CASE STUDY
Modernizing Health Plan Enrollment Through Predictive Process Modeling
THE CHALLENGE
Outdated systems and manual processes were costly and inefficient, and impacted customer service
A major national healthcare insurance payer that serves more than 5 million members nationwide aspired to reimagine its enrollment process by leveraging modern digital solutions. The client struggled with old, disparate systems, a cumbersome user interface, incongruent data and highly manual work, resulting in fragmented processes, inefficiencies and errors.
These issues were compounded with staffing capacity during peak enrollment seasons, incurring additional costs and process error waste. These challenges experienced throughout member enrollment, from intake to processing and fulfillment, also negatively impacted downstream claims and customer service processes.
Optimity had previously worked with the client to deliver an enrollment and customer service modernization strategy and roadmap. Now the client was ready for actionable Lean process efficiency and customer-centric design solutions to deliver a trusted, user-friendly process to increase enrollment throughout, reduce cost, enable resource flexibility and improve customer service.
Optimity’s team took a hybrid, iterative approach that combined human-centric design thinking with Lean process optimization.
OUR SOLUTION
A quantitative and qualitative approach that drives efficient workflow and delighted user adoption
To meet these challenges, Optimity’s team of Lean process engineers and user experience experts took a hybrid, iterative approach that combined human-centric design thinking with Lean process optimization.
Through facilitated focus groups, business users and leadership aligned on the overall problem statement, and through personas and journey mapping exercises, they reached consensus on key user groups and their challenges and uncovered the areas of greatest importance and opportunity. Through design thinking-driven ideation exercises, we were able to harness the collective intelligence of a diverse group, from stakeholders to processors, all in one room, to brainstorm opportunities for the ideal future state.
Our team worked with the client’s enrollment users and stakeholders to build and test multiple workflow simulation models in order to measure potential throughput and cost improvement scenarios. Our Lean process simulation modeling techniques enabled us to clearly visualize the process and use data to uncover and predict the process approach that would deliver optimal results.
Through rapid UX prototyping, we reimagined a unified enrollment platform that connects multiple systems and data to provide a consistent, user-friendly interface. Having an interactive prototype that stakeholders could touch and feel also enabled us to envision and further optimized these process workflow routings, resource loading and activity automation.
The project created data-driven quantitative guidance to reduce process waste and defects, improve user adoption and apply effective technology for potential automation.
TOOLKIT
User Interviews
Personas and Journey Mapping
Facilitated Focus Groups
Collective Intelligence Workshop
Real-time Prototyping and Visualization
Workflow Simulation Modeling
THE RESULTS
Developed a scenario-tested Lean process that minimized waste, enabled RPA automation, and increased overall efficiency
Simulation modeling and prototyping accelerated insight into future performances and enabled evidence-based decisions
Designed UI model to maximize user adoption and effectiveness
Roadmap of continuous improvement recommendations driven from measurable impacts
Visibility to impact downstream processes, including claims, customer service and billing
The client is now using these optimized process models to drive further IT system use cases, designs and development backlog
