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At Simplify Healthcare, we provide powerful and practical solutions to address the challenges faced by our clients in the Healthcare Payer space. Check out some of our case studies to view our solutions in action and how it helped health plans succeed in the industry.

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Reduce duplicate content by 80% with leading-edge benefits content management solution

Discover how a large Healthcare Payer leveraged Experience1™ to display accurate, up-to-date plans and benefits information to members and enrich plan benefits discovery and shopping experience.

Improve member plan and benefits shopping experience

Improved member engagement, satisfaction, and retention

Provide accurate, consistent, compliant, and real-time information to all target applications
Reusable content and rules

100% increase in productivity and operational efficiency
Improved customer service productivity

Automated generation of plan benefit explanation content
Support member self-service

Deliver content across multiple channels and applications in near real-time
 

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Implementing a turnkey group benefits plan management solution in 5 weeks

Discover how a large Healthcare Payer in the West leveraged Benefits1™.Group to simplify the benefits plan design and filing process for its Small Group and Individual Qualified Health Plans.

Simplify Qualified Health Plan management and improve data quality and accuracy

Easy Benefits Configuration and Filing

Streamline the filing preparation process to save approximately 180 hours
Cost-Effective Solution

Budget-friendly solution for the ACA plans
Errata-Free Compliance

Auto-generate 508-compliant QHP PBT, SBCs, and SOBs

Focus on Innovation

Reallocate resources to ACA product development
 

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Reduce ANOC, EOC, and SB review cycle by up to 6 weeks

Discover how a large Healthcare Payer leveraged Benefits1™.Medicare’s end-to-end PBP management and document generation capabilities to accelerate speed to market, fast-track review cycles, increase compliance, and reduce production timelines.

Improve focus on innovation and capitalize on critical business growth opportunities

Speed to Market

25% improvement in speed to market
End-to-End Compliance

Generate 508 compliant ANOC, EOC, and SB documents
Operational efficiency

33% reduction in production timelines
Fast-track review cycles

Review cycles reduced by 6 weeks
 

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Improve SBC Generation Timelines by up to 50%

A large Healthcare Payer on the East Coast with more than half a million members and a very high growth rate was challenged with an outdated tool and inefficient SBC generation process. The Payer creates more than 7,000 SBCs every year. It was looking for a solution that could accurately auto-generate SBCs and integrate SBCs to the central data repository.

Automate SBC Generation and Integration to Central Repository

Automated SBC Generation

Reduced the time required to generate SBCs by up to 50%.
Improved Compliance

Enabled the downstream of compliant documents to targeted systems
Streamlined Workflows

Created a robust and efficient workflow that boosted productivity and efficiency.
Automated Exporting of SBCs

Enabled transfer of SBCs to the client’s central data repository in a few clicks.
 

Based on all the challenges we faced, we wanted a single source of truth to provide everything we needed for SBC integration. We teamed up with the Simplify Healthcare Team to create not only the SBCs but the Metadata and .csv files needed to move the SBC internally. This streamlined our whole process.

–Senior Technical Business Consultant

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Automate State Filings and Benefit Plan Configuration

A large health plan in the Northeast, providing small and large group coverage and serving more than a million members, needed a solution that could ensure all its benefit information from thousands of plans was up-to-date, reusable, and available enterprise-wide. It also needed to expedite the benefit plan development process and compliance by automating state submissions, a regulatory mandate.

Automate State Filings and Benefit Plan Configuration

Access to a Single Source of Truth

Eliminated 95% of data redundancy and minimized errors
Reduced Operational Costs

Achieved the ability to seamlessly suspend and reinstate products and plan packages in real-time
Automated State Filings

Automation of state filings process by generating necessary documents accurately in a few clicks
Improved Member Satisfaction

Improvement in member service through better manpower allocation resulting from efficient processes

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Publish plans faster on the Medicare Advantage marketplace

A large Payer was struggling with their Medicare Advantage (MA) plan management. They were unable to integrate data from multiple sources into a single integrated system to get a 360-degree view of information and drive accurate and efficient data and processes. They were looking for ways to eliminate manual legacy processes, automate MA product/plan configuration and document generation processes, improve the quality of care and patient engagement, consolidate data, and accelerate speed to market.

Accelerate speed to market with a single source of truth for MA plan configuration

Faster speed to market

Improved speed to market to successfully become the first company to publish plans on the Medicare Advantage marketplace.
Improved quality of care

Enabled integrated data operability for data-driven and collaborative MA product management and care management.
Access to single source of truth

Leveraged a single source of truth to automate CMS PBP bid submissions, auto-generate documents, and elevate productivity.
Optimize Medicare Star ratings

Helped manage last-minute CMS changes, decrease submission errors, lower admin costs, and risk of penalties to optimize CMS Star ratings.

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Reduce quotes to claims configuration processing timelines by 50%

A leading health plan on the East Coast was challenged due to disparate legacy systems and manual processes across the account operations unit. Their complicated quotes to claims configuration processes were slow and prone to errors and took an average of 23-37 calendar days for varying complexity plans. They were looking for an end-to-end benefit plan management solution to redesign and streamline the operational processes, reduce the number of manual steps, save time from quotes to claims processing, and get groups into production.

Reduce quotes to claims configuration processing timelines by 50%

Shorter processing time

Helped in achieving zero claims processing errors with shorter processing time and fast turnaround of the products.
Performance Optimization

Helped in reducing the quotes to claims configuration processing time to 10 calendar days from an average 23-37 days.
Improved product setup time

57% reduction in the average product setup and 64% time saved in the end-to-end group setup time.
Savings in non-claims activities

57% savings in non-claims activities which helped in reducing time and cost and achieve operational excellence.
 

Benefits1™.Group has been a tremendous success, and we have met or exceeded all of our goals! We have gained significant efficiencies while eliminating costly manual errors. We cut the end-to-end group setup time by 64%, and there have been zero claims processing errors from the plan setup.

–Director, Operations

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Reduce benefit product build timelines by 80%

A large health plan on the East Coast with more than half a million members and a very high growth rate was challenged with manual, outdated, and error-prone benefit product configuration processes. It was an ongoing challenge for the health plan to streamline enrollment period activities and other benefit plan management processes without any last minute back and forth. To improve the benefit plan management processes, they set a goal of reducing their product build timelines to 7 calendar days.

Reduce benefit product build timelines by 80%

Faster product build timelines

80% reduction in the benefit product build timelines using a single source of truth.
Faster optimized processes

The benefit plan management processes reduced from an average of 18 calendar days to 3.5 calendar days.
Reduced claims recoveries

Reduction in the errors impacting the claims management processes with faster turnaround time.
Simplify plan management

Faster optimization and automated processes to deal with high volumes of new groups and renewals.
 

The Benefits1™.Group tool has enabled us to greatly reduce turnaround times while improving and maintaining quality results. Our performance results during this past Open Enrollment cycle were our best to date; and we attribute those results to the combination of people, process and technology- with the Benefits1™.Group technology being a key contributor to our outcomes. We view Benefits1™.Group as a true partner and look forward to our continued collaboration.

–Director, IT Delivery who has accountability for the Product configuration team

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Improve speed to market by 70% and reduce data redundancy by 90%

A consortium of large health plans was challenged by benefit plan data proliferation across their IT ecosystem. Their end-to-end benefit plan lifecycle was error-prone with disconnected manual processes involving a series of bandaid solutions. Additionally, the consortium had large health plans with conflicting priorities, which prevented a “one size fits all solution.”

Create a single source of truth for benefit plans and improve speed to market by 70%

Faster speed to market

Improved speed to market by up to 70% by reducing the renewal process time from 28 hours to 4 hours.
Improved data quality and consistency

Reduced data redundancy by up to 90% and improved data accuracy and consistency by up to 80%.
Improved processes and efficiency

Reduced benefit errors by up to 70% and improved process efficiency by up to 67%.
Improved member satisfaction

Significant improvement in member Provider satisfaction.

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Create single source of truth, automate documents, and accelerate speed to market by 80% for TPAs

A large TPA was struggling with a tedious manual process for onboarding new groups and renewing them. Their process involved capturing benefit plan and new group onboarding data across 20+ disjoint documents with 250+ pages each. In addition to this, the SBC, Benefit Matrix, Faxback, and SPDs were generated manually.

Automate onboarding and renewals and improve customer service quality by 70%

Faster speed to market

80% improvement in speed to market with data consolidated in a single source of truth.
Faster turnaround time

Automated document generation provided a fast turnaround time to TPA client change requests.
Robust workflow process

A robust workflow process ensured all the stakeholders were informed and data was well organized and loaded by TPA.
Simplify document management

Auto-generation of key collateral materials and accurate management of benefit plan and new group onboarding data.

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Reduce data redundancy by 98%

A mid-size health plan wanted to optimize the benefit plan implementation on the Core-Admin platforms. The following were their key pain points:

  • Significant data redundancy which prevented them from effectively testing and troubleshooting
  • Integration with Salesforce – a lot of the front-end information was captured in the CRM tool that had to be re-keyed
  • SBCs, QHPs, and other document generation – the manual processes were time-consuming and error-prone

Integrate with Core-Admin systems and improve data reusability by 98%

Faster Core-Admin integration

Faster Core-Admin platform benefit product build in less than 4.5 calendar days using a single source of truth.
Improved quality scores

Improved quality scores by up to 95.7% across all touchpoints using automated benefit plan management solution.
Faster Implementation

Reduction in average renewal time per product to 13 mins and new group implementation time to 3 hours.
Increase in data reusability

Improved data consistency within the Core-Admin system and data reusability by up to 98%.