As the healthcare insurance industry grows more competitive, each player is looking to improve the quality of care and rein in costs. Health plans are challenged continuously with balancing operational efficiency and profitability with improving customer experiences, and the two areas haven’t always worked in harmony despite being so closely associated.

Many health plans are focusing on tech innovation to address the issue, but what’s not needed is a new type of insurance company. Instead, existing successful insurance companies must serve and learn about their customers with the same seamless digital experience they’ve come to expect everywhere else.


We have the technology – it’s the industry’s acceptance and implementation where we need to continue to innovate. Health plans that develop better interfaces will be able to meet health customers where they are. It’s this type of empathetic approach that will drive customer service and help ensure retention. That’s the ultimate goal: incentivizing the commercial use of new tools and technology and making all aspects of care effective and efficient for users.

A well-suited CRM solution is one way to go about it, as it can capture data across the enterprise in a scalable fashion, consolidate it into one aggregated view, visualize and analyze it in a meaningful way, and use it to engage with customers and provide superior user experiences. Now, health plans have very unique informational and operational needs that render traditional CRM offerings obsolete.

The question many face is whether they should use their internal resources and build custom or buy new industry specific solutions that are now available?

We obviously have some skin in the game, but here are a few things for payors to note when considering CRM solutions tailored specifically to the health insurance industry.

  • An out-of-the-box solution eliminates the need for lengthy and costly engagements with consultants. There is no capital expense and those savings are passed along to customers who also benefit from ongoing feature deployments.
  • Time and effort managing licenses can be burdensome and violations can be significant. A SaaS is designed to be flexible and customizable, and customers can easily add news users by simply adjusting their license subscription.
  • Best practices. Among the benefits of having industry standards built into your ready-made solution are: operations, sales, care management workflows; ruled-based insurance recommendations; real-time insurance data feeds; and deeper analytics and reporting.
  • Security and compliance. The vendor team takes responsibility for monitoring, compliance and security, while also providing a way to track and automate state and federal requirements. Also, privilege level security ensures the appropriate access to member data.