Fixing The Quote-to-Card Process Yields Bigger Results

The adage says, “If it ain’t broke, don’t fix it.” But what if it is broken and you just don’t know it? That’s the problem facing many health insurers and their quote-to-card process. On the surface, things look reliable but in reality, the process is often hampered by errors and delays, frustrating members and providers. The broken process also stymies growth of administrative services only (ASO) products. That’s important since nearly two-thirds of covered workers in the US are enrolled in self-funded plans, according to KFF, and ASO is an area of differentiation for insurers in a competitive marketplace.

The quote-to-card process, which incorporates such things as sales, underwriting, product configuration, enrollment, and identification card generation, is the front door for ASO customers. When it works well, it accelerates sales and generates loyalty with employers. Unfortunately, many insurers are dealing with outdated legacy technology systems and fragmented data sources. These structural weaknesses result in manual workarounds, inaccurate pricing, delayed quotes, and increased administrative burden on staff, among other things.

Insurers need to modernize this process through automation, better data integration, and streamlined workflows. Below we outline steps companies can take to start this transformation. Insurers we’ve worked with on this front have realized substantial returns, including a 25% to 40% improvement in sales close rates.

Recognize the warning signs

Start with this question: Do you know if your quote-to-card process is broken?

Most leaders don’t realize how much friction exists until they step back and look at the process holistically. Part of the problem is that, to meet employer demands for more customized ASO offerings, insurers have developed modular products that cover everything from cost transparency and employee support to risk mitigation and tailored benefit design. This resulted in a patchwork of fixes, with each department addressing its own needs. We’ve identified four main pain points for insurers as they try to boost and scale ASO operations:

• Legacy systems strain: Legacy systems and processes that are unable to flex with modular product demands and volume spikes, and integrate with new point solutions
• Inefficient workflows: Inefficient quote-to-card workflows cause enrollment bottlenecks and member/customer dissatisfaction
• Resourcing constraints: Resource strain during peak enrollment seasons leading to overtime and quality risks
• Inability to compete: Limited ability to customize offerings quickly leads to lost accounts to more agile competitors

What a modern process looks like

Leading insurers we’ve worked with approach quote-to-card with a strategic and coordinated mindset. They have their eyes set on end-to-end transformation rather than piecemeal solutions. The approach can be divided into three categories. One is organizational: mapping the process across sales, underwriting, product build, enrollment, and compliance, then eliminating unnecessary handoffs and clarifying accountability. The second is about data: consolidating data into a single source of truth for products, customers, and pricing. The third shift is technological: embedding automation and artificial intelligence (AI) to handle repetitive tasks, support underwriting, validate eligibility files, and generate ID cards with fewer errors. Since AI can analyze large chunks of data instantaneously, it can also help ensure that benefits are designed and set up properly and conduct end-to-end testing in real time to detect problem areas.

Payers we’ve worked with to adopt these principles have taken major steps to automate routine functions, improve access to data across departments, better manage requests for customization, and stand up cross functional teams to manage the transformation. We estimate that these steps will lead to a 25% reduction in personnel costs and cut lead times from more than 35 days to under 10 days.

Don't delay taking action

Undertaking this process improvement effort can seem daunting. But it is manageable if approached with discipline. As mentioned above, start by diagnosing problem areas. One way to do this is through shadow teams to test various functions. It’s also critical to benchmark performance to identify areas for improvement. And rather than waiting for a multi-year overhaul to show results, the most effective programs celebrate early wins, breaking the roadmap into achievable blocks that demonstrate value.

Modernizing the quote-to-card process shouldn’t be viewed in isolation. The effort can yield significant results across all lines of business from more integrated data systems and streamlined workflows. Payers that fail to act risk being overtaken by the trend to outsource to third party administrators and other competitors. Insurers taking a proactive approach can turn their ASO segment into a differentiator that lowers costs, improves broker relationships, accelerates sales, and adapts to evolving employer expectations.