Transforming Healthcare Member Enrollment, from Weeks to Just Minutes
Back to Success StoriesOverview
Sky Solutions supports the digital transformation of a large regional healthcare payer serving approximately 1.5 million members. Like many healthcare payers, the organization is committed to modernization initiatives that improve healthcare access and enhance the member experience. A critical component of this mission is the ability to respond quickly and efficiently to changing market conditions and evolving member expectations, ensuring continued access to timely and seamless healthcare options.
One area within the health insurance industry that has long been a prime candidate for digital transformation—offering significant opportunities to reduce costs, eliminate waste, and improve the member experience—is the member enrollment process.
One area within the health insurance industry that has long been a prime candidate for digital transformation—offering significant opportunities to reduce costs, eliminate waste, and improve the member experience—is the member enrollment process.
Goal
The organization sought to enhance the member experience by streamlining the enrollment process, ultimately reducing enrollment timelines, decreasing case resolution times, and increasing Enrollment Processor productivity.
Challenge
Outdated member enrollment processes and technologies posed numerous challenges, including manual, paper-based workflows; limited system integration and data accessibility; increased administrative burden; heightened compliance risks; and a poor overall member experience.
For more than a decade, the organization relied on Lotus Notes, a legacy CRM and ERP system, to support critical business functions, including member enrollment. Historically, enrolling a new member took anywhere from several days to a few weeks and involved multiple manual steps, requiring access to and interaction with numerous disconnected systems and data sources. These inefficiencies led to member frustration and delays, data inaccuracies and discrepancies, reduced member acquisition and retention, and ultimately posed risks to revenue targets. It became clear that Lotus Notes could no longer provide the functionality required to effectively address these challenges.
For more than a decade, the organization relied on Lotus Notes, a legacy CRM and ERP system, to support critical business functions, including member enrollment. Historically, enrolling a new member took anywhere from several days to a few weeks and involved multiple manual steps, requiring access to and interaction with numerous disconnected systems and data sources. These inefficiencies led to member frustration and delays, data inaccuracies and discrepancies, reduced member acquisition and retention, and ultimately posed risks to revenue targets. It became clear that Lotus Notes could no longer provide the functionality required to effectively address these challenges.
Solution
Sky Solutions supported the migration of the member enrollment process from Lotus Notes to a modern, low-code, cloud-based platform using Pega. The new system streamlined and automated key enrollment functions, enabled integration with critical disparate systems and data sources, and provided enhanced reporting and visibility into reengineered workflows. Additionally, the platform supported rapid scalability and adaptability to meet future business needs.
Technologies/Methodologies
- Low Code
- Agile
- DPA
- Pega
- Cloud
Outcome
Since the new enrollment solution on Pega went live, the total enrollment timeline has decreased from several days or weeks to just a few days—and in some cases, only minutes. Case resolution time has been reduced by approximately 86%, while Enrollment Processor productivity has increased by 95%.