See How We Helped One HR Provider Automate Healthcare Eligibility and Enrollment
To understand the value of automating healthcare eligibility and enrollment for employers, it’s important to first recognize the Hawaiian Prepaid Health Care Act of 1974. Under this state law, all employees in Hawaii are required to have (or at least be offered) healthcare coverage if they work 20+ hours per week for 4 consecutive weeks. This is not the only way to receive benefits; some employers provide healthcare regardless of hours worked, for example. But at a minimum, companies in Hawaii must comply with this law. As a result, many employers partner with a professional employer organization (PEO) to manage their HR solutions.
The Challenge:
Enter our client, a full-service HR company offering comprehensive HR services, benefits, and payroll management for Hawaiian businesses. To manage new healthcare enrollments and comply with the Hawaiian PHCA law, a six-member benefits team generated a weekly report to manually enroll eligible employees. Because the report was only generated once a week, the data was often stale. Eligibility, therefore, was not guaranteed just because the employee was in the report. Instead, the benefits team re-validated every employee’s eligibility prior to enrollment. This included activities like checking the employee’s termination status or following up with employers for additional info. Only after re-validation could the team manually enroll an employee into their benefits system, iSolved.
While a single manual enrollment only takes 2-3 minutes, the weekly report contained hundreds of employees, and each validation could add minutes to hours of overhead. Each week, the benefits team could only process 50% of the employees in the report, putting compliance with the Hawaiian law at risk. At the same time, our client was fast approaching their open enrollment period, a time in which a large number of employees enroll in healthcare.
Our Approach to Automate Healthcare Eligibility and Enrollment
To support the benefits team, ArgonDigital initiated efforts to automate the enrollment of employees into healthcare via iSolved. This initiative aimed to decrease the workload associated with manual enrollments for the benefits team and address the issue of eligible employees who were yet to be enrolled.
iSolved auto enrollment is a process where enrollment files containing the benefits information for all eligible employees in a company are imported into the system. Using the weekly report as a starting point, we drafted a high-level process flow and elicited from the benefits team the requirements that prevented an employee from auto enrolling. Inhibitors to enrollment were things like manually entered notes, which were difficult to parse systematically, or union employees. Iterating over a process flow made it easy for our stakeholders to visualize their process and identify the logic barring an employee from auto enrollment. Over the course of a few sessions, we nailed down the process and drafted the requirements for our minimum viable product (MVP) solution.
What We Did to Automate Healthcare Eligibility and Enrollment
We implemented our MVP solution in the low code/no code enterprise automation platform, Workato. The solution ingested the data from the weekly report, performed queries against the data based on our requirements, and respectively dropped the employees into an auto enroll report or a manual enroll report. Producing these reports helped us to test our logic and gave us a sense of the next steps to auto enroll more employees in future iterations. Once we identified the employees to auto enroll, we generated one import file per company containing all the eligible employees for that company.
Outcome #1 - Realizing Immediate Value
Within two months of the project starting, we had a fully functional MVP solution and began testing with the benefits team. By importing the enrollment files, a process that might have taken 30 minutes to enroll 10 employees now only took 2-3 minutes.
The Next Step
Because of Workato’s intuitive graphical interface, once we had a basic solution working, we started to iterate quickly on additional requirements, churning out new functionality almost daily. Additionally, rather than managing a dev team, most of the work was developed by the product manager who defined the requirements with a technical architect reviewing and ensuring best practices.
Uncovering Additional Challenges to Automate Healthcare Eligibility and Enrollment
As we continued testing our MVP solution with the benefits team, we discovered data issues with the weekly report. Not only were we still encountering stale data, but we also discovered that the integrity of the data coming into the report was not always good. Despite a working solution, the benefits team was still performing additional validations to enroll employees.
How We Overcame These New Challenges
To resolve the issue, we worked with our client’s technical team to switch their data source from the static weekly report to a Snowflake table pulling in the accurate fields from each respective system in real-time. Because Workato already had built-in compatibility with Snowflake, moving to the new data source only required minor modifications to pull in the right fields, producing a revised solution within a week.
The Path to Successfully Automate Healthcare Eligibility and Enrollment
Going from a completely manual process to our MVP auto enroll solution in Workato took less than two months, minimizing spent budget and getting the benefits team actively enrolling employees in production prior to their open enrollment period. The initial MVP helped us auto enroll 15% of the eligible employees, with the insight to quickly iterate to upwards of 70% of eligible employees, with minimal dev time required.
