Healthcare New Business and Enrollments

Business Challenge
For today’s insurers, membership growth is increasingly dependent on customer response times. Service Level Agreements (SLAs) require higher levels of operational performance and when SLAs are not achieved, insurers experience poor customer satisfaction and retention, which can seriously impact the bottom line.

The volume and complexity of enrollment applications, combined with dependencies on paper-based and manual business processes, has led to the inconsistent, counterproductive and often costly administration of healthcare enrollment.

Additionally, these rigid, paper-based systems are often inflexible and unable to support change without significant lead times and large resource commitments.

As such, insurers need comprehensive solutions that improve the efficiency of enrollment processes; reduce administrative expenses; and enable them to efficiently manage cases requiring interdepartmental reviews; comply with SLAs for installing new members within allowable timeframes; and, quickly create and modify business processes as needed. The solution must also provide support for outsourcing of processes or sub processes.

Solution
IPD’s Ultera/P8 for Healthcare New Business and Enrollments supports end-to-end management of new member enrollment and underwriting. This begins by capturing and storing applications within the IBM Enterprise Content Management (ECM) repository. Using optional business rules engine integration to enable straight-through-processing, applications that are complete are automatically underwritten and approved without staff intervention. For incomplete applications, the solution automatically creates and distributes electronic work items to the appropriate next step in the process – usually for additional research or underwriting – based on configurable business rules.

In cases where additional data – such as medical records – are requested, Ultera/P8 for Healthcare New Business and Enrollments monitors receipt, automatically associates the new information with the existing case file upon arrival and alerts the appropriate staff member that work is ready to resume. Staff members are assigned to work based on their specific role as defined within the solution interfaces. These interfaces increase productivity and accuracy by providing only the documents and data necessary for decision-making, as well as associated task completion options. Throughout the remainder of their lifecycles, cases requiring ongoing medical or other review are automatically directed and monitored for return or completion by leveraging Ultera/P8’s for Healthcare New Business and Enrollments process tracking and reporting functionality. This ensures efficient process management across departmental boundaries and ongoing compliance with SLA’s.

Additionally, when new groups are sold and new business practices are required, Ultera/P8 for Healthcare New Business and Enrollments provides drag-and-drop workflow maps and intuitive configuration consoles to enable the rapid creation of new and modified process definitions by business analysts, without the need for code development. Using historical Ultera/P8 for Healthcare New Business and Enrollments data, these definitions may be simulated and the processes optimized before they are deployed, providing the ability to quickly respond to changing business needs and support ongoing process improvement initiatives.

Value Proposition
Designed and built by insurance industry experts and based on real-world customer requirements, Ultera/P8 for Healthcare New Business and Enrollments supplies multiple and specific features for new business and enrollments. The solution is scalable from the smallest to largest numbers of users across geographically dispersed operations, improve performance, reduce costs, comply with contractual mandates and respond to changing business conditions.

Ultera/P8 for Healthcare New Business and Enrollments delivers a low total cost of ownership and a compelling return on investment, with complete payback in less than 12 months. In addition, IPD clients report dramatic performance improvements and business returns, including cycle time reductions of 50 percent or more, productivity increases of better than 45 percent, and processing cost reductions exceeding 40 percent, with assured compliance, and within a fully configurable solution that is often deployed across most of the core operational areas of insurance organizations.

As an out-of-the-box application, Ultera/P8 for Healthcare New Business and Enrollments is proven to implement faster and with lower risk than custom- and integrator-built solutions. Many IPD clients required no coding effort whatsoever to meet their exact requirements.