Executive Summary
Mastek partnered with an Arizona-based non-profit healthcare organization to modernize its customer service experience for the Medicare Advantage (MA) population, resulting in nearly $240,000 in annualized savings. By migrating to the Salesforce CRM and integrating multiple legacy systems, Mastek significantly improved call center efficiency, customer satisfaction, and regulatory compliance.
Background
This non-profit organization provides nearly 2 million customers with health insurance and services, including Medicare Advantage plans designed for seniors and those with disabilities. The company employs over 3,000 staff members across three offices in the western region of the US, all dedicated to helping consumers get and stay healthy.
Challenge
When members and healthcare providers contact the organization’s call center, they expect fast, accurate responses to their questions and inquiries. But the company lacked the technology infrastructure to deliver a quality service experience.
Customer service representatives (CSRs) in the Medicare Advantage teams needed to swivel among five disparate, siloed applications to serve callers: HealthRules Payer (HRP) for claims data, OnBase for documentation, a NICE IVR system, Excel, and email. Because these systems weren’t integrated and lacked scalability, CSRs found it slow and cumbersome to handle common tasks like verifying caller identity for regulatory compliance, enrolling new members, and answering member or provider questions, especially as the member base grew. It was incredibly time-consuming just to create an issue within HRP, reducing staff productivity and hindering customer service.
As members grew more frustrated by high call handle times and delays, the client’s customer satisfaction ratings suffered—dropping as low as 2.5 out of 5 for one Medicare Advantage plan. It was clear the organization needed a more robust technology infrastructure to meet customer service expectations.
Solutions
- Salesforce Service Cloud
- Salesforce Health Cloud
- Mulesoft
- Reliable and insightful report generation
Results
The healthcare payer tapped Mastek for the project based on our deep experience and track record with other payers. Mastek kicked off the engagement in April 2023 with a technical discovery of the client’s systems from a Medicare Advantage (MA) line of business (LOB) perspective and then proposed that the MA Service teams could successfully move to the Salesforce CRM based on available infrastructure that was being used by other LOBs, creating a unified data view and improving process efficiency. Mastek completed this complex transformation in two phases totaling less than eight months.
Mastek resources also helped migrate the massive volume of data (including millions of claims), integrated multiple systems, conducted extensive testing, developed documentation, and led train-the-trainer sessions to support a smooth transition. Overall, close to 120 MA Service team members were migrated from HRP to Salesforce. The Mastek team worked closely with the client’s subject matter experts and internal project manager to complete the engagement on a seven-month timeline, going live with the first phase in September 2023 and the second phase in December 2023 while ensuring no impact to open enrollment.
Now Salesforce is the central platform for nearly 120 users including CSRs, leads, and managers across six Medicare Advantage teams, equipping them to provide a high-quality service experience. They can complete a call from start to finish within Salesforce, with a complete view of member demographics, group data, plan data, call history, provider data, claims history, and case status.
Driving Major Cost Savings
The client is realizing nearly $240,000 in annualized savings through the improved call center processes enabled by the Salesforce migration.
- Average call handle time dropped by more than 30% in just the first few months, saving 533 hours of CSR time per month and an estimated $120,000 per year.
- The additional time a CSR spends after the call to wrap up the details dropped by 50%.
- The enrollment team has saved 40 hours per month just by spending less time validating a new member’s demographic information.
- The process of completing prior authorization forms is significantly faster, resulting in estimated savings of over $31,000 annually.
- The Care Gap team is spending far less time massaging data manually, reducing data load time from 10 hours to 30 minutes.
Streamlining the Work
Before, it took many tedious steps and an average of two to six minutes just to determine if the issue the member or healthcare provider was calling about already existed in HRP and whether it was open or resolved. Now, the call automatically triggers a Salesforce Case 360 Creation process and loads all the relevant data. Then it guides the CSR through a fast, easy process to create a new issue if needed and categorize the reason, using simple drop-down menus. This process has accelerated issue identification and resolution by about 50%.
The Care Gap team is finding it quicker and simpler to conduct outreach to determine the reason for the gaps in care and take measures to address and document those gaps in order to improve member care. They no longer use manual spreadsheets or spend hours handling data; instead, they access the necessary data and implement a solution right within Salesforce.
The Salesforce migration also streamlined HIPAA compliance, helping the client safeguard patient health information. CSRs previously conducted HIPAA verifications by asking the caller multiple questions and tracking the responses in Excel, which slowed the process and introduced compliance risks. A new verification launcher automatically identifies the caller from their queue and populates their member data on a shortcut screen, enabling the CSR to quickly verify identity and move on to addressing their issue.
CSRs have even gained better visibility into the member communication preferences, eliminating unwanted touchpoints and improving the service experience.
Delivering Robust Reports for Improved Insights
Reporting has improved significantly with the move to Salesforce, placing much more information at the Medicare Advantage teams’ fingertips.
Mastek provided managers with training on how to create reports customized to their own needs or to suit a leadership team request. They can easily report on metrics like percentage of HIPAA verifications completed, number of cases open vs resolved, issues that are overdue or will be soon, or average issue resolution time, for example. Managers can also create custom dashboards, choosing which reports they need to view at a glance. These reporting capabilities have reduced unproductive meeting time and improved visibility into the call center’s daily operations.
Creating a Better Path Forward
Encouraged by these results, the client plans to move other lines of business off disparate legacy systems and leverage the Salesforce functionality to improve customer service. With a robust CRM as the foundation, the company is positioned to enhance its experience on the member, provider, and broker portals, providing self-service options for tasks like requesting an ID card, changing an address, checking a claim’s status, and many more. Through a successful Salesforce migration, Mastek has paved a simpler path forward for other business lines.
Value Created
- Multiple systems migrated and integrated on planned schedule and budget
- Significant cost savings realized across six teams
- Faster, more responsive customer service
- Improved efficiency and CSR productivity
- More consistent regulatory compliance
