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3 Effective Payer Strategies for Health Insurance Companies

By Cheryl Gibson 05.05.21 Payer Strategy in healthcare: DOcotr and patient exchanging health insurance information, interior shot of a doctor's office and desk
Reading time: 5 minutes

When it comes to building a proper strategy for Payers in the healthcare world, there’s a lot to consider. For every segment within the Payer ecosystem or within a particular organization, there are different elements to take into account.

At Silverline, we like to start big and work our way down the funnel into the nitty gritty details. It helps to first determine what is necessary right now, and what would be nice to have in the future. Using our industry-specific experience and Salesforce expertise, we help health insurance companies figure out the right plan of attack and build a strategic roadmap for success.

Three particular areas of focus are key for Payers. Quite commonly, this is where we begin the process. They are: 

  1. Elevate engagement to drive business outcomes
  2. Maximize revenue through increased market share
  3. Lower administrative costs by streamlining business processes

Let’s explore how to go about implementing strategies to spark innovation in health, care delivery, and health plan solutions.

1. Elevate engagement to drive business outcomes

This strategy can start with small changes. Improving engagement can be as simple as knowing a member’s preferred method of communication. 

The member experience is enhanced with personalized journeys which meet the member where they are, at the right time. Conversations can take place based on the member preference (online, chat, text, and phone).

Within Salesforce, automated workflows guide members and the Payer’s member services team to ensure the most beneficial user experience. These personalized journeys guide members safely through the complexity of healthcare. They also allow them to have an active role in their health outcomes. 

Members can engage directly with their care coordinator and health care provider through care plans. These provide goals, tasks and proactive interventions targeted at improving the health of the member. Care plans can be enriched with electronic health record data, personalized articles, and a linear view designed to keep health care providers abreast of the member’s ongoing care. 

Chronic care management can be engaging and thoughtful, driving change in the member’s health. Further engagement driven through Salesforce’s Next Best Action provides a trigger to the member services representatives of critical gaps in care. For example, a member being overdo for their colonoscopy. 

Let’s not forget about providers

Provider engagement is also key in driving business outcomes. Through a provider portal built within Salesforce Communities, providers can view their patients’ claims and  perform authorizations.

In addition, providers can actively collaborate within their patients’ care plans and remotely monitor their activity. This helps ensure health improvement and adherence to medications. Improving the health of their patients is the number one priority for providers and the foundation for value-based care. 

Population health data captured throughout Health Cloud and external systems (e.g., claims),  can be analyzed through the Risk Stratification application. This application performs analytics driven to improve the lives of members through predictive modeling. With the right data, AI helps identify patients at risk for unplanned hospital admissions and seeks to understand population health trends. 

2. Maximize revenue through increased market share

When looking to optimize processes, you have to make the system beneficial for the sales team. 

Key functionality like account planning, pipeline management, and forecasting are only beneficial if the sales team keeps the data current and accurate. We’ve all heard the term “garbage in, garbage out” and that phrase is very relevant here. Silverline believes the Payer’s system must allow for an intuitive user interface that provides:

  • Important data to sales leadership
  • Accessible tools for the sales team to manage their book of business

The ability to access the system in all venues is also critical for the internal sales team. A lot of sales activity can be managed effectively from the road in real time. For example:

  • Closing opportunities
  • Adding products to quotes
  • Assigning tasks
  • Updating notes

Monitoring pipeline activity will also increase the effectiveness and accuracy of forecasting. Opportunity insights can assist sales leadership with predictions on the likelihood of a client’s action. For example, whether the customer will renew or terminate their contract.

Payers can increase their channel distribution through effective broker portals, thereby allowing brokers an efficient and effective way of quoting and managing their book of business. Payers are often considered not easy to do business with, given the limited ability for partners to conduct self-service activities.

Make use of your broker portal

Through the broker portal, brokers can do more than manage their book of business. They can also monitor their quotes, perform renewals, and assist their members through communication of life events and demographic changes with their designated Payer.

Improve retention with more effective account management and client activity monitoring. Customer satisfaction can also increase through effective self-service tools and a heightened level of engagement. 

Go-to-market strategies can benefit from the data captured within one system. Product portfolios can be monitored for effectiveness, while opportunity insights may provide a venue to explore new product offerings based on:

  • Client preferences
  • Claims utilization
  • Risk stratification
  • Other contributing factors

Payers can become more nimble by leveraging the complete picture of their clinical data and client base. 

3. Lower administrative costs by streamlining business processes 

Developing solutions for improved patient experiences and reduced costs of care can start at the administrative level. The easiest ways to tackle process improvement are automation and self-service. We’ll start with the latter. 

Self-service capabilities

Our first recommendation is always to provide self-service capabilities for key stakeholders such as: brokers, group administrators, providers, and members. This improves processes and dispels the notion that Payers are hard to do business with.

Offered through Salesforce communities, this function also eliminates bottlenecks caused by manual processes. An employer portal can allow Group administrators to perform self-service eligibility changes, contract administration, and access to client-facing reporting indicating client-level utilization. 

Simplified portals for key stakeholders (both internal and external) can decrease time spent chasing down paperwork and approvals. They can also increase time spent on interactions, and improvements to client relationships.

Portals like these also cut down on call center times — a win for everyone involved. 

Automation

Manual processes can bring any organization to their knees in terms of speed to market. Payers are no different. Automating business processes is critical to increased effectiveness, timeliness, and accuracy. Streamlined, automated business processes benefit all those involved in the Payer ecosystem.

For example, many member-related business processes can be addressed through the member portal, allowing for an intuitive, user-friendly flow.  Member portals facilitate actions such as: 

  • View Claims (Ded & OOP Status, Pre Auth/Referrals)
  • View ID card
  • Search providers
  • Complete forms
  • Respond to tasks for their care plans
  • Dispute claim (grievance & appeals)
  • Review articles & Q/A

Allowing members access to self-service capabilities and to actively participate in their healthcare drives efficiencies and improves member satisfaction.

Automation for sales teams

It’s no secret time management is one of the highest requirements for succeeding in sales. According to Forbes, “Nearly two-thirds (64.8%) of reps’ time, on average, is spent in non revenue-generating activities, leaving only 35.2% for functions related to selling.”

It is important to engage the sales team early on in the transformation process to understand what manual tasks can be automated to improve their efficiency. It is also critically important that the health system’s portal be engaging and intuitive to reduce time “learning” the system. Automated guidance can be leveraged to assist sales in the collection of key client insights. 

You can’t have an automated end-to-end process without including downstream partners. Many times, the same data is rekeyed throughout internal systems which cause delays and coding errors. Ensuring that the proper parties have access to relevant information reduces time spent entering data and increases time spent acting on it.

Automation for administration

There is tremendous opportunity for improvement in business processes. Disparate and siloed systems and inefficient, redundant workflow processes are distinct areas which plague Payers today. Silverline recommends various levels of system integration. This offers Payers a single data source of truth without having to “house” all of the information within Salesforce. 

Payers need a way to efficiently manage interactions and preparation of client documents, such as: 

  • Proposals
  • Contracts
  • Meeting presentations
  • And more

The right partner is actually the best strategy

Working with an implementation partner that understands your specific needs is key. And not just your technical needs. Your industry needs are what guide the technology requirements of your company.

At Silverline, we understand these business processes within the Payer community because we’ve experienced them firsthand. We’re able to think of things a little bit differently and understand what the pain points are for a Payer. More importantly, we know how to address them.

We understand that some Payers may use Salesforce today, either the Sales or Service Cloud, because Health Cloud is still fairly new to the marketplace. We encourage Payers to consider Health Cloud, and we are primed to assist with the transition. 

Our team of experts is ready to  drive improved business processes to help your organization perform at a higher level. Reach out.

Ready to see real results? We can help.

Get in Touch

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