Leading health insurance payer moves to cloud.
At a Glance
In 2014 a top five national health insurance payer began using Elixir®, a ComOps platform, to produce and manage two of their mission critical Medicare/Medicaid documents. They had previously outsourced their customer communications. The move was so successful that by 2019 they moved three more documents onto the platform. This resulted in a 60% efficiency boost across five products and a significant decrease in errata. This case study explores the challenges they faced, their subsequent digital transformation, and the ComOps tools they used to streamline and expedite their operation.
Client: Top-five national health insurer
A top-five national health insurance group with 280B+ USD in annual revenue. This organization provides market leading service to over 146 million members through private, corporate, and government funding.
Challenge: Expensive and slow outsourcing
An inefficient and expensive system for producing, managing, and updating regulated Medicare/Medicaid documents through a third party.
Goal: Move to self-service
Take ownership of regulated customer communications. Move to full self-service production and management of regulated documents. Increase efficiency. Reduce errata.
Result: 60% faster time-to-market
Ownership and self-service for five mission critical regulated documents. An average boost of 60% efficiency in time-to-market for all five documents on the Elixir® platform.
Growing pains
This insurer was near the top of their game, but needed to modernize.
In 2014 one of the largest health insurance payers in the country saw an opportunity for change. They were leading their segment and continued growth was on the horizon, but they were frustrated by the inefficiency of their customer communications and documentations processes.
Part of their success had come from their ability to grow and expand in the Medicaid/ Medicare sector. They offered a variety of plans to a diversity of members. However, every plan they offered required generating, updating, and delivering complex sets of regulated documents.
The Center for Medicare and Medicate Services (CMS) has very strict regulations concerning customer communications and plan documentation. These communications are essential to bringing new products to market.
The insurer had a longstanding practice of outsourcing their customer communications. As the insurer continued to expand their business, they were weighed down their outsourced communications management system:
- It was expensive: Costs were incurred for every document generated, every edit, and every update.
- The process was slow: Even the smallest change in a document required a complicated chain of custody, and complex approval process.
- It was error prone: The constant back-andforth lead to errata, which incurred federal penalties and hurt the insurer’s reputation and bottom line.
The insurer needed to take ownership of their documentation process. They needed a new solution.
Innovative leaders bring change
The insurer had the foresight to choose a partner and a solution that would address its current challenges and enable future goals.
Change is slow in regulated industries. To this day, some major businesses are still storing their documents on decadesold mainframe computers. Inefficient and expensive processes often remain in practice because change is scary. The idea of a “digital transformation” sounds expensive and difficult on human resources.
Similarly, outsourcing customer communications management (CCM) used to be considered best practice in the health insurance field.
The decision makers at this company were not afraid of change. They saw the potential for self-service and freedom from their third party CCM. They saw that new technologies like a cloud-based service platform and automated document generation tools could revitalize their mission.
The insurer partnered with Elixir Technologies, a ComOps company with 37+ years of experience in document management and partnerships with many of the top health insurance payers in the country. Together they implemented Elixir, a cloud-based ComOps platform, and started taking ownership of their member communications.
Partnering for success
The insurer started with achievable goals and invested in growth.
The first projects the insurer tackled with Elixir were the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents. Both are complicated documents that must be produced and updated every year for every plan.
Elixir offered an immediate price reduction from the insurer’s outsourced CCM. Their annual budget for ANOCs and EOCs had been over 1.5M USD. To implement the Elixir platform and transfer all existing documents to the cloud required an initial investment of only 400k USD. This left over 1M USD in allotted budget to grow and empower internal human resources.
The insurer could save money and invest directly in itself and its teams.
Elixir Technologies handled the implementation of technology and transfer of data. The biggest challenge for the insurer was empowering internal employees to take charge of the company’s documents. The solution to this challenge was built into the partnership.
Elixir offers comprehensive training services. After one session, a Marketing Specialist at the company said that the training: “covered everything, it went beyond my responsibilities, and helped me understand the whole process… now I understand more, I am a lot more comfortable with the solution.”
“[the training] helped me understand the whole process... now I understand more, I am a lot more comfortable with the solution.” – Marketing Specialist
Challenges
- Document production was owned by a third party. Speed to market was out of the insurer’s control.
- Stakeholders were siloed. Each team interacted independently with the outsourced CCM. This was inefficient. It created bottlenecks and redundancies in the workflow.
- The old, overcomplicated system was prone to errata.
- The chain of custody for documents was convoluted, resulting in workflow redundancies and errors.
Solutions
- Elixir’s automation tools enable userfriendly self-service for document production and editing. The Smart Template and Component Management System allow non-technical users to produce new documents efficiently. Then the centralized workflow approval gets these documents to market quickly.
- Elixir enables real-time communication and active collaboration between users and stakeholders. Marketing teams and compliance teams now work on documents simultaneously. Centralizing the workflow eliminated major bottlenecks and redundancies.
- Elixir automates errata review and approval workflow. Discrepancies and errata are automatically flagged. The process is expedited and transparent.
- Elixir automates and centralizes archival. It lets users freely access and review documents from any stage in their lifecycle.
Success at scale
The insurer replicated their success by moving more documents onto Elixir.
In the first year, the insurer took ownership of their ANOCs and EOCs. The Elixir platform streamlined the production process. They had complete self-service for updating and editing documents. By 2019 the insurer had added three more mission critical documents to the Elixir platform. Now the insurer has ownership of their Benefit Highlights, Vendor Information Sheets, and Summary of Benefits documents.
What started as a solution for EOCs and ANOCs has brought an average boost of 60% efficiency in time-to-market for all five of their documents on the Elixir platform.
The numbers speak for themselves
With five major documents on the Elixir platform, the company saves time and maximizes its output. They benefit from realtime, cross-team collaboration, automated document production, streamlined editing, and automated errata review.
On average, they have reduced the time it takes to produce and edit five mission critical documents by 60%. This includes reductions in edit time of 74% for ANOCs and 72% for EOCs.
Their returns compound every year. From 2020 to 2021, the company saw a 40% decrease in errata across all its documents on the Elixir platform.
ComOps powered efficiency enables the insurer to bring more plans to market across all their lines of business.
They found a solution and a partnership that grows with them.
Growing together
When COVID 19 hit, the insurer was forced to move to remote work. Having already switched to Elixir on the cloud, their member communications operations were uninterrupted. Elixir let their excellent service and production stay consistent throughout their period of remote work.
A ComOps platform is essential to modern companies in regulated industries. It empowers employees to perform at peak efficiency in the face of new challenges. This health insurer’s organization continues to grow and expand, and Elixir continues to meet their needs and bolster their mission.
Elixir is proud to partner with three of the top five health insurance payers in the country, like the one in this case study.
60% less time to produce 5 mission-critical communications
