health care insurance opportunity

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From Complexity and Frustration to Simplicity and Effectiveness it is the most viable foundation for discovering new opportunities that build momentum and inspire growth.

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health care insurance opportunity

  1. 1. W H I T E P A P E RThe Healthcare Insurance CRM Opportunity:From Complexity and Frustration to Simplicity and Effectiveness Executive Summary If there is one universal truth in this industry, it’s the likelihood that employers, consumers, and agents are shopping around—not just for cost, but for ease-of-business. In particular, agents want to work with a healthcare payer that makes closing deals easier, and that gives them what they need to increase the likelihood of sales success. With stakeholders demanding a ‘care network’ of transactions linking employers, agents, members, provider organizations, payers and suppliers, CRM has emerged as the preferred business platform. Furthermore, it is the most viable foundation for discovering new opportunities that build momentum and inspire growth.
  2. 2. The Healthcare The complexity of operating in the healthcare insurance sector is due in part to the sheer volume of information Insurance Paradox that is generated. Despite this complexity, key stakeholders—employers, providers, agents, members, Driven by run-away medical inflation, growing competition and new consumers—demand a level of integration and and economic and political pressure, the healthcare service that is unprecedented. industry continues to be in the midst of an unprecedented period of consolidation, realignment, and restructuring. The message to payers from these key stakeholders is simply figure it out. They want payers to find ways to We’ve all heard it before: the regulatory pressures dramatically improve efficiency and service levels, and (HIPPA), the cost of doing business growing out of to better leverage their most precious commodity— control, increased competition, and the increasing move information. They demand a better, faster connection to to consumer-directed healthcare. All these issues have higher quality data, and want faster response times. been contributing to payers having difficulty improving their profit margins. Meanwhile, market forces have However, payers confront many systematic obstacles pushed the healthcare industry to become more efficient to collaborating and sharing information with key and to provide higher levels of service to all of their stakeholders. As a result, most healthcare insurance key stakeholders. companies suffer from organizational inefficiency, and the expensive and unfortunate consequence is a gradual breakdown of valuable stakeholder relationships. Reconciling the paradox comes down to The pressure is on for healthcare payers to adapt, one thing: getting smarter when it comes to and begin operating in real-time by linking front-office integrating business, data, and people. And systems with the billing, membership, claims, and medical doing it now. management systems of the back office. For those organizations that choose to operate at this Herein lies the paradox to success in Healthcare higher, more profitable level, the necessary platform for Insurance. We know the industry grows more complex business becomes the Internet. Although paper-based and operationally demanding with every quarter. We also processes and information may still be the norm in this know that providing high-touch, integrated service to key industry, payers recognize that ‘the norm’ is the source stakeholders is critical in order to gain momentum in a of the relationship jeopardizing obstacles. highly competitive environment. So what now? With stakeholders demanding a care network of Reconciling the paradox comes down to one thing: transactions linking employers, agents, members, provider getting smarter when it comes to integrating people, organizations, payers and suppliers, CRM has emerged processes, and data. And doing it now. Because for as the Internet-powered tool that clears those obstacles. every healthcare organization that leans, with the best of Recent Gartner numbers indicate that between 2000 and intentions, towards business as usual (“we just need to 2002, the number of payer organizations with a CRM get better at what we do”), there will be another that gets strategy has tripled, while those with plans to develop one closer to operating at a higher, more sustainable and in the near future has increased eightfold.* more profitable level (“we just need to get smarter at how Before too long, it will no longer be a competitive we work to achieve our objectives”). advantage for a healthcare insurer to take this step. Rather, it will be the industry benchmark. *Gartner Inc., ‘Healthcare Payer Study: CRM Spending/Deployment Rising’, 15 August 2002.2 Pivotal CRM | White Paper
  3. 3. The Challenge Report: The place for each line of business and each market segment, and underwriting and sales use different systems,Healthcare Insurance Company making any degree of efficiency or cross-departmental communication almost impossible. In addition, a highWe’ve looked at some of the external factors driving proportion of poor quality, paper-based data funnels fromchange in the healthcare insurance industry—namely the sales to underwriting, especially during high season.paradox of an increasing demand for improved servicein conjunction with intense pressure to reduce costs. Marketing – In order to produce campaigns that areNow let’s examine the internal limitations and challenges relevant and compelling to the right audiences, marketingthat impact the day-to-day operation of the healthcare needs access to complete information. Typically, there areinsurance company. disparate systems and methods for lead tracking, each of which provides only an incomplete perspective intoAcquiring New Business – New business sales reps success. The time required to bring multiple sources ofneed to produce more proposals faster, with 100% data together for analysis is prohibitive.accuracy. It sounds like a simple enough directive,however, the current paper-based workflow, or stand- Without a precise understanding of your book of business,alone quoting system, makes it almost impossible to it’s difficult to know which is the ideal product to sell toachieve. Often, the number of days spent just to generate which target segment. And with a lack of visibility into howrates results in lost business. With poor inter-departmental many times a plan was quoted or sold and by whom,communication and inefficient business processes, marketing cannot view or understand the win-loss ratioreps are focused on operational tasks rather than being against a specific competitor’s product line.focused on closing deals. Healthcare payers need todo whatever it takes to keep salespeople where they Operations – Operations, being responsible for finalizingbelong—not in the office wrapped up in details, but in the sales with the group setup and member enrollment,the field, selling. face their greatest impediment in labor-intensive data entry processes. Payers tend to have several back-endRenewing Business – The winning factor at renewal systems where information must be re-keyed many times,time is raising the flag early enough. Most often, reps are leading to a high rate of error, and an unacceptablealerted with the right information too late due to inefficient, turnaround time for group setup.labor-intensive processes on the back-end. The timecrunch means they lose the chance to re-quote in order Agent Relations – For agents, getting an initial quote andto competitively sharpen the deal, or negotiate rates completing the steps to close business can be laboriouswith underwriting. Reps can often expect double-digit and frustrating. Significant delays in payer responsepercentage increases in premium of as much as 20 or 25 greatly limit how quickly the agent can turn around theper cent. This trend underscores the importance in giving right offer for consumers. Since agents are often not ablesales more time to negotiate with the customer to find the to access self-service, the processes necessary to releaseright benefit mix and rate structure. RFPs and quotes and manage the book of business are difficult.Above all, payers are challenged to keep relationshipswarm and properly maintained all year, which would lay For instance, many agents sell from 9 to 5, and preparethe foundation for easier and more dependable renewals. for upcoming sales activities in the evening or over theGiven a warmer renewal environment and an easier weekend—when there are no payer resources to answerprocess, underwriting would be able to focus more on their questions. Agents should be able to work how andsigning new business. when they want, with a quick response and no barriers to access. Conversely, payers need to know when agents areUnderwriting – The process and response time for spreadsheeting them—and if they are, in effect, subsidizinggenerating rates is sluggish due to multiple spreadsheets the agent’s business. The utmost goal: to avoid beingand disparate systems. A separate process is often in categorized as a ‘column B’ payer with agents. Pivotal CRM | White Paper 3
  4. 4. The Solution: Customer Relationship Management: CRM for Healthcare Insurance What Is It? Healthcare insurers who aspire to operate at a higher, Customer Relationship Management, or ‘CRM’, is a category more sustainable and more profitable level are those who of software applications used by companies to connect data, say, “We need to get smarter at how we work to achieve people, and processes across the customer-facing front- office (sales, marketing, service and partner [agent/provider] our objectives.” management). The simplest essence of CRM’s mission is to help companies know how their customers like to do business, Customer Relationship Management (CRM), a suite of so that customers keep coming back to buy more. software applications for integrated sales, marketing and service that sits on top of an Internet business platform, When it comes to CRM for healthcare insurance, the diversity is the necessary ‘get smarter’ tool. CRM reconciles the of stakeholders that impact market share justifies expanding the definition. Think of CRM as Constituent Relationship paradox of increased demand for better service and Management—a tool that manages all the relationships that increased pressure to reduce costs, simply making it contribute to making, managing, and servicing the book of easier for your company to do business. business, from agents to customers and beyond. Not all CRM is equal—when qualifying vendors, make sure the suite of software applications has good breadth of capabilities Customer Relationship Management across all constituent-facing functions of your company. It (CRM)… is the necessary ‘get smarter’ tool should be capable of delivering everything from assisted selling of complex solutions to online catalogs, self-service that reconciles the paradox of increased websites, unified knowledgebases, marketing ROI calculation, demand for better service and increased and more. pressure to reduce costs. To learn more about what Customer Relationship Management looks like for the Healthcare Insurance industry, keep reading. This paper will provide specific examples of CRM at work in the areas of member retention, agent loyalty Customer Relationship Management (CRM)… is the and internal efficiencies. necessary ‘get smarter’ tool that reconciles the paradox of increased demand for better service and increased pressure to reduce costs. Where processes are weak, laborious or roundabout, CRM streamlines. Where the wires of important relationships are crossed, CRM reconnects the right people sensibly. And where visibility is lacking, CRM brings clarity into the market, sales channel performance, key stakeholder activity, history and preferences, and overall business trajectory.4 Pivotal CRM | White Paper
  5. 5. Improvement Points in the Healthcare EnterpriseWhen CRM is embraced by front-line employees, the operational impact is dramatic. Redundant, laborious processesthat once jeopardized the integrity of key relationships are redesigned. Let’s consider some of the healthcare payer’smost common efficiency barriers, and look at a CRM-driven approach to smooth the path to a more profitable modelof business. RED LIGHT OBSTACLES GREEN LIGHT ACTION Sales force is not focused on selling. Automate sales cycle friction points. Enable online quoting, which allows reps to do Reps process quotes via fax and e-mail, most of the initial data entry. Allow internal sales to access a single, unified system so and spend time re-keying information. that all sales activity ‘lives’ in one place. Sales reps are slow to respond to Automate basic, labor-intensive tasks. Move paper-intensive processes and records opportunities. Significant delays exist to online, (members, groups, agents, online quoting), with anytime, anywhere access. generate rates for proposals, verify and deliver proposals, set up a new group, and process renewals. Data exists across multiple fragmented Unify data to a single platform. Record group-member-agent-payer interactions, quote ‘islands’. Management is unable & coverage history. Create a single view of all coverage, including line-of-business and to analyze and report on business products, and a complete book of business view. Bring back-office data to the front- performance, view full group or individual office in a friendly, integrated format. coverage, and understand the agent book of business. No integration to membership & billing. Integrate all processes to a single system. Bring all sold policies online with Employees spend time on duplicate data membership & billing systems. Connect census information from membership systems, entry, resulting in significant errors. then link to a document assembly system. Poor agent loyalty. Slow turnaround time Increase agent ease-of-business. Offer instant, 24x7 rates, easy-to-use rapid proposal for quotes results in being categorized as creation tool, and enable convenient agent self-service. a ‘column B’ payer in proposals. Reactive management of book of Proactively manage book of business. Automate the renewal process, and alert the business. Critical renewal opportunities right rep to deal-critical data. are not flagged early enough, and are often lost. This results in high rates of customer attrition. High demand for agent support. Agents Increase agent self-sufficiency. Streamline quoting for faster proposals, and provide are unable to view their full book of agents with online access to their book of business. Give agents access to the status of business, and have a lack of visibility into all outstanding quotes, as well as tools to help them sell more faster. quote status. Labor-intensive enrollment process. Streamline the enrollment process. Move the enrollment process online. Validate Enrollment information is often incomplete, data as it is entered on online application, with only properly completed applications and inefficient workflow delays group forwarded to operations/group setup. setup. Data-entry of group and member applications bottlenecks during high- season, resulting in late enrollment applications and a high rate of error in enrollment data. Slow contract setup. Verifying proposed Accelerate contract setup process. Integrate all front-end data directly into back-end contracts (group, census & enrollment systems, and eliminate re-keying of all info already captured during the sales process. info) is difficult, with inefficient workflow and a high rate of error due to re-keying data. Pivotal CRM | White Paper 5
  6. 6. Mapping the Results of CRM: Strategic The Spillover Effect Strategic Decision-Making Impact I M PA C T CRM Ease-of-Business Impact Strategic Strategic Productivity Impact Decision-Making Tactical Impact I M PA C T Level One Results: Productivity Impact CRM Ease-of-Business Impact Improve the speed, accuracy and efficiency of internal processes. Productivity Impact At the most elementary level, CRM automates the front Tactical office processes that span sales, marketing, underwriting, and operations. Employees spend more time servicing and selling key constituents, and less time shuffling paper. CRM delivers a great deal of functional, process-based tools to help employees be more productive in selling, marketing, and servicing key stakeholders. When users embrace an easy-to-use, In the next section, we’ll examine how tactical productivity tailored system, companies get measurably improvements map to increasingly profound impact at better at the front-office tactics that help to higher, more strategic levels of business. grow and service the book of business. The first level of CRM impact is the improved speed, accuracy and efficiency of internal processes—or improved productivity of individuals—in which labor In order to focus employees on the most value-add sales, and paper-intensive processes are streamlined. marketing and service activities while reducing the time spent on laborious tasks, CRM needs to be intuitive and The second level of impact is measured when the payer convenient. It should require minimal training, with reps being becomes easier to do business with, both from an agent able to create a quote, for instance, without any difficulty. and consumer perspective. With an easy-to-use, tailored system, companies get The third and most profound level of impact is when the measurably better at the front-office tactics that help to grow ‘sweet spot’ of optimal business profitability is revealed. and service the book of business. The right kind of CRM is When the right mix of products, markets, sales model and invaluable to all people and processes engaged in selling, agents is identified, you have all the elements required to marketing and servicing the book of business—and the make smarter and more strategic business decisions. impact of those productivity improvements make a difference to the bottom line. Let’s examine these three levels of CRM impact. Some of the most apparent bottom-line results include the reduction of administrative overhead, shortened sales cycles, and easier collaboration and sharing of data, which means greater profitability. Increase Responsiveness – One of the most dramatic results from CRM is the improved speed and efficiency across internal processes. When the front-office activities of the book of business are unified into a single, centralized system, information is immediately available, and the paper- chase is eliminated. Employee focus moves to servicing key stakeholders, rather than on limited-value details that serve as obstacles to world-class service. Create a Unified ‘Corporate Memory’ – One of the most valuable corporate assets is data. This includes key stakeholder history, preferences and status, sales channel performance, quote status, market trends and more. Unifying6 Pivotal CRM | White Paper
  7. 7. this data to create a cohesive corporate memory is vital todemonstrating trust and credibility to all stakeholders, from Strategicagents and agents to end-members. CRM grants instant Strategic Decision-Makingaccess to data for key stakeholders, providing them with the Impact I M PA C Ttools necessary to access the data they want. CRM Ease-of-Business ImpactIncrease Face Time with Agents, Consumers, Groups Productivity Impactand Individuals – Increasing face time is always an effective Tacticalsales tactic. Developing new relationships or strengtheningyour existing relationships will always result in more businesscoming your way. As the CRM system eliminates inefficient Level Two Results: Ease-of-Business Impactprocesses, employees can re-allocate time and resourcestowards managing key relationships more proactively and Increase the likelihood of agent success and employermore profitably. group & member satisfaction.Gain More Insight on Performance & Market Trends – The productivity improvements described previouslyCRM precisely tracks the sales pipeline and win/loss ratios. manifest themselves powerfully from the agent, employerAnalyze why some deals are more consistently won, and group, and member perspective. Although it’s one of thewhy others are more likely to stall or be lost, and capture more qualitative of results from CRM, the smooth, high-detailed competitive information for each proposal. Leverage level convergence of people and processes is one of thethis insight to focus on the areas that need improvement, most meaningful.and share the best practices of top performers with others When this convergence occurs, it streamlines thewho need the encouragement and wisdom the most. greater operations of the company and extends this newIntensify the Selling Focus – CRM makes the process efficiency outside the walls of the organization, passingof closing business easier. For instance, it accelerates the on an improved model of business to agents, employerissuing of rates, giving the sales team the ability to produce groups and members.a complete proposal package with the click of a button. External stakeholders will notice streamlined processesSales reps spend less time on administrative tasks, and and the convergence that results, however, a highermore time working with the prospect, customer, or agent. degree of ease-of-business—the kind that tangiblyCollect More Accurate Data in Less Time – The quality of impacts the bottom line—is only achieved by establishingdata and efficiency will increase as duplicate data entry is self-service.eliminated. Users can only enter validated information whichis ultimately sent to the back-end system, thus eliminatingthe potential for re-keyed errors. If there is one universal truth in this industry, it’s the likelihood that employers,Clearly, healthcare insurance organizations see dramaticimpact from CRM at the tactical level. The productivity of consumers, and agents shop around forindividuals will increase, and labor and paper-intensive ease-of-business.processes will be streamlined. Let’s look at the next levelof impact, and see what happens when these operationalimprovements become apparent to agents, employer Although there are heavy demands on payers to providegroups, and members. self-service for external constituents, attempting to offer self-service without a CRM foundation only causes requests to flow into employees at a greater speed, only to hit the road blocks of inefficient processes. CRM- integrated self-service results in increased efficiency, convenience, and stakeholder awareness. Where there was once friction, sluggish response and unmet needs, there is now a sudden abundance of focus, familiarity and consideration. In particular, agents want to work with a healthcare payer that makes closing deals easier, and that gives them what they need to increase the likelihood of sales success. This is where CRM-integrated self-service has the greatest impact. Pivotal CRM | White Paper 7
  8. 8. If there is one universal truth in this industry, it’s the Agents Issue Quotes More Easily Through Self-Service likelihood that employers, consumers, and agents shop – CRM eliminates the delay your agents face in getting around for ease-of-business. a proposal to the end consumer. Moving the quoting system online means that agents access a secure portion Increasing the likelihood of sales success means of your website to produce proposals in minutes. This delivering role-specific website portals with quoting efficiency is clearly noted by the end consumer, since and book of business management tools, since they they receive clear, accurate answers instantly rather than eliminate the paper-dominated enrollment process that having to wait hours or even days. Internal staff are freed has traditionally frustrated employer groups, individuals, from the endless stream of faxes they receive today, not and members. They also unshackle internal resources only for new business but also for renewals and mid-cycle from the administrivia of responding to RFPs via fax, or benefit changes. Agents are empowered by being able rekeying from hundreds of enrollment applications. to manage their own book of business, and to do so in a more proactive and responsive manner. The process of enrollment isn’t the only one that has a great impact on ease-of-business for stakeholders. Agent Ease-of-Business Increases – With an online Consider the quote preparation process, during which solution in place for the agent community, they benefit agents initially work with payers. There are many factors from streamlined processes. Quotes created by agents involved in quoting healthcare insurance—quotes can in the online system are immediately fed into the CRM become complex very quickly, especially when it comes system, and can feed all downstream processes. to delivering personalized, tailored quotes that are more likely to close business. Success depends a great deal Re-keying of information is dramatically reduced, and on how well your sales team and agents understand internal staff can communicate with agents in more prospects and customers upfront. dynamic and trackable methods than via phone. From the first quote and the enrollment process to feeding legacy systems and processing renewals, every activity and The proactive model is ‘institutionalized participant is linked in a unified, automated environment. listening’—you plan and act according to Paper is Eliminated from the Enrollment Process what makes good business sense to agents, – Enrollees need not understand how to navigate employer groups, and members. the complex world of inter-dependencies. An online enrollment system eliminates errors and provides an easy, fool-proof data collection experience in which employers A CRM system for sales staff and agents is a starting and members can start and stop when they want to point to create quotes for your prospects and customers gather more information if needed. The intelligence that are transparent, easily understood and responsive. of the system streamlines the experience as much as It will enable them to quickly and effectively work with the possible—for instance, questions that do not pertain to underwriting department to create quotes in very short an enrollee are never asked, and printing of the collected order, without delays. data is automatically completed on existing state-filed PDFs for signing. All manual data-entry tasks and forms Being first to respond with an accurate, tailored quote sets that had to be completed on paper forms are eliminated, the bar in the competitive race. It’s an enviable position to in favor of a single consolidated, electronic system that be in, rather than bringing up the rear and frustrating the guides employees, agents and consumers through the prospects and customers by holding back an informed process step-by-step. decision. Or worse yet, delivering an inaccurate quote, which can lead prospects and customers to doubt Data Quality Increases with Self-Service – Enabling integrity. And that’s no way to begin a new relationship, external constituents for self-service means that they now or maintain an existing one. enter their own data. However, the payoff is not just in moving data entry away from your internal personnel. By Consider a few more examples of how properly- removing the extra steps of writing down information and implemented, healthcare-designed CRM enables a more re-keying it, the quality of data is infinitely improved. Cost proactive model of business: savings can be staggering—eliminate the retouching of the same data multiple times, and gain the capacity to process far more. Constituents will not mind contributing the right information with an easy-to-use, intelligent system—agents get faster proposals, and enrollees get completed application forms with fewer errors.8 Pivotal CRM | White Paper
  9. 9. Internal Employees are Redeployed to MoreValue-Add Activities – With the time gained by freeing Strategicinternal staff from laborious and inaccurate data entry, Strategic Decision-Makingshift focus to activities that matter more. Initially, agents Impact I M PA C Twill require assistance to be introduced to self-service, CRM Ease-of-Businessbut after that, internal staff can be redirected to the Impacthigh-value tasks they always wanted to do but could not, Productivity Impactsince they were buried in process administrivia. Identify Tacticaltop-performing agents, and assign internal staff tomanage those relationships more proactively. Nurturethe next tier of agents to help move them into the Level Three Results:top-performer level. Spend more time on selling the total Strategic Decision-Making Impactbenefits of your organization when working with prospectsand customers, rather than struggling just to stay on top Identify the right mix for optimal profitability.of the paper-chase. At the most profound level of impact, your company willIf every constituent is very clear on both what is required no longer waste effort trying to squash square pegs intoto successfully sell and buy to mutual satisfaction, round holes (in a very saturated market). Instead, youthe result will be a much higher proportion of happier will conduct stakeholder interactions and move forwardprospects and customers, and more profitable based on a clear understanding of the trajectories ofrelationships with agents. demand, your business and the market. With a deepened understanding of the highs (and lows) of businessIt takes much less energy to listen to the needs of performance, companies are able to direct high-levelstakeholders proactively than it does to try and fix a business decisions more intelligently.broken process or relationship reactively. The proactivemodel is ‘institutionalized listening’—you plan and actaccording to what makes good business sense to agents, The moment that CRM’s visibility helps aconsumers, employer groups, individuals, and members. company to answer the most fundamentalWe’ve seen how the second level of CRM impact is ‘what next’ questions is a breakthroughthe point at which efficiency takes root on the receiving one, in which a new collective confidenceend—and key stakeholders, thanks to self-service,tangibly notice an extraordinarily seamless experience is gained.and a more attentive partner. The moment that CRM’s visibility helps a companyNext, let’s examine the third and most profound level of to answer the most fundamental ‘what next’ questionsCRM impact in which companies begin making high-level is a breakthrough one, in which a new collectivedecisions more intelligently. confidence is gained. Think of your company as a collection of assets. Products, people, processes. Data, expertise, relationships. The trick to maintaining momentum in a challenging business environment is figuring out the right mix—identifying that point at which all your assets converge ‘just so’ to result in profitability. With CRM having delivered stronger efficiency across the front office, as well as self-service capabilities to key external constituents, such as agents, employer groups, and members, how do companies figure out where to invest the additional resources, time and money that’s been saved? The answer lies in knowing and owning operational strengths and weaknesses, and making highly informed decisions that capitalize on the good and minimize the not-so-good. Pivotal CRM | White Paper 9
  10. 10. • Why is product X being enthusiastically promoted by our smaller agents, and ignored by our key or exclusive KnoW YouR: agents? • Why do we win more deals with group size X vs. group Top Producers size Y? Member Needs • Should we create more variations of Product Y, or Weak, Laborious Process Points should we grow our agent community to sell more of Employee Needs the existing configuration? Market Trends • Should we be even trying to sell in this particular target market/competitive arena? Does our win rate make it worthwhile? • Are there any specific tactics that our top performing reps and agents do that our lower performers aren’t ...Then IdenTIfY The RIghT MIx of: aware of? Training • Do we have products now with market potential that we aren’t promoting enough? Support We have a limited budget for training. Should we invest Process Improvements it towards advancement of our top agents, or a catch-up Site Visits initiative of our smaller agents? Marketing Campaigns The moment that CRM’s visibility helps a company to Micro-Advertising answer the most fundamental ‘what next’ questions Commission Model is a breakthrough one, in which a new collective confidence is gained. It is that invigorating moment when a payer begins directing the strategic path of its assets—its products, people, processes, data, expertise, relationships—from deep insight gained from smart, ...To gRoW YouR: timely analysis of business performance. Agent Value & Loyalty It’s good business sense to ‘play to your strengths’. In healthcare insurance, your strength lies within a core Level of Responsiveness community of agents. An analytical approach based on a Employee Efficiency CRM system helps companies to deeply understand why Stakeholder Satisfaction some agents close more business than others, and grow the value of this revenue-critical community. Win Rate Product Penetration Maximizing corporate investment in the agent community is a matter of finding the right mix of tools and information, combined with a weighted approach favoring the most valuable agents. This is the ‘sweet spot’—that point at which don’t intend to do all at once. In the interest of investment all the right assets intersect for maximum profitability. longevity, make sure the solution you choose has the breadth to grow and flex with your company as business conditions change. Making It Work for With that in mind, one of the most important philosophies Heathcare Insurance to follow when selecting, designing and building a CRM When selecting a CRM system for Healthcare Insurance, system is that of developmental precision—or making there are two categories of selection criteria to consider: sure you get everything that’s necessary, and no more. System Suitability and Vendor Suitability. Employees, the most important contributor to CRM success, will adopt and embrace a system only if it doesn’t overwhelm them. To make sure you develop CRM ‘Making it Work’ Part One: System Suitability with developmental precision, understand the concept of Everything you need, nothing you don’t: simplicity is a Breadth versus Depth. powerful thing ‘Breadth’ refers to how comprehensive a CRM system is. First, make sure the solution has the right features that If CRM has breadth, it has the right mix of functionality stretch across sales, marketing and service—even if you stretching across all the constituent-facing teams in10 Pivotal CRM | White Paper
  11. 11. your company. CRM with breadth has the potential to continued development and tweaking, with incrementalcontribute in every function of your company, even if you return on investment. Your system will never be set indon’t do it all at once. Breadth is important when you want stone—and you shouldn’t want it to be. Your businessyour CRM to grow, to stay relevant and expand its role in needs to be engineered to keep pace, and that includesyour success. your CRM system. A CRM system should facilitate customization by making it easy to change the way in which customer data is one of the most important philosophies organized and used. Think of a puzzle. Most CRM to follow when selecting, designing and vendors glue the picture to the puzzle pieces. If you want building CRM is that of developmental to change the shape of the puzzle pieces to better suit precision—or making sure you get your needs, it’s very difficult to do so without breaking the everything that’s necessary, and no more. picture. Ideally, the picture (your book of business data) should be kept separate from the puzzle pieces (how the data is organized). This means you can change the shape of the puzzle pieces—or how your book of business dataMeanwhile, ‘Depth’ refers to how much functionality a is organized—any way you want, without disturbing theCRM system has. If CRM has depth, it has an almost actual data itself. The ‘picture’ is glued to the ‘pieces’ onlylimitless number of features. It’s like an iceberg—chances when the data is used.are good that you’ll only ever need what you see abovethe surface of the water. But the excess adds to the costof purchasing and implementing, and you’ll be weighteddown by the massive amount of unnecessary features don’t presume you’ll get it right the firstliving in the system. Most important, overwhelmed users time, or all at once. Count on makingwill be disenchanted right from the outset. adjustments and iterations—taking safe,Instead, your CRM vendor should deliver the majority of manageable steps.what you need out-of-the-box, specially designed for thehealthcare insurance industry. The remaining, specializedfunctionality that makes your system yours should be quickly At Pivotal CRM, the secret to how we do this is calledadded through cost-effective customization. That way, you’ve metadata, or data about data. We keep it separate,got everything you need. And nothing you don’t. accessible and highly changeable. It means that as your book of business, offerings, market conditions andOnce you have validated that the CRM system will deliver regulatory requirements change, your CRM system canbreadth of functionality to address key challenges, you need adapt without interruption to critical systems and withto ensure the technology, experience and business style of minimal cost and effort. So that it stays relevant, alignedthe CRM vendor is the right match for your company. and meaningful.‘Making it Work’ Part Two: Industry Experience & Dedication First, make sure the vendor you choose has designedVendor Suitability CRM precisely for your kind of company. Most softwareGet the right approach, knowledge and experience on vendors take a broad-brush approach when it comesyour side. to serving vertical markets. They develop a solution that attempts to serve a broad vertical category such asFrom a technology perspective, begin by assessing the healthcare. In contrast, Pivotal CRM’s Headstart approachflexibility of the applications, which impacts the cost- is to identify more specific, niche vertical segments—suchefficiency and speed of deployment and ongoing change. as healthcare payers—that have a clear set of moreThen, assess the dedication and experience of the vendor specific common needs.to the healthcare insurance industry, and examine theapproach and methodologies the vendor will use to At Pivotal CRM, our approach is to develop precisely-ensure your company measures tangible business results tailored offerings based on a relevant framework offrom the system. microvertical-designed functionality, and then work with each customer to further tailor the system. Pre-configured business rules and workflow, highlySpeed & Cost of Deployment adaptable data models and robust customization tools& Customization make it easy and cost-efficient to change and adapt toCRM is a journey, not a destination. It is not a matter of create an absolute ideal. The system is designed to beinstalling software, and being done. By its very nature, backwards-engineered from your most critical corporatea CRM system should always have an open door for objectives, existing processes and operational and brand differentiators. Pivotal CRM | White Paper 11
  12. 12. This critical partner should have a deep and intimateunderstanding of industry trends, business requirements The Final Wordand processes, including knowledge of common people We know the healthcare insurance industry grows morechallenges within a healthcare organization; the sales complex, operationally demanding, and competitive withcycle; industry regulations; the tradition of paper-based every quarter. For those organizations who strive to operateprocesses; healthcare products and riders; rating at a higher, more sustainable and more profitable level, CRMmethodologies; and the need for simplicity for end-users. is a breakthrough tool. It is a collective jumpstart that raises the bar for the competition, while raising the efficiency ofThe vendor you choose should also have hands-on every interaction for the stakeholder community.experience helping healthcare payers identify and followa clear path to the right business results.CRM is not a software purchase—if it were, it would berelatively easy. Companies who excel at CRM see it forwhat it is—a results purchase. This means working withyour CRM vendor to go far beyond a one-time softwareROI assessment to report meaningful business results.The key is closing the loop. Once you’ve identified yourphase-one business objectives, make sure your CRMvendor baselines your performance. This is to assess yourprogress before, during and after deployment. Combineall those perspectives, and you gain the full picture ofyour business trajectory (and CRM’s impact on it). Thisis institutionalized accountability. With comprehensive,precise results measurement built directly into your CRMsystem, you will clearly see the numbers and charts onhow your business is improving over time. For more information or a complete list of our worldwide offices, please visit www.pivotal.com. Copyright © CDC Software 2007. All rights reserved. The CDC Software logo and Pivotal CRM logo are registered trademarks and/or trademarks of CDC Software.

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