Over the years, one of the most active practices we have had has surrounded the automation of the Group (especially Small Group) quoting and enrollment processes. In the pre-ACA days, much code was written (and blood spilled) over the complexities of selling business across 51 markets, each governed by separate DOIs and state-specific rules covering everything from benefit requirements, to year-over-year risk adjustment limitations and unidirectional, state-to-state situs arrangements. With ACA, our hopes turned toward a more consistent federal approach to benefit structures, pricing models, etc. However, reality brought "grand-mothering", non-EHB (Essential Health Benefits) plans, segmentation of business into risk-adjusted and non-risk-adjusted categories, as well as an additional level of complexity where most carriers now had multiple lines of group business each with its own complexities (and likely its own systems).

One of my favorite quotes comes from the French writer Antoine de Saint-Exupery: "Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away." I have found in my career that simple solutions are often found on the far side of complexity – meaning complex solutions appear first, and simple solutions take much more work to find. Inadvertently, the group segment of our industry has found themselves solidly in the complex region of the solutions in the name of trying to achieve market simplicity. At no point in the year is this complexity on greater display (and with the greatest impact to the bottom line) than right now during the peak of the group open enrollment season. The deficiencies in your systems and processes become painfully obvious in your staff's extra-long days and in the teams of "temporary" helpers you enlist to get those renewal proposals out the door and the enrollment changes processed back into the membership system. Ask yourself, is this yet another year you will get to mid-January and heave a sigh of relief and swear you will not do this again? Will you promise to find a way out of this crunch-time nightmare for next year? But beware, great, simple solutions can be much harder to find than complex ones...

Finding that elusive simple solution is possible, but it comes with embracing a few scary concepts. First, you must look at your process as a whole. The problem you have is not a scalable enrollment system. The problem you have is a scalable member engagement system. If you focus on "enrollment," then you will design solutions that get people enrolled, but that don't go beyond that. I have seen it time and time again in our client's existing solutions; enrollment is the squeaky wheel that gets the focus at the expense of a more balanced and holistic approach to engaging with your members and groups. I have seen many carriers with well-built on-boarding systems that cannot renew the business, or process a change in coverage, or allow a client to view and pay their bill. If all you focus on is the onboarding customer journey, you will miss the many other necessary interactions with the members and groups that you need to process during the year (which is more than just processing claims, by the way). So, broaden your use cases to cover the entire customer lifecycle (shopping, on-boarding, coverage changes, service cases and questions, bill payment, AND renewals), and find a tool or a platform of integrated solutions that can help you manage the members across ALL interactions you have with them. When you broaden your scope, you will also start to see areas where you can go beyond your current interaction model into new member value-add areas like predictive care management, proactive educational outreach, and the offering of additional benefits.

If you embrace this broader focus, you will inevitably run up against those dreaded internal silo walls, but this is an opportunity not a disaster. Your customer doesn't have those walls, doesn't understand why the service agent they are talking to about their latest confusing EOB doesn't know that they just got a letter from care management about joining a pre-diabetic wellness program. They want a partner they can engage with, who knows them, who can, at a minimum, track their own interactions with them. In most organizations, getting this 360-degree view of a member is still a seeming impossibility: Service has their tools, Sales has theirs, Care management has theirs, etc. And for most members, the most important member of the insurer's team is their provider, who is typically even more disconnected from the insurer than they are. So, to break down these barriers, we must talk about integration, tying these disparate systems together to create a view of the member that shows what is needed by the carrier to provide the holistic service they want to provide. However, with integration usually comes more complexity, unless we plan the integration intentionally. In order for these systems to work to your expectations, you cannot build silos first and then connect them, you must start with a holistic view and ask bigger questions. But the payoff is there if you first consider the bigger picture. Designing a system that is member-centric – a single system that brings all of the data about the member together in one spot – is one such simpler answer to this integration process. Tie the data together intentionally, integrate to the systems of record with the intent of pulling data into one cohesive view of the member, not just chaining together the mediocre systems you have today.

So, if you buy into a holistic, barrier-less, member-centric view of your customers, you have one last boundary to cross to get you to your nirvana of simple processes and solutions. The last step is automation, the automatic processing of workflow and the automated learning and prediction of your customers' behaviors. This last step, however, is enabled by all the others. With your data in one location, you can easily build tools to both learn from the combined mass of data, and to act on those conclusions. The reduction in complexity of processes and in your staffing model can come with a single system that takes on the efforts of managing the simple outreach (welcome letters, renewal notifications, etc.) to even doing automated scoring and predictive care management outreach. These automated processes are achievable in the health payor space just as they are in other sales and service verticals, but it requires us to take off the blinders and prioritize building the systems that our customers, and even our employees, want. Take the pain you are feeling now during open enrollment and channel that into a purpose to change, to implement the systems that support our members and their needs without overburdening our employees with manual work-around processes. These systems do not have to remain only on a poster in your architect's office, they can be built, they just require the right focus, approach, and the drive to make your systems work for you and not the other way around.