While insurers scramble to keep up with the changes and stay abreast of developments as a result of the latest health care reforms, insurers are looking at the next steps, and technology is definitely a factor.
“The reform goes well beyond point solutions,” Elizabeth Hart, principal, Healthcare Solutions, at Pegasystems Inc., tells INN. “This is going to impact all departments, and organizations need technology that allows them to reposition themselves for this and other seismic changes in the industry.”
To address this, Pegasystems announced the availability of Individual Sales Process Manager for Healthcare (ISPM), the most recent in a growing suite of solutions designed to increase efficiency and speed innovation for health care organizations. A multi-channel sales and enrollment solution supporting both direct-to-consumer and agent-driven activities, ISPM streamlines and tailors the acquisition and on-boarding process for individual health care insurance consumers, the company says.
“We have heard from several [health insurance] clients that this technology was something they wanted, moving forward,” Hart says. “Most payers have small individual market memberships, and now need to prepare for major growth for volume and changes. For the last several months, even before health care reform passed, we’ve been working closely with several customers on this new solution. They’re asking for solutions that are going to immediately drive down costs, and be responsive to dynamically changing regulations. We believe there is a significant market need for technology, specifically for on-boarding new enrollees, and maximizing revenue while keeping costs in check.”
Built on Pegasystems’ SmartBPM platform, ISPM combines process automation with intelligent decisioning, which enables health insurers to provide a streamlined, end-to-end sales and enrollment experience for individual consumers, regardless of the channel—Web, e-mail or phone—they choose for interactions. ISPM is designed to provide real-time rates and quotes, automate the underwriting process, guide application submission and instantly update all back-end systems with accurate enrollment data. ISPM’s automation of individual sales activities creates greater efficiencies to handle increased volume, and speeds on-boarding activities for quicker sales attainment, the company says.
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