Case Study - newsletter strip banner

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.

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A Large Health Payer Leveraged eMedicareSync™ VAP to Timely and Cost-Effectively Create Compliant ANOCs/EOCs and SBs

Read this case study by Simplify Healthcare to learn how a large Health Payer in the Northeast leveraged eMedicareSync™ Value Assurance Package to timely and cost-effectively generate compliant ANOCs/EOCs and SBs.


Elbow-to-elbow support for end-to-end document generation

Zero Compliance Issues

Generated fully compliant ANOC/EOC and SB documents

Cost-Effective Solution

Budget-friendly solution for document generation

100% Accurate Documents

Built documents with zero errors

Peace of Mind

No last-minute rush or long and stressful working hours

 

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A Large Payer Improved SBC Generation Timelines by up to 50% with eBenefitSync™

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Payer on the East Coast with more than half a million members and a very high growth rate was challenged with an outdated tool and inefficient SBC generation process.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

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A Large Health Plan Automated its State Filings and Benefit Plan Configuration With eBenefitSync™

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

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A large Payer became the first to publish plans on the MA marketplace using eMedicareSync™

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.

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A leading Payer reduced quotes to claims configuration processing timelines by 50% with eBenefitSync™

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.

 

eBenefitSync™ 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

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A large Payer reduced its benefit product build timelines by 80% using eBenefitSync™

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 eBenefitSync™ 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 eBenefitSync™ technology being a key contributor to our outcomes. We view eBenefitSync™ as a true partner and look forward to our continued collaboration.

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

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A consortium of large Payers improved speed to market by 70% and reduces 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.

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A large TPA consolidated over 250 pages of Group and plan data and automated documents

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.

*All personal information submitted by you will be used by us in accordance with our Privacy Policy.

A midsize Payer integrates Core-Admin systems with a single source of truth to 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%.