MST Solutions Shop & Enroll Medicare Accelerator

With an estimated four million baby boomers aging into the Medicare system each year, and an increasing number of health insurance providers offering attractive Medicare Advantage and Medigap plans, member attrition across Medicare Advantage policy providers is quite high. To stay ahead of your competitors, you need ways to maximize member engagement and scale operations without bloating support staff. One way to do that is to empower your Medicare beneficiaries with a self-service portal that puts enrollment and knowledge at their fingertips. 

Using Salesforce’s intelligent platform and apps like Salesforce Health Cloud, MuleSoft, and Vlocity, along with pre-built solutions developed in house, we’ve developed a Medicare Advantage enrollment accelerator designed to quickly deliver self-service shop and enroll capabilities to your organization’s Medicare program. This suite of pre-built solutions enhances Salesforce’s out-of-the-box features, quickly configures your system to better handle the unique requirements for Medicare programs and contributes to enrollment expansion while at the same time lifting burden away from overtaxed support centers. 

MAJOR FEATURES

  • Automated OEC file generation for ease of application processing and CMS integration* 
  • Accelerator to load the following data into Salesforce Vlocity through easy upload functionality in Excel: * 
    • Plans and Zip Code/County mapping  
    • Plans to Benefits mapping with summary descriptions  
    • Drug Reference data that enables beneficiaries to search for covered drugs in each plan  
    • Pharmacy network data that enables beneficiaries to search for available in-network pharmacies 
  • API’s to integrate with third party PBM (Pharmacy Benefit Management) system for drug and pharmacy look up* 
  • API to integrate with third party PBM system for drug pricing comparison* 
  • API to integrate with provider directory for in-network provider search* 
  • Enhanced provider search functionality integrated with Google Maps* 
  • Enhanced pharmacy search functionality integrated with Google Maps* 
  • Enhanced drug comparison functionality which compares the drug prices across the plans and pharmacies which is currently a gap in the out of the box functionality* 
  • Enhanced plan comparison feature which includes supplemental plans like dental or vision*  
  • Compliance with current CMS and HIPAA regulations, PHI data encryption, security needs, and ADA accessibility


Building block technology ensures that the Shop and Enroll accelerator meshes seamlessly with our other accelerators. Extend your reach and scale operations when you need it, where you need it. 
 

This offering is proficient at managing full service self-enrollment for new and renewing members, including a knowledge base for plan comparison and provider lookups, plan selection, and auto-delivery of contract materials. It’s designed to streamline and boost member enrollment through easy-to-use dashboards that automate the workflow quickly and securely from initial inquiry to completed application. Through analytics, each inquiry is logged, tracked, and categorized, with data delivered in real time via reports and custom dashboards to all concerned constituents. 

ADDITIONAL FEATURES

  • Complete online self-service experience for beneficiaries to view and compare plans and submit their Medicare application 
  • Easy plan configuration for internal staff to designate plans by state, county, or zip code 
  • Reports and dashboards for internal staff for various KPI’s 
  • Knowledge Base for member research and plan comparison 
  • View and search for pharmacy, drug prices, and in-network providers 
  • Dynamic, intuitive dashboards and step-by-step, guided workflows 
  • Automated email-based communication for various stages throughout the application processing 
  • Full integration and customization capability for provider lookups and drug pricing comparison across plans 

BENEFITS AND ROI

  • Enjoy a faster time to market with streamlined plan shopping and enrollment via pre-built solutions that enhance Salesforce’s out-of-the-box features 
  • Brings clarity to complex information, making it easier for members to make informed decisions 
  • Lifts burden away from support teams and cuts processing time down  
  • Eliminates manual processes, improving operational efficiency 
  • Reduces costs through elimination of legacy technology, and overuse of third-party applications 
  • Sets a foundation to grow Medicare enrollment by attracting discerning baby boomers 

MST SOLUTIONS HEALTH CARE ACCELERATORS

Download your copy of the guide for free

About MST

Founded in 2012, MST Solutions is the largest independent Salesforce consulting partner in the American Southwest region. With Summit level status in the Salesforce ecosystem and a 5 out 5 Customer Satisfaction score, we’re service experts who take service to a whole new level. Through the framework of a proven effective Roadmap to Results, our team of Salesforce architects, developers, project managers, and administrators add our expertise to your team to craft agile, innovative solutions that answer your organization’s operational challenges today and grow as you grow. 

Recent Articles

Let's connect

Whether you’re ready to move forward or just testing the waters to see what you need, join our email list to get great information on working with products like Salesforce directly to your inbox.