EnterpriseEnrollmentManagement

E E M

TopLine Strategies

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.

A Process In Transition

Enrollment

Broker/Agency

Carrier

Employer

Employee

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Overhauling the small group enrollment process can drive high returns on investment and significantly improve customer services.

Large HealthCare Carriers Look to Improve Small Group Enrollment

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Small Group EnrollmentChallengeThe current manual process is encumbered by hand-written forms, redundant processes and parcel delivery services, periodically interrupted by computers.

IssuesManual Forms

Redundant Processes

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A Costly ProblemThe current Quote-to-Onboarding process is costly, time consuming and error prone and results in an on-boarding delay that costs the broker and the carrier.

HR Manager

Employee/Family

Manager at the Agency/Broker

Executive at Carrier

Delivery GuyCarrier

Broker

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Employee/EmployerFrustrationThe current process wears down the entire value chain, including the end customer.

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The Driving ForcesHealth 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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From Old to NewThe 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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The Keys to Delivering EEMS Success

Value Ease of Use Control Secure Support

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

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Key Number 1: ValueDistinctive benefit, service, and productivity value-adds relative to the prior manual process.

Gains in Clarity

Gains in Commitment

Gains in Solid Understanding

Gains in Efficiencies

Gains in Effectiveness

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Key Number 2: Ease of UseIntuitive ease of use including a highly polished look and feel in the user interface (such as a “pixel-perfect” look and feel). Intuitiveness

Pixel-Perfect Comfort

Familiar Experience

BetterExperience

No Learning Curve

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Key Number 3: ControlComplete 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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Key Number 4: SecurityA confidence in the impenetrable personal and health information security. HIPAA

Compliant

Intrusion Detection

PHI Regulations

Data Encryption Algorithms

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Key Number 5:SupportInstantaneous access to customer service assistance.

24 Hour Self Service

SupportFull

Knowledgebase & FAQs

Anytime, Anywhere Access

Instantaneous Access

Multiple Simultaneous Access to Same Form

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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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TopLine Strategies

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.•Complete agent visibility into the group and employee/associate enrollment lifecycle.

For the Agency/Broker

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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 vital carrier IT data processing systems and standards.

For the Carrier

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Enabling Technologies & Standards Are HereOptimization 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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Engagement LifecycleAchieving this effective experience is dependent upon a good start that fits cleanly into the engagement (on-boarding) lifecycle process.

Undifferentiated Market

OpportunitiesQualified

LeadPre-EnrollmentCommitment

EnrolledClient

Marketing Automation

xRM/CRM Quotation

xRM/.NetEnrollmentApplication

Client Benefit Understanding Satisfaction

xRM/BI Application Completion Management

Health & Benefit

Management Portals for Employee and

Family

Enabling Technology

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Engagement LifecycleAchieving this effective experience is dependent upon a good start that fits cleanly into the engagement (on-boarding) lifecycle process.

Undifferentiated Market

OpportunitiesQualified

Lead

Marketing Automation

xRM/CRM Quotation

xRM/.NetEnrollmentApplication

xRM/BI Application Completion Management

Health & Benefit

Management Portals for Employee and

Family

Enabling Technology

Pre-EnrollmentCommitment

EnrolledClient

Client Benefit Understanding Satisfaction

Advantages to integrating health portals and the enrollment application

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The Benefit Reality GapAlthough 93% of employers think it’s important for their employees to understand & appreciate their benefits, only 19% believe employees actually do.

19%

93%

Think it’s Important that they Understand

1-in-5 believe employees actually understand

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Health Portals Will ThriveComplementing 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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Critical FunctionalityTo 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

Security Suite

Rich DashboardCRM/xRM Functions/Interface

Employer Portal Employee Portal Broker/Agent Portal

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Critical FunctionalityTo 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

Security Suite

Rich DashboardCRM/xRM Functions/Interface

Employer Portal Employee Portal Broker/Agent Portal

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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Employer PortalFeatures:•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•Key contacts for employers with up-to–date information•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

Robert Wallace

Vision

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Broker/Agency PortalFeatures:•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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Employee PortalFeatures:•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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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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Rich DashboardFeatures:•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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Security Responsibility

Risk Analysis

Security Strategy

Remediate Secured ThirdParties

Training Evaluate

Confidentiality

Integrity

Availability

Security SuiteRock 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)

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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.

TopLine Strategies

TopLine Strategies

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:•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)

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