W H I T E
P A P E R
The Healthcare Insurance CRM Opportunity:
From Complexity and Frustration to Simplicity and Effectiveness
If there is one universal truth in this industry, it’s the likelihood that employers, consumers,
and agents are shopping around—not just for cost, but for ease-of-business. In particular,
agents want to work with a healthcare payer that makes closing deals easier, and that gives
them what they need to increase the likelihood of sales success.
With stakeholders demanding a ‘care network’ of transactions linking employers, agents,
members, provider organizations, payers and suppliers, CRM has emerged as the preferred
business platform. Furthermore, it is the most viable foundation for discovering new
opportunities that build momentum and inspire growth.
The Healthcare The complexity of operating in the healthcare insurance
sector is due in part to the sheer volume of information
Insurance Paradox that is generated. Despite this complexity, key
stakeholders—employers, providers, agents, members,
Driven by run-away medical inflation, growing competition and new consumers—demand a level of integration and
and economic and political pressure, the healthcare service that is unprecedented.
industry continues to be in the midst of an unprecedented
period of consolidation, realignment, and restructuring. The message to payers from these key stakeholders
is simply figure it out. They want payers to find ways to
We’ve all heard it before: the regulatory pressures dramatically improve efficiency and service levels, and
(HIPPA), the cost of doing business growing out of to better leverage their most precious commodity—
control, increased competition, and the increasing move information. They demand a better, faster connection to
to consumer-directed healthcare. All these issues have higher quality data, and want faster response times.
been contributing to payers having difficulty improving
their profit margins. Meanwhile, market forces have However, payers confront many systematic obstacles
pushed the healthcare industry to become more efficient to collaborating and sharing information with key
and to provide higher levels of service to all of their stakeholders. As a result, most healthcare insurance
key stakeholders. companies suffer from organizational inefficiency, and
the expensive and unfortunate consequence is a gradual
breakdown of valuable stakeholder relationships.
Reconciling the paradox comes down to
The pressure is on for healthcare payers to adapt,
one thing: getting smarter when it comes to and begin operating in real-time by linking front-office
integrating business, data, and people. And systems with the billing, membership, claims, and medical
doing it now. management systems of the back office.
For those organizations that choose to operate at this
Herein lies the paradox to success in Healthcare higher, more profitable level, the necessary platform for
Insurance. We know the industry grows more complex business becomes the Internet. Although paper-based
and operationally demanding with every quarter. We also processes and information may still be the norm in this
know that providing high-touch, integrated service to key industry, payers recognize that ‘the norm’ is the source
stakeholders is critical in order to gain momentum in a of the relationship jeopardizing obstacles.
highly competitive environment. So what now?
With stakeholders demanding a care network of
Reconciling the paradox comes down to one thing: transactions linking employers, agents, members, provider
getting smarter when it comes to integrating people, organizations, payers and suppliers, CRM has emerged
processes, and data. And doing it now. Because for as the Internet-powered tool that clears those obstacles.
every healthcare organization that leans, with the best of Recent Gartner numbers indicate that between 2000 and
intentions, towards business as usual (“we just need to 2002, the number of payer organizations with a CRM
get better at what we do”), there will be another that gets strategy has tripled, while those with plans to develop one
closer to operating at a higher, more sustainable and in the near future has increased eightfold.*
more profitable level (“we just need to get smarter at how
Before too long, it will no longer be a competitive
we work to achieve our objectives”).
advantage for a healthcare insurer to take this step.
Rather, it will be the industry benchmark.
*Gartner Inc., ‘Healthcare Payer Study: CRM Spending/Deployment Rising’, 15 August 2002.
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The Challenge Report: The place for each line of business and each market segment,
and underwriting and sales use different systems,
Healthcare Insurance Company making any degree of efficiency or cross-departmental
communication almost impossible. In addition, a high
We’ve looked at some of the external factors driving proportion of poor quality, paper-based data funnels from
change in the healthcare insurance industry—namely the sales to underwriting, especially during high season.
paradox of an increasing demand for improved service
in conjunction with intense pressure to reduce costs. Marketing – In order to produce campaigns that are
Now let’s examine the internal limitations and challenges relevant and compelling to the right audiences, marketing
that impact the day-to-day operation of the healthcare needs access to complete information. Typically, there are
insurance company. disparate systems and methods for lead tracking, each
of which provides only an incomplete perspective into
Acquiring New Business – New business sales reps success. The time required to bring multiple sources of
need to produce more proposals faster, with 100% data together for analysis is prohibitive.
accuracy. It sounds like a simple enough directive,
however, the current paper-based workflow, or stand- Without a precise understanding of your book of business,
alone quoting system, makes it almost impossible to it’s difficult to know which is the ideal product to sell to
achieve. Often, the number of days spent just to generate which target segment. And with a lack of visibility into how
rates results in lost business. With poor inter-departmental many times a plan was quoted or sold and by whom,
communication and inefficient business processes, marketing cannot view or understand the win-loss ratio
reps are focused on operational tasks rather than being against a specific competitor’s product line.
focused on closing deals. Healthcare payers need to
do whatever it takes to keep salespeople where they Operations – Operations, being responsible for finalizing
belong—not in the office wrapped up in details, but in the sales with the group setup and member enrollment,
the field, selling. face their greatest impediment in labor-intensive data
entry processes. Payers tend to have several back-end
Renewing Business – The winning factor at renewal systems where information must be re-keyed many times,
time is raising the flag early enough. Most often, reps are leading to a high rate of error, and an unacceptable
alerted with the right information too late due to inefficient, turnaround time for group setup.
labor-intensive processes on the back-end. The time
crunch means they lose the chance to re-quote in order Agent Relations – For agents, getting an initial quote and
to competitively sharpen the deal, or negotiate rates completing the steps to close business can be laborious
with underwriting. Reps can often expect double-digit and frustrating. Significant delays in payer response
percentage increases in premium of as much as 20 or 25 greatly limit how quickly the agent can turn around the
per cent. This trend underscores the importance in giving right offer for consumers. Since agents are often not able
sales more time to negotiate with the customer to find the to access self-service, the processes necessary to release
right benefit mix and rate structure. RFPs and quotes and manage the book of business
Above all, payers are challenged to keep relationships
warm and properly maintained all year, which would lay For instance, many agents sell from 9 to 5, and prepare
the foundation for easier and more dependable renewals. for upcoming sales activities in the evening or over the
Given a warmer renewal environment and an easier weekend—when there are no payer resources to answer
process, underwriting would be able to focus more on their questions. Agents should be able to work how and
signing new business. when they want, with a quick response and no barriers to
access. Conversely, payers need to know when agents are
Underwriting – The process and response time for spreadsheeting them—and if they are, in effect, subsidizing
generating rates is sluggish due to multiple spreadsheets the agent’s business. The utmost goal: to avoid being
and disparate systems. A separate process is often in categorized as a ‘column B’ payer with agents.
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Customer Relationship Management:
CRM for Healthcare Insurance What Is It?
Healthcare insurers who aspire to operate at a higher, Customer Relationship Management, or ‘CRM’, is a category
more sustainable and more profitable level are those who of software applications used by companies to connect data,
say, “We need to get smarter at how we work to achieve people, and processes across the customer-facing front-
office (sales, marketing, service and partner [agent/provider]
management). The simplest essence of CRM’s mission is to
help companies know how their customers like to do business,
Customer Relationship Management (CRM), a suite of
so that customers keep coming back to buy more.
software applications for integrated sales, marketing and
service that sits on top of an Internet business platform, When it comes to CRM for healthcare insurance, the diversity
is the necessary ‘get smarter’ tool. CRM reconciles the of stakeholders that impact market share justifies expanding
the definition. Think of CRM as Constituent Relationship
paradox of increased demand for better service and Management—a tool that manages all the relationships that
increased pressure to reduce costs, simply making it contribute to making, managing, and servicing the book of
easier for your company to do business. business, from agents to customers and beyond.
Not all CRM is equal—when qualifying vendors, make sure the
suite of software applications has good breadth of capabilities
Customer Relationship Management across all constituent-facing functions of your company. It
(CRM)… is the necessary ‘get smarter’ tool should be capable of delivering everything from assisted
selling of complex solutions to online catalogs, self-service
that reconciles the paradox of increased websites, unified knowledgebases, marketing ROI calculation,
demand for better service and increased and more.
pressure to reduce costs. To learn more about what Customer Relationship
Management looks like for the Healthcare Insurance industry,
keep reading. This paper will provide specific examples of
CRM at work in the areas of member retention, agent loyalty
Customer Relationship Management (CRM)… is the and internal efficiencies.
necessary ‘get smarter’ tool that reconciles the paradox
of increased demand for better service and increased
pressure to reduce costs.
Where processes are weak, laborious or roundabout,
CRM streamlines. Where the wires of important
relationships are crossed, CRM reconnects the right
people sensibly. And where visibility is lacking, CRM
brings clarity into the market, sales channel performance,
key stakeholder activity, history and preferences, and
overall business trajectory.
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Improvement Points in the Healthcare Enterprise
When CRM is embraced by front-line employees, the operational impact is dramatic. Redundant, laborious processes
that once jeopardized the integrity of key relationships are redesigned. Let’s consider some of the healthcare payer’s
most common efficiency barriers, and look at a CRM-driven approach to smooth the path to a more profitable model
RED LIGHT OBSTACLES GREEN LIGHT ACTION
Sales force is not focused on selling. Automate sales cycle friction points. Enable online quoting, which allows reps to do
Reps process quotes via fax and e-mail, most of the initial data entry. Allow internal sales to access a single, unified system so
and spend time re-keying information. that all sales activity ‘lives’ in one place.
Sales reps are slow to respond to Automate basic, labor-intensive tasks. Move paper-intensive processes and records
opportunities. Significant delays exist to online, (members, groups, agents, online quoting), with anytime, anywhere access.
generate rates for proposals, verify and
deliver proposals, set up a new group,
and process renewals.
Data exists across multiple fragmented Unify data to a single platform. Record group-member-agent-payer interactions, quote
‘islands’. Management is unable & coverage history. Create a single view of all coverage, including line-of-business and
to analyze and report on business products, and a complete book of business view. Bring back-office data to the front-
performance, view full group or individual office in a friendly, integrated format.
coverage, and understand the agent book
No integration to membership & billing. Integrate all processes to a single system. Bring all sold policies online with
Employees spend time on duplicate data membership & billing systems. Connect census information from membership systems,
entry, resulting in significant errors. then link to a document assembly system.
Poor agent loyalty. Slow turnaround time Increase agent ease-of-business. Offer instant, 24x7 rates, easy-to-use rapid proposal
for quotes results in being categorized as creation tool, and enable convenient agent self-service.
a ‘column B’ payer in proposals.
Reactive management of book of Proactively manage book of business. Automate the renewal process, and alert the
business. Critical renewal opportunities right rep to deal-critical data.
are not flagged early enough, and are
often lost. This results in high rates of
High demand for agent support. Agents Increase agent self-sufficiency. Streamline quoting for faster proposals, and provide
are unable to view their full book of agents with online access to their book of business. Give agents access to the status of
business, and have a lack of visibility into all outstanding quotes, as well as tools to help them sell more faster.
Labor-intensive enrollment process. Streamline the enrollment process. Move the enrollment process online. Validate
Enrollment information is often incomplete, data as it is entered on online application, with only properly completed applications
and inefficient workflow delays group forwarded to operations/group setup.
setup. Data-entry of group and member
applications bottlenecks during high-
season, resulting in late enrollment
applications and a high rate of error in
Slow contract setup. Verifying proposed Accelerate contract setup process. Integrate all front-end data directly into back-end
contracts (group, census & enrollment systems, and eliminate re-keying of all info already captured during the sales process.
info) is difficult, with inefficient workflow
and a high rate of error due to re-keying
Pivotal CRM | White Paper 5
Mapping the Results of CRM: Strategic
The Spillover Effect Strategic
I M PA C T
Strategic Productivity Impact
I M PA C T
Level One Results: Productivity Impact
Improve the speed, accuracy and efficiency of internal
At the most elementary level, CRM automates the front
Tactical office processes that span sales, marketing, underwriting,
and operations. Employees spend more time servicing and
selling key constituents, and less time shuffling paper.
CRM delivers a great deal of functional, process-based
tools to help employees be more productive in selling,
marketing, and servicing key stakeholders.
When users embrace an easy-to-use,
In the next section, we’ll examine how tactical productivity tailored system, companies get measurably
improvements map to increasingly profound impact at
better at the front-office tactics that help to
higher, more strategic levels of business.
grow and service the book of business.
The first level of CRM impact is the improved speed,
accuracy and efficiency of internal processes—or
improved productivity of individuals—in which labor In order to focus employees on the most value-add sales,
and paper-intensive processes are streamlined. marketing and service activities while reducing the time
spent on laborious tasks, CRM needs to be intuitive and
The second level of impact is measured when the payer convenient. It should require minimal training, with reps being
becomes easier to do business with, both from an agent able to create a quote, for instance, without any difficulty.
and consumer perspective.
With an easy-to-use, tailored system, companies get
The third and most profound level of impact is when the measurably better at the front-office tactics that help to grow
‘sweet spot’ of optimal business profitability is revealed. and service the book of business. The right kind of CRM is
When the right mix of products, markets, sales model and invaluable to all people and processes engaged in selling,
agents is identified, you have all the elements required to marketing and servicing the book of business—and the
make smarter and more strategic business decisions. impact of those productivity improvements make a difference
to the bottom line.
Let’s examine these three levels of CRM impact.
Some of the most apparent bottom-line results include the
reduction of administrative overhead, shortened sales cycles,
and easier collaboration and sharing of data, which means
Increase Responsiveness – One of the most dramatic
results from CRM is the improved speed and efficiency
across internal processes. When the front-office activities of
the book of business are unified into a single, centralized
system, information is immediately available, and the paper-
chase is eliminated. Employee focus moves to servicing key
stakeholders, rather than on limited-value details that serve
as obstacles to world-class service.
Create a Unified ‘Corporate Memory’ – One of the
most valuable corporate assets is data. This includes key
stakeholder history, preferences and status, sales channel
performance, quote status, market trends and more. Unifying
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this data to create a cohesive corporate memory is vital to
demonstrating trust and credibility to all stakeholders, from Strategic
agents and agents to end-members. CRM grants instant Strategic
access to data for key stakeholders, providing them with the Impact
I M PA C T
tools necessary to access the data they want.
Increase Face Time with Agents, Consumers, Groups
and Individuals – Increasing face time is always an effective
sales tactic. Developing new relationships or strengthening
your existing relationships will always result in more business
coming your way. As the CRM system eliminates inefficient Level Two Results: Ease-of-Business Impact
processes, employees can re-allocate time and resources
towards managing key relationships more proactively and Increase the likelihood of agent success and employer
more profitably. group & member satisfaction.
Gain More Insight on Performance & Market Trends – The productivity improvements described previously
CRM precisely tracks the sales pipeline and win/loss ratios. manifest themselves powerfully from the agent, employer
Analyze why some deals are more consistently won, and group, and member perspective. Although it’s one of the
why others are more likely to stall or be lost, and capture more qualitative of results from CRM, the smooth, high-
detailed competitive information for each proposal. Leverage level convergence of people and processes is one of the
this insight to focus on the areas that need improvement, most meaningful.
and share the best practices of top performers with others
When this convergence occurs, it streamlines the
who need the encouragement and wisdom the most.
greater operations of the company and extends this new
Intensify the Selling Focus – CRM makes the process efficiency outside the walls of the organization, passing
of closing business easier. For instance, it accelerates the on an improved model of business to agents, employer
issuing of rates, giving the sales team the ability to produce groups and members.
a complete proposal package with the click of a button.
External stakeholders will notice streamlined processes
Sales reps spend less time on administrative tasks, and
and the convergence that results, however, a higher
more time working with the prospect, customer, or agent.
degree of ease-of-business—the kind that tangibly
Collect More Accurate Data in Less Time – The quality of impacts the bottom line—is only achieved by establishing
data and efficiency will increase as duplicate data entry is self-service.
eliminated. Users can only enter validated information which
is ultimately sent to the back-end system, thus eliminating
the potential for re-keyed errors. If there is one universal truth in this
industry, it’s the likelihood that employers,
Clearly, healthcare insurance organizations see dramatic
impact from CRM at the tactical level. The productivity of consumers, and agents shop around for
individuals will increase, and labor and paper-intensive ease-of-business.
processes will be streamlined. Let’s look at the next level
of impact, and see what happens when these operational
improvements become apparent to agents, employer Although there are heavy demands on payers to provide
groups, and members. self-service for external constituents, attempting to offer
self-service without a CRM foundation only causes
requests to flow into employees at a greater speed, only
to hit the road blocks of inefficient processes. CRM-
integrated self-service results in increased efficiency,
convenience, and stakeholder awareness. Where there
was once friction, sluggish response and unmet needs,
there is now a sudden abundance of focus, familiarity
In particular, agents want to work with a healthcare payer
that makes closing deals easier, and that gives them what
they need to increase the likelihood of sales success. This is
where CRM-integrated self-service has the greatest impact.
Pivotal CRM | White Paper 7
If there is one universal truth in this industry, it’s the Agents Issue Quotes More Easily Through Self-Service
likelihood that employers, consumers, and agents shop – CRM eliminates the delay your agents face in getting
around for ease-of-business. a proposal to the end consumer. Moving the quoting
system online means that agents access a secure portion
Increasing the likelihood of sales success means of your website to produce proposals in minutes. This
delivering role-specific website portals with quoting efficiency is clearly noted by the end consumer, since
and book of business management tools, since they they receive clear, accurate answers instantly rather than
eliminate the paper-dominated enrollment process that having to wait hours or even days. Internal staff are freed
has traditionally frustrated employer groups, individuals, from the endless stream of faxes they receive today, not
and members. They also unshackle internal resources only for new business but also for renewals and mid-cycle
from the administrivia of responding to RFPs via fax, or benefit changes. Agents are empowered by being able
rekeying from hundreds of enrollment applications. to manage their own book of business, and to do so in a
more proactive and responsive manner.
The process of enrollment isn’t the only one that has
a great impact on ease-of-business for stakeholders. Agent Ease-of-Business Increases – With an online
Consider the quote preparation process, during which solution in place for the agent community, they benefit
agents initially work with payers. There are many factors from streamlined processes. Quotes created by agents
involved in quoting healthcare insurance—quotes can in the online system are immediately fed into the CRM
become complex very quickly, especially when it comes system, and can feed all downstream processes.
to delivering personalized, tailored quotes that are more
likely to close business. Success depends a great deal Re-keying of information is dramatically reduced, and
on how well your sales team and agents understand internal staff can communicate with agents in more
prospects and customers upfront. dynamic and trackable methods than via phone. From the
first quote and the enrollment process to feeding legacy
systems and processing renewals, every activity and
The proactive model is ‘institutionalized participant is linked in a unified, automated environment.
listening’—you plan and act according to Paper is Eliminated from the Enrollment Process
what makes good business sense to agents, – Enrollees need not understand how to navigate
employer groups, and members. the complex world of inter-dependencies. An online
enrollment system eliminates errors and provides an easy,
fool-proof data collection experience in which employers
A CRM system for sales staff and agents is a starting and members can start and stop when they want to
point to create quotes for your prospects and customers gather more information if needed. The intelligence
that are transparent, easily understood and responsive. of the system streamlines the experience as much as
It will enable them to quickly and effectively work with the possible—for instance, questions that do not pertain to
underwriting department to create quotes in very short an enrollee are never asked, and printing of the collected
order, without delays. data is automatically completed on existing state-filed
PDFs for signing. All manual data-entry tasks and forms
Being first to respond with an accurate, tailored quote sets that had to be completed on paper forms are eliminated,
the bar in the competitive race. It’s an enviable position to in favor of a single consolidated, electronic system that
be in, rather than bringing up the rear and frustrating the guides employees, agents and consumers through the
prospects and customers by holding back an informed process step-by-step.
decision. Or worse yet, delivering an inaccurate quote,
which can lead prospects and customers to doubt Data Quality Increases with Self-Service – Enabling
integrity. And that’s no way to begin a new relationship, external constituents for self-service means that they now
or maintain an existing one. enter their own data. However, the payoff is not just in
moving data entry away from your internal personnel. By
Consider a few more examples of how properly- removing the extra steps of writing down information and
implemented, healthcare-designed CRM enables a more re-keying it, the quality of data is infinitely improved. Cost
proactive model of business: savings can be staggering—eliminate the retouching of
the same data multiple times, and gain the capacity to
process far more. Constituents will not mind contributing
the right information with an easy-to-use, intelligent
system—agents get faster proposals, and enrollees get
completed application forms with fewer errors.
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Internal Employees are Redeployed to More
Value-Add Activities – With the time gained by freeing Strategic
internal staff from laborious and inaccurate data entry, Strategic
shift focus to activities that matter more. Initially, agents Impact
I M PA C T
will require assistance to be introduced to self-service,
but after that, internal staff can be redirected to the Impact
high-value tasks they always wanted to do but could not, Productivity Impact
since they were buried in process administrivia. Identify Tactical
top-performing agents, and assign internal staff to
manage those relationships more proactively. Nurture
the next tier of agents to help move them into the Level Three Results:
top-performer level. Spend more time on selling the total Strategic Decision-Making Impact
benefits of your organization when working with prospects
and customers, rather than struggling just to stay on top Identify the right mix for optimal profitability.
of the paper-chase.
At the most profound level of impact, your company will
If every constituent is very clear on both what is required no longer waste effort trying to squash square pegs into
to successfully sell and buy to mutual satisfaction, round holes (in a very saturated market). Instead, you
the result will be a much higher proportion of happier will conduct stakeholder interactions and move forward
prospects and customers, and more profitable based on a clear understanding of the trajectories of
relationships with agents. demand, your business and the market. With a deepened
understanding of the highs (and lows) of business
It takes much less energy to listen to the needs of performance, companies are able to direct high-level
stakeholders proactively than it does to try and fix a business decisions more intelligently.
broken process or relationship reactively. The proactive
model is ‘institutionalized listening’—you plan and act
according to what makes good business sense to agents,
The moment that CRM’s visibility helps a
consumers, employer groups, individuals, and members.
company to answer the most fundamental
We’ve seen how the second level of CRM impact is ‘what next’ questions is a breakthrough
the point at which efficiency takes root on the receiving one, in which a new collective confidence
end—and key stakeholders, thanks to self-service,
tangibly notice an extraordinarily seamless experience
and a more attentive partner.
The moment that CRM’s visibility helps a company
Next, let’s examine the third and most profound level of
to answer the most fundamental ‘what next’ questions
CRM impact in which companies begin making high-level
is a breakthrough one, in which a new collective
decisions more intelligently.
confidence is gained.
Think of your company as a collection of assets.
Products, people, processes. Data, expertise,
relationships. The trick to maintaining momentum in
a challenging business environment is figuring out the
right mix—identifying that point at which all your assets
converge ‘just so’ to result in profitability.
With CRM having delivered stronger efficiency across
the front office, as well as self-service capabilities to key
external constituents, such as agents, employer groups,
and members, how do companies figure out where to
invest the additional resources, time and money that’s
been saved? The answer lies in knowing and owning
operational strengths and weaknesses, and making
highly informed decisions that capitalize on the good
and minimize the not-so-good.
Pivotal CRM | White Paper 9
• Why is product X being enthusiastically promoted by
our smaller agents, and ignored by our key or exclusive KnoW YouR:
• Why do we win more deals with group size X vs. group Top Producers
size Y? Member Needs
• Should we create more variations of Product Y, or Weak, Laborious Process Points
should we grow our agent community to sell more of Employee Needs
the existing configuration?
• Should we be even trying to sell in this particular target
market/competitive arena? Does our win rate make it
• Are there any specific tactics that our top performing
reps and agents do that our lower performers aren’t ...Then IdenTIfY The RIghT MIx of:
• Do we have products now with market potential that we
aren’t promoting enough? Support
We have a limited budget for training. Should we invest Process Improvements
it towards advancement of our top agents, or a catch-up Site Visits
initiative of our smaller agents? Marketing Campaigns
The moment that CRM’s visibility helps a company to Micro-Advertising
answer the most fundamental ‘what next’ questions Commission Model
is a breakthrough one, in which a new collective
confidence is gained. It is that invigorating moment
when a payer begins directing the strategic path of its
assets—its products, people, processes, data, expertise,
relationships—from deep insight gained from smart, ...To gRoW YouR:
timely analysis of business performance.
Agent Value & Loyalty
It’s good business sense to ‘play to your strengths’. In
healthcare insurance, your strength lies within a core Level of Responsiveness
community of agents. An analytical approach based on a Employee Efficiency
CRM system helps companies to deeply understand why
some agents close more business than others, and grow
the value of this revenue-critical community. Win Rate
Maximizing corporate investment in the agent community
is a matter of finding the right mix of tools and information,
combined with a weighted approach favoring the most
valuable agents. This is the ‘sweet spot’—that point at which don’t intend to do all at once. In the interest of investment
all the right assets intersect for maximum profitability. longevity, make sure the solution you choose has the
breadth to grow and flex with your company as business
Making It Work for
With that in mind, one of the most important philosophies
Heathcare Insurance to follow when selecting, designing and building a CRM
When selecting a CRM system for Healthcare Insurance, system is that of developmental precision—or making
there are two categories of selection criteria to consider: sure you get everything that’s necessary, and no more.
System Suitability and Vendor Suitability. Employees, the most important contributor to CRM
success, will adopt and embrace a system only if it
doesn’t overwhelm them. To make sure you develop CRM
‘Making it Work’ Part One: System Suitability with developmental precision, understand the concept of
Everything you need, nothing you don’t: simplicity is a Breadth versus Depth.
‘Breadth’ refers to how comprehensive a CRM system is.
First, make sure the solution has the right features that If CRM has breadth, it has the right mix of functionality
stretch across sales, marketing and service—even if you stretching across all the constituent-facing teams in
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your company. CRM with breadth has the potential to continued development and tweaking, with incremental
contribute in every function of your company, even if you return on investment. Your system will never be set in
don’t do it all at once. Breadth is important when you want stone—and you shouldn’t want it to be. Your business
your CRM to grow, to stay relevant and expand its role in needs to be engineered to keep pace, and that includes
your success. your CRM system.
A CRM system should facilitate customization by making
it easy to change the way in which customer data is
one of the most important philosophies organized and used. Think of a puzzle. Most CRM
to follow when selecting, designing and vendors glue the picture to the puzzle pieces. If you want
building CRM is that of developmental to change the shape of the puzzle pieces to better suit
precision—or making sure you get your needs, it’s very difficult to do so without breaking the
everything that’s necessary, and no more. picture. Ideally, the picture (your book of business data)
should be kept separate from the puzzle pieces (how the
data is organized). This means you can change the shape
of the puzzle pieces—or how your book of business data
Meanwhile, ‘Depth’ refers to how much functionality a
is organized—any way you want, without disturbing the
CRM system has. If CRM has depth, it has an almost
actual data itself. The ‘picture’ is glued to the ‘pieces’ only
limitless number of features. It’s like an iceberg—chances
when the data is used.
are good that you’ll only ever need what you see above
the surface of the water. But the excess adds to the cost
of purchasing and implementing, and you’ll be weighted
down by the massive amount of unnecessary features don’t presume you’ll get it right the first
living in the system. Most important, overwhelmed users time, or all at once. Count on making
will be disenchanted right from the outset. adjustments and iterations—taking safe,
Instead, your CRM vendor should deliver the majority of manageable steps.
what you need out-of-the-box, specially designed for the
healthcare insurance industry. The remaining, specialized
functionality that makes your system yours should be quickly At Pivotal CRM, the secret to how we do this is called
added through cost-effective customization. That way, you’ve metadata, or data about data. We keep it separate,
got everything you need. And nothing you don’t. accessible and highly changeable. It means that as
your book of business, offerings, market conditions and
Once you have validated that the CRM system will deliver regulatory requirements change, your CRM system can
breadth of functionality to address key challenges, you need adapt without interruption to critical systems and with
to ensure the technology, experience and business style of minimal cost and effort. So that it stays relevant, aligned
the CRM vendor is the right match for your company. and meaningful.
‘Making it Work’ Part Two: Industry Experience & Dedication
First, make sure the vendor you choose has designed
Vendor Suitability CRM precisely for your kind of company. Most software
Get the right approach, knowledge and experience on vendors take a broad-brush approach when it comes
your side. to serving vertical markets. They develop a solution that
attempts to serve a broad vertical category such as
From a technology perspective, begin by assessing the healthcare. In contrast, Pivotal CRM’s Headstart approach
flexibility of the applications, which impacts the cost- is to identify more specific, niche vertical segments—such
efficiency and speed of deployment and ongoing change. as healthcare payers—that have a clear set of more
Then, assess the dedication and experience of the vendor specific common needs.
to the healthcare insurance industry, and examine the
approach and methodologies the vendor will use to At Pivotal CRM, our approach is to develop precisely-
ensure your company measures tangible business results tailored offerings based on a relevant framework of
from the system. microvertical-designed functionality, and then work
with each customer to further tailor the system.
Pre-configured business rules and workflow, highly
Speed & Cost of Deployment
adaptable data models and robust customization tools
& Customization make it easy and cost-efficient to change and adapt to
CRM is a journey, not a destination. It is not a matter of create an absolute ideal. The system is designed to be
installing software, and being done. By its very nature, backwards-engineered from your most critical corporate
a CRM system should always have an open door for objectives, existing processes and operational and brand
Pivotal CRM | White Paper 11
This critical partner should have a deep and intimate
understanding of industry trends, business requirements
The Final Word
and processes, including knowledge of common people We know the healthcare insurance industry grows more
challenges within a healthcare organization; the sales complex, operationally demanding, and competitive with
cycle; industry regulations; the tradition of paper-based every quarter. For those organizations who strive to operate
processes; healthcare products and riders; rating at a higher, more sustainable and more profitable level, CRM
methodologies; and the need for simplicity for end-users. is a breakthrough tool. It is a collective jumpstart that raises
the bar for the competition, while raising the efficiency of
The vendor you choose should also have hands-on
every interaction for the stakeholder community.
experience helping healthcare payers identify and follow
a clear path to the right business results.
CRM is not a software purchase—if it were, it would be
relatively easy. Companies who excel at CRM see it for
what it is—a results purchase. This means working with
your CRM vendor to go far beyond a one-time software
ROI assessment to report meaningful business results.
The key is closing the loop. Once you’ve identified your
phase-one business objectives, make sure your CRM
vendor baselines your performance. This is to assess your
progress before, during and after deployment. Combine
all those perspectives, and you gain the full picture of
your business trajectory (and CRM’s impact on it). This
is institutionalized accountability. With comprehensive,
precise results measurement built directly into your CRM
system, you will clearly see the numbers and charts on
how your business is improving over time.
For more information or a complete list of our worldwide offices, please visit www.pivotal.com.
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