Sky Solutions supports digital transformation for a large regional healthcare payer that serves roughly 1.5 million members. Like many healthcare payers, they have committed to various modernization initiatives aimed at improving access to healthcare and enhancing member experience. Critical to this mission is the ability of the organization to quickly and efficiently respond to market changes and member expectations and continue to provide members with timely and frictionless access to desired healthcare options. One area within the health insurance industry that has long been a prime target for digital transformation, given the opportunity to significantly cut cost and waste, and improve member experience, is in the member enrollment process.
This organization sought to enhance member experience by streamlining the member enrollment process and ultimately reduce the enrollment timeline, decrease case resolution time and increase Enrollment Processor productivity.
Outdated member enrollment processes and technologies have long posed several challenges to include manual and paper-based processes, lack of integration with other systems and data sources, limited accessibility, increased administrative burden, increased compliance risk and poor member experience, to name a few.
For over a decade, this organization relied on Lotus Notes, an older legacy CRM and ERP system, to facilitate a significant portion of their critical business processes, one of which was member enrollment. Historically at this organization, enrolling a new member took anywhere from several days to a few weeks and involved several highly manual processes that required access and interaction with several disparate systems and data sources. This resulted in frustration and delays on the part of various members, data inaccuracies and discrepancies, decreases in member acquisition and retention, and ultimately threatened revenue goals and targets.
It was readily apparent that the existing system, Lotus Notes, was simply incapable of providing the functionality required to mitigate and alleviate these challenges.
Sky helped to support the migration of the member enrollment process from Lotus Notes to a modern, Low-Code, cloud-based system, in this case Pega, that would provide the capability to streamline and automate several of the enrollment process functions, to integrate the required disparate systems and data sources critical to this process, provide reporting and visibility into the reengineered processes, and enable rapid scalability and adaptability for the foreseeable future.
The new Enrollment function on Pega has been live for over a year and since that time, the total enrollment timeline has been reduced from several days or weeks to only a few days or a matter of minutes. Case resolution time has been reduced by roughly 86% and Enrollment Processor Productively has increased by 95%.
Sky Solutions is a Digital-First enablement partner that believes in using a human-centered approach to address the most complex and rapidly evolving business process challenges facing public sector clients. Our core capabilities include Low-Code / No-Code Development, Cloud Services, Digital Process Automation & Robotics Process Automation (DPA/RPA), Human Centered Design (HCD), Artificial Intelligence & Machine Learning Services (AI / ML), and Agile DevSecOps. Additionally, we’re partnered with several leading-edge Business Process Management (BPM), Automation, and Low-Code Platforms. For more information on how Sky Solutions is helping to enable the Digital-First enterprise, visit www.skysolutions.com. Follow Sky’s LinkedIn for news and updates.
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