at it at Elixir. Our purpose-built SaaS offerings, professional services, and extensive experience with this kind of project ensure your team’s success.
Curious how might this look at your org? Contact us to book a 30-minute consultation and learning session.
