Download our whitepaper on EEM here -> http://www.toplinestrategies.com/eem Cost pressure on health carriers has been intense for years, and health care reform is increasing that pressure further. Health insurance carriers are targeting the small group enrollment process for optimization. Most small group employer and employee enrollment processes are encumbered by hand-written forms, parcel delivery services, and four or more layers of redundancy. Change has to come. To realize the promise an optimized enrollment process can deliver to health insurance carriers industry-wide, the broker, employer, and employee must embrace the carrier’s new enrollment workflow with enthusiasm. This piece outlines the strategic roadmap to get there.

1. E E M
Enterprise
Enrollment
Management

2. A Process In Transition Carrier
The health insurance small-group
enrollment process is a prime target for
breakthrough process optimization in the
$2.1 trillion U.S. health care system. The
enrollment process constituents are ready
for change.
Broker/Agency Employer
Enrollment
Employee
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3. Large HealthCare
Carriers Look to Improve
Small Group Enrollment
Overhauling the small group enrollment
process can drive high returns on
investment and significantly improve
customer services.
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4. Small Group Enrollment
Challenge
The current manual process is
encumbered by hand-written forms,
redundant processes and parcel delivery
services, periodically interrupted by
computers.
Issues
Manual Forms
Redundant Processes
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5. A Costly Problem Executive
The current Quote-to-Onboarding process
is costly, time consuming and error prone
at Carrier
and results in an on-boarding delay that
costs the broker and the carrier.
Carrier
Delivery Guy
Broker Manager at the
Agency/Broker
Employee
/Family
HR
Manager
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6. Employee/Employer
Frustration
The current process wears down the entire
value chain, including the end customer.
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7. The Driving Forces
Health industry technology is moving at a
breakneck speed. This rapid pace of
change is driven by competitive pressures
that are buffeting carriers and other
stakeholders.
•Carriers with large R&D budgets, especially large
multi-state carriers
•Brokers using new tools to pit one carrier against
the other on price
•Federal government health care reform and the
changes likely to result from that effort on the
national level
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8. From Old to New
The old process & systems of multi-tiered
layers and redundancy, needs to be
replaced as the new emerges.
• What are the common requirements/keys of a
successful Enterprise Enrollment Application
System?
• How do the constituent users /application personae
express their interests and priorities?
• How do these requirements translate into
application features and functions?
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9. The Keys to Delivering
EEMS Success
To achieve enthusiastic adoption, stakeholders
in the enrollment process must experience:
• Distinctive benefit, service, and productivity value-adds
relative to the prior manual process
• Intuitive ease of use
• Complete control and visibility into the enrollment
application process
• A confidence in the impenetrable security of the personal
and health information
• Instantaneous access to customer service assistance
Ease
Value Control Secure Support
of Use
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10. Key Number 1:
Value
Distinctive benefit, service, and
productivity value-adds relative Gains in
to the prior manual process.
Clarity
Gains in
Commitment
Gains in Solid
Understanding
Gains in
Efficiencies
Gains in
Effectiveness
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11. Key Number 2:
Ease of Use
Intuitive ease of use including a highly
polished look and feel in the user interface
Intuitiveness
(such as a “pixel-perfect” look and feel).
Pixel-Perfect
Comfort
Familiar
Experience
Better
Experience
No Learning
Curve
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12. Key Number 3:
Control
Complete control and visibility into their
enrollment application process. Fill out
Form on
Their Time
Fill out Form
at Their Place
Promoted
When Ready
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13. Key Number 4:
Security
A confidence in the impenetrable personal
and health information security. HIPAA
Compliant
Data
Encryption
Algorithms
Intrusion
Detection
PHI
Regulations
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14. Key Number 5:
Support
Instantaneous access to customer service 24 Hour
Self Service
assistance.
Support
Full
Knowledgebase
& FAQs
Anytime, Anywhere
Access
Instantaneous
Access
Multiple
Simultaneous
Access to
Same Form
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15. Enterprise Enrollment
Management Improvements
for Small Groups
•Less confusing and resource consuming.
•More manageable and completed more quickly.
•More secure and private (health information and
health privacy) than manual forms and physical
exchange.
•Applicant friendly including immediate access to
assistance.
•More broadly informative. For the Employer/
Employee
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16. Enterprise Enrollment
Management Improvements
for Small Groups
•Effective broker control of group information
•An ability to deliver enrollment help to their client
companies and groups and those associated with
these entities.
•On-boarding optimization (including health portal
access) to afford them the broadest selection within
the insurance carrier’s product set. For the
•Complete agent visibility into the group and
employee/associate enrollment lifecycle. Agency/Broker
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17. Enterprise Enrollment
Management Improvements
for Small Groups
•Accuracy and productivity improvements driven by
measurable ROI.
•HIPAA/PHI compliance.
•Improvement in enrollee first impressions.
•Advancing the perception with enrollees and brokers
that the carrier is adding value to its insured clientele
and broker community interests and priorities.
•Integration to and compliance with, all established
For the
vital carrier IT data processing systems and standards. Carrier
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18. Enabling Technologies
& Standards Are Here
Optimization of the enrollment process is
now possible through the use of mature
enabling technologies that incorporate
industry standards and best practices.
These include:
• Dynamic forms
• Pixel-perfect user interface standards
• Data encryption algorithms
• Workflow management systems
• Interaction tracking through Relationship
Management systems (xRM)
• Advanced dashboards that leverage instant access
in-memory Business Intelligence
• Electronic medical records (EMR) standards
Securely hosted personal health management
portals that carry health data that is fully compliant
with HIPAA and PHI regulations
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19. Engagement
Lifecycle
Achieving this effective experience is
dependent upon a good start that fits
cleanly into the engagement (on-boarding)
lifecycle process.
Undifferentiated Client Benefit
Qualified Pre-Enrollment Enrolled
Market Understanding
Lead Commitment Client
Opportunities Satisfaction
Health &
Benefit
Management
xRM/BI
xRM/.Net Portals for
Application
Marketing xRM/CRM Enrollment Employee and
Completion
Automation Quotation Application Family
Management
Enabling Technology
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20. Engagement
Lifecycle Advantages to integrating
Achieving this effective experience is
dependent upon a good start that fits health portals and the
cleanly into the engagement (on-boarding)
lifecycle process.
enrollment application
Undifferentiated Client Benefit
Qualified Pre-Enrollment Enrolled
Market Understanding
Lead Commitment Client
Opportunities Satisfaction
Health &
Benefit
Management
xRM/BI
xRM/.Net Portals for
Application
Marketing xRM/CRM Enrollment Employee and
Completion
Automation Quotation Application Family
Management
Enabling Technology
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21. The Benefit
Reality Gap
Although 93% of employers think it’s
important for their employees to
understand & appreciate their benefits,
only 19% believe employees actually do.
1-in-5 believe employees
actually understand
Think it’s Important
19% that they Understand
93%
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22. Health Portals
Will Thrive
Complementing the value associated with
improving the small group enrollment
process efficiency are other high value
benefits to the carrier. These include
advantages resulting from integrating the
enrollment process to employee and family
health management portals. The benefits
could:
•Enrich enrollee experience
•Improve first impressions
•More permanently connect the carrier
with the insured
•Increase health portal usage by
insured
In the long run, these components of the
expanded enrollment solution may have an
even more positive impact for insurance
carriers than the enrollment process
improvement.
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23. Critical
Functionality
To ensure the re-engineered
enrollment process achieves
the full range of opportunity, it
must have six important feature
categories:
•Employer Portal
•Employee Portal
•Broker/Agency Portal
•CRM/xRM Functions/Interface
•Rich Dashboard
•Security Suite
Employer Portal Employee Portal Broker/Agent Portal
CRM/xRM Functions/ Rich Dashboard
Interface
Security Suite
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24. Critical Separating the small
Functionality group enrollment process
To ensure the re-engineered improvement effort into
enrollment process achieves
the full range of opportunity, it
discrete phases and
must have six important feature aligning each with its
categories: distinct return on
•Employer Portal
•Employee Portal investment will manage
•Broker/Agency Portal
•CRM/xRM Functions/Interface risk and ensure
•Rich Dashboard measurable success.
•Security Suite
Employer Portal Employee Portal Broker/Agent Portal
CRM/xRM Functions/ Rich Dashboard
Interface
Security Suite
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25. Employer
Portal
Features:
•Online enrollment for employers
•Data and statistics about employee enrollment
activity through reporting capabilities
•Highly personalized employer dashboards
•Bills and payments follow-up
•Comprehensive tracking and reporting capabilities
of enrollment and renewal processes
•High visibility into all insurance plan partners
Vision
•Key contacts for employers with up-to–date
information
Robert Wallace
•Ability to administer multimedia including
educational podcasts, videos, and animations
•Ability to administer robust health libraries, articles,
and daily news for sharing with employees
•Secured and targeted messaging to employees on
health-related issues
•Short-form health insurance brochure
•Terms to know
•Ability to view enrollment information any time
•Ability to manage the enrollment process
•Detailed audit trail to track changes over time
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26. Broker/
Agency Portal
Features:
•Multi-user interactive environment that enables
brokers to assist in the completion of an application,
either in person or over the phone
•Support for broker monitoring of application
completion process by account
•Renewal support through proactive triggers and
alerts
•Online access to most up-to-date forms
•Easy support for calculation of shared commissions
between brokers and agents
•Support for cross-selling and up-selling to new and
existing clients
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27. Employee
Portal
Features:
•A clean, uncluttered, visually appealing look
•A rapid, intuitive enrollment experience
•A level of usability that increases enrollee
acceptance
•Ability to grant employees instant access to benefits
elections through online confirmation statements
•Ability for employees to self-print their own health
insurance ID card
•Benefit overview displayed in a way that lets
employees self-service most questions in this area
•A universally familiar tab interface
•Clear labels
•Express prescriptions/claims
•Big buttons including instant access to help with a
“chat button”
•Multimedia including educational podcasts, videos,
and animations
•Robust health libraries, articles, and daily news for
sharing with employees
•Simple tools such as a "go back" key
•A clear “percent complete” bar providing a continual
message of progress toward application completion
•An "application summary" of remaining responses to
be completed
•Language preference options to support non-
English speaking employees
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28. CRM/xRM
Functions
Interface
Why xRM Functionality:
•These systems provide excellent
tracking tools, workflow management,
auto-campaigns, strong reporting and
back office integration
•It’s the xRM automation and
customization of xRM that --
• Enables the delivery of the form,
• Encourages the timely
completion of the enrollment
process
• Reminds the constituency of
available resources
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29. Rich
Dashboard
Features:
•Customized Broker Dashboards
•Customized Employer/HR Dashboards Analyze
critical business metrics with customizable
dashboard views that illustrate your organization’s
state of health
•Provide—on a “click”—with KPIs, maps, rankings,
forecasts, progress against benchmarks, activities
status, customer service, and contextual details to
authorized stakeholders
•Enable fast, reliable business decisions based on
accurate and usable information
•Optimize the human investment with a reporting
connection that links up with customer data stores to
extend business intelligence—and help monitor
changes or trends
•Identify where help is required
•Provide a separate data repository built to optimize
data load time but minimize query effects on
response time of the live enrollment/CRM
environment
•Track key metrics such as:
•Enrollment by Broker
•Enrollment by Employer
•Enrollment by Industry
•Percentage to Completion
•Campaigns Sent
•Most Difficult Questions
•Number of Campaigns
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30. Security Suite
Rock Solid and Fully Compliant
Security
•SAS 70 facilities and procedures, with
offsite redundancy and load balancing
•PCI compliant hosting including 2-factor
authentication for system users
•HIPAA compliance end to end (see detail
below on this vital topic)
Integrity
Confidentiality Availability
Security Risk Security Remediate Secured Training Evaluate
Responsibility Analysis Strategy Third
Parties
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31. The Business
Case is Made
•Comprehensive integration and development
of a small group enrollment lifecycle is now
practical.
•However, to achieve the promising returns that
an Enterprise Enrollment Management system
can deliver for small groups, carriers must
gain enthusiastic adoption across the wide
multi-organization workflow.
•The combination of mature enabling
technologies makes this achievement possible
with integrated health management web
portals, secure hosting and data encryption,
in-memory dashboards built with state-of the
art Business Intelligence toolsets &
Relationship Management platforms (xRM) to
manage interactions and workflows.
•Careful application of project management
methodologies is essential. Separating the
small group enrollment process improvement
effort into discrete phases and aligning each
with its distinct return on investment will
manage risk and ensure measurable success.
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32. The Topline Strategies
Total Story
TopLine Strategies delivers the complete integration and development of sales and marketing technologies to
corporations and institutions. We analyze client requirements and apply innovative processes and technologies to
improve and strengthen our client’s revenue streams and customer interactions. The experience of our team and
disciplined project management practices ensure our clients timely delivery and measurable results.
Core Practices: Key Partnerships:
•Relationship Management
•Marketing Automation
•Enterprise Content Management
•Business Intelligence
•CIO & CTO Services
•IT Human Resource Consulting & Staffing
Our analysts, project managers and application development engineers have extensive experience with the
requirements of mid-enterprise corporations and institutions, including the following:
Comprehensive Lifecycle Approach:
•Financial Services
•Insurance and Health Management
•Education & Government
•High Technology
•Energy & Resource Management
•Firms with complex channels (agents, brokers, franchisees, partners)
You can learn more at www.toplinestrategies.com
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33. Next Steps
Visit the TopLine website, social sites or
call us to learn more about Enterprise
Enrollment Management.
1 2 3
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TopLine Strategies on Slideshare
Visit www.toplinestrategies.com Call (480) 503.8584 x257 TopLine Strategies’
Social Presence
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34. Learn More
View TopLine Strategies’
Slideshare Presentation on xRM
Download our Whitepaper at
http://bit.ly/toplineemmswp
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