Healthcare customer relationship management case study

Sharing Onix’s experience in developing custom CRM software for an American health insurance company

This case study on customer relationship management for healthcare businesses shows how Onix’s developers created a tailored solution that allowed to digitize insurance agents’ work process at minimum cost for the company.

Healthcare
Industry
5 specialists
Team size
USA
Location
6 months
Project duration

[ Business goals ]

Onix’s client, a California-based medium-sized health insurance company, needed to:

1) help its account managers and managers serve and handle customers more effectively
2) make the lead and customer management processes digital

The client had assessed several existing customer relationship management solutions, starting with Salesforce.

They came to the conclusion that those products' feature sets are bloated and buying accounts and functionality from them would be cumbersome and impractical financially.

The company decided to develop a custom CRM system and host it independently.
The web application for desktop computers would be used exclusively by the company
and run on its private server. With this request, they approached Onix’s specialists, with whom they were already working on another project.

[ Project scope ]

Onix’s team was commissioned to:

﹂ Develop CRM functionality enabling insurance agents to create accounts and plan and manage interactions with leads, opportunities, and customers

﹂ Design an intuitive user experience (UX) and user interface (UI) enabling insurance agents to navigate the system easily and perform their daily tasks faster

﹂ Ensure that the system is HIPAA-compliant, as the CRM would be collecting and storing protected health information (PHI)

﹂ Deploy the system on the company’s private server

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[ The app’s flow and key features ]

The goal was to streamline customer account management for health insurance agents.

The company's potential customers (leads) can sign up online or have their information manually entered by health insurance agents.

The system supports seamless communication, task management, and document sharing. Notifications keep the agents updated on new accounts and tasks.

This workflow is supported by a number of app features:

Insurance Lead Account Creation Methods

Accounts are created in two ways:

through an online form that leads fill out on the company’s website
manually, when an insurance agent enters a lead’s information:

﹂ name
﹂ phone number
﹂ email
﹂ gender
﹂ date of birth
﹂ Medicare beneficiary identifier
﹂ ZIP-code
﹂ healthcare proxy’s contacts
﹂ health plan
﹂ primary care physician
﹂ pharmacy

Assigning Leads to Agents

When a manager receives a lead from the website, they assign it to an insurance agent as an “open account”.

Lead Communication and Task Management

Once an agent has received or created an account, they can start communications with the lead via phone or email. The system facilitates scheduling, assigning, and tracking these interactions (tasks) and results, as well as uploading and sharing documents.

System Notifications

The system sends notifications (on the user’s interface and via emails) regarding new accounts, assigned tasks, etc.

Lead Status Indicators

As agents interact with leads, they indicate when they “contact” and “convert” a lead. They may also mark an account as “lost”.

Lead to Customer Journey

A lead proceeds through the pipeline, changing their category from “Lead” to “Opportunity” and from “Opportunity” to “Contact” (a customer who bought a health plan).

Account Management and Search Filters

Agents can manage accounts in each category – Leads, Opportunities, and Contacts – on separate pages. They can search accounts by name and filter them by dates, status (open pending, closed/won, overdue, rejected, not qualified), assignee, and source.

Comprehensive Account Information Overview

Each account page contains the person’s contact information and MBI, healthcare proxy’s contacts, health plan, primary care physician, pharmacy, medication, other important details that agents can enter as notes, relevant documents, agent’s tasks regarding the account, and the whole history of the account’s interactions with the company.

Stats and Reports

Reports enable agents and managers to see the essential statistics, such as AEP and OEP success percentages, monthly Leads and Opportunities, Leads-to-Closed and Opportunities-to-Closed monthly ratios, current Leads and Opportunities by status, and more.

Integrating Customer Support Module: Overview

Contacts would phone the company when they need assistance with their health plans. An automatic system would identify the customer calling and retrieve all information about them to the customer support’s interface. Their interface also enables creating and assigning tasks for solving the Contact’s problem, and the software would record all customer support’s actions regarding the call. This customer support module still needs to be integrated.

Project phases

Requirements and Documentation

Before development began, Onix’s developers gathered and had the client's CRM requirements approved.

The documents included:

SRS with functional and non-functional requirements
UX charts and UI mockups executed by Onix’s designer in Figma
a detailed work breakdown and effort estimation in hours (Google spreadsheet)
timeline with planned start and end dates for each project phase

Healthcare Data Security

Development started in January 2023 with one back-end and one front-end developer, overseen by a part-time project manager. Measures to ensure healthcare data security included:

leads’ consent for processing their contact information when they fill out the online form
the principle of least privilege for the system users
password rotation
inactive user log-out after 15 minutes

Evolution of UI Usability

The user interface went through several iterations as the team tried to maximize its usability at the client’s request.

Testing Conducted by QA Engineer

One quality assurance engineer conducted the necessary testing.

System Rollout:
June 2023

The system was presented to the end-users in June 2023.

Core technology stack we used

Cake PHP,

PostgreSQL,

Angular

[ Results ]

The project met our client's expectations perfectly, providing a straightforward yet powerful solution to their core problem.

Instead of incurring hefty monthly fees for third-party CRM services, the client made a one-time payment for a lean solution they will use for years, paying only for hosting and maintenance.

The CRM system built by Onix’s specialists provided many benefits:

﹂The implementation and user onboarding were both easy﹂The system reduces the need for manual data entry and thus errors﹂The CRM speeds up lead processing and helps distribute the workload better﹂The software has increased the insurance agents’ productivity

﹂A system that accurately reflects the company’s business process and fully meets the employees’ needs eliminates the need for experimenting with off-the-shelf solutions, which would be confusing, costly, and involve data migration﹂Should the company need to shift to an off-the-shelf solution, migrating data from their own CRM to the third-party service

Overall, the client is highly satisfied with the cost-effective, customized CRM solution.