Breaking New Ground in Medicare CX

Breaking New Ground in Medicare CX

Introduction: The Evolution of a Revolution

Welcome to part three of our series exploring the transformative power of CRM and specialized consultancy in healthcare. Having explored the conceptual landscape and dived into a specific case study, we now journey into the inner workings of the CX track for this effort, where a cross-functional team from the healthcare payer organization and Curate Partners came together to revolutionize the Medicare experience through Human-Centered Design.

Setting the Stage

Imagine a vibrant, dynamic space buzzing with the electricity of new ideas—welcome to the payer organization’s Innovation Center. Here, a multidisciplinary team of Curate Partners Purple Squirrels, payer organization employees, UX designers, Salesforce experts, Business and Technology Leaders, Patients, and project managers came together to ideate, experiment, and transform the customer experience (CX) for Medicare business.

The Human-Centered Design Approach

Human-Centered Design (HCD) served as the guiding philosophy. Unlike traditional approaches that focus on system needs, HCD revolves around the end-user—patients in this case—and aims to understand their journey deeply. 

Research: Interviews and Surveys

The team conducted one-on-one interviews and developed surveys aimed at capturing the ‘Voice of the Customer.’ This initial research was pivotal in understanding what the patients truly valued and where their pain points lay.

Journey Mapping

Armed with qualitative and quantitative data, the team moved to journey mapping. This exercise revealed the entire patient lifecycle, from becoming aware of the Medicare plans available to post-treatment engagement.

Buyer Persona and Segmentation

Data coalesced into distinct buyer personas, which were then segmented based on several parameters like age, healthcare needs, and digital savviness. This segmentation helped in tailoring different services to different user groups.

Service Design and Workshops

Service Design workshops were held to align all touch points a patient would encounter. Workshops were highly interactive, featuring storyboarding sessions that visualized the entire patient experience.

UX Concepts and Designs

The UX team, enriched by the research and workshop findings, produced wireframes and prototypes, transforming conceptual ideas into actionable designs.

Outcome: An Exemplary Model for Medicare CX

The combined efforts materialized into a comprehensive CX strategy, tailor-made for Medicare patients. The innovation center, once just a space, became a crucible where ideas turned into solutions.

Metrics Speak: KPIs and Success

  • Improving Net Promoter Score (NPS)
  • Growing Customer Retention
  • Increasing Employee Satisfaction
Health Payer Customer Satisfaction

Linking it All Together: The Trilogy in Perspective

If parts one and two were about setting the stage and introducing the characters, part three is the triumphant climax. Where CRM systems provided the foundation and specialized teams built upon it, Human-Centered Design offered the finishing touches that transformed a service into an experience.

Conclusion: The Big Win

The journey through the Innovation CX track wasn’t just a win for the Medicare business team; it was a leap forward for patients and the healthcare industry at large. By focusing on Human-Centered Design, we didn’t just solve problems; we anticipated them, turning challenges into opportunities and skeptics into believers.

As the age wave continues to rise, this triad—of CRM, specialized consultancy, and Human-Centered Design—shows us that with the right approach and tools, we can ride this wave, not just with survival in mind, but with a vision to thrive. And in doing so, we redefine the journey of aging itself.

Ready to redefine your customer experience strategy? Contact Curate Partners to discover how we can transform your challenges into unprecedented opportunities.

Through Human-Centered Design, Curate Partners and the payer organization have proven that innovation is not a one-time event but an ongoing journey. As we continue to explore and expand, we’re paving the way for a healthcare experience that is not just efficient but empathetic, not just business-savvy but deeply human. And this is just the beginning.

The material and information contained in this resource is for general interest purposes only and is based on our experience; it does not constitute financial, legal, or investment advice.

Building a Strong Payment Integrity Program: Challenges and Solutions for Health Plans 


Unraveling Payment Integrity Challenges: Tactics for Sustainable Success

  1. Chad Roswick, VP Healthcare Consulting, Curate Partners
  2. Dennis Rossi, Data & Analytics Solutions Partner, Curate Insights
  3. Emily O’Brien, VP Healthcare Solution, Curate Partners

Healthcare costs are a major concern, and health plans are constantly seeking ways to optimize their spending. Payment integrity (PI) programs play a crucial role in this effort by identifying and preventing improper payments. However, building a successful PI program can be challenging. This blog post dives into the key takeaways from our recent webinar on this topic, exploring the common hurdles health plans face and outlining best practices to overcome them.

1. Data: The Foundation and the Challenge

At the heart of any PI program lies data. Unfortunately, accessing the right data can be a significant obstacle. Data is often scattered across various systems, requiring close collaboration with IT to ensure its quality and completeness. Additionally, platform migrations can further disrupt data access for PI initiatives.

2. Data Analytics: The Engine that Drives Results

A robust PI program goes beyond simply having data. It requires a certain level of data analytics maturity within the organization. This involves having a dedicated data platform, robust data quality processes, and skilled personnel who can manage and analyze the information effectively.

3. Governance: Setting the Course for Success

For an in-sourced PI program to thrive, establishing a formal governance structure is essential. This typically involves an executive committee that provides strategic direction and allocates resources. Additionally, a working group with representatives from various departments is crucial for evaluating and approving new opportunities.

4. Internal Capabilities: Building a Scalable Solution

Many health plans have internally developed PI tools. While these tools may have served initial needs, they can often lack scalability and rely heavily on manual processes. Regularly evaluating internal processes and technology is crucial to ensure they can support the program’s growth and future needs.

5. The Future of Payment Integrity: Shifting to a Prepay Model

Traditionally, PI programs reviewed claims after payment (retroactive approach). However, there’s a growing focus on shifting to a prepayment model (proactive approach) to identify and prevent improper payments upfront. This can improve provider relationships by reducing claim denials later and streamline processes for both health plans and providers.

Beyond the Basics: Additional Tips for Success

The webinar also offered valuable insights beyond the core challenges:

  • Engage IT Early: Involving IT from the outset ensures a smoother implementation process and facilitates access to the necessary data.
  • Prioritize Independence: Avoid piggybacking PI initiatives onto other large programs. This can lead to resource allocation issues and hinder the effectiveness of both programs.
  • Collaboration is Key: Partnering with the business side is crucial for defining data quality standards. Clear communication and collaboration will ensure the program focuses on identifying and preventing the most impactful improper payments.

Building a strong PI program requires careful planning and ongoing evaluation. By addressing the challenges discussed above and implementing the suggested best practices, health plans can leverage PI programs to optimize their spending and ensure they are delivering the best possible value for their members.

View Full Webinar:


Curate Partners Welcomes Chad Roswick as Vice President of Healthcare Consulting

Curate Partners Welcomes Chad Roswick as Vice President of Healthcare Consulting

VP of Healthcare Consulting at Curate PartnersWoburn, MA – Tuesday, December 12th, 2023 – At the forefront of industry innovation, Curate Partners, a leading Strategy Consulting and On-Demand Specialized Talent Services provider, is excited to announce the addition of Chad Roswick as Vice President of Healthcare Consulting. Chad joins us during a period of significant growth and transformation, bringing his extensive experience in healthcare operations and payment integrity to further enhance our healthcare practice.

As an accomplished industry leader, Chad brings a wealth of expertise, having previously assumed pivotal leadership positions at L.A. Care Health Plan and Optum, where he oversaw strategic cost management, operational optimization, and collaborative remediation and deployment. This notable addition underscores Curate Partners’ unwavering commitment to not only uphold our tradition of excellence but also to redefine the possibilities within healthcare consulting. Chad’s remarkable leadership track record, coupled with his strategic vision, empowers us to provide our clients with even more impactful solutions.

Chad’s most recent success as a Payment Integrity Consultant saw him orchestrate a rapid transformation of Payment Integrity operations at a client, crafting a visionary roadmap that promises to redefine the landscape for health plans. His strategy, enriched with process, data analytics and predictive modeling, has set the stage for reducing medical expenses by a notable 8%–10%, marking a significant leap in operational efficiency and financial health for our clients.

Dan Foley, CEO of Curate Partners, shared his enthusiasm: “Chad’s arrival marks another key milestone in Curate Partners’ journey. His exceptional leadership and innovative mindset are the catalysts we need to amplify the impact of our healthcare consulting practice. We’re on the cusp of a new era of healthcare transformation, and Chad’s role will be instrumental in driving our mission forward.”

Echoing this sentiment, Chad Roswick remarked, “Being part of Curate Partners is truly an honor, and I’m excited about the opportunity to play a role in the remarkable work being undertaken here. The team’s unparalleled talent and commitment set the bar high, and I am enthusiastic about the prospect of guiding our healthcare practice towards new horizons. I aspire to contribute to innovative solutions that will help propel our clients’ operations into the future. ”

This strategic expansion underscores Curate Partners’ ambition to lead and redefine the healthcare consulting space – truly delivering end to end value for their clients.

About Curate Partners

Curate Partners, a Strategy Consulting and On-Demand Specialized Talent Services provider, excels in guiding clients through transformative journeys, enhancing customer experiences, and fostering competitive digital innovations. Offering expertise in strategy development, project roadmap design, resource planning, talent fulfillment, and program execution, Curate Partners boasts a team of subject matter experts. With a network of acclaimed product managers, CX leads, UX designers, digital, data, and other vital technology professionals, we empower clients to achieve meaningful business transformations.
Media Contact
Jess Rousseau, Senior Marketing Manager
Curate Partners
jess.rousseau@curatepartners.com | 833.828.7283 | www.curatepartners.com

Navigating the Medicare Maze

Navigating the Medicare Maze:

How Curate Partners and CRM Tools Are Revolutionizing Healthcare

Introduction: The Continuation of a Journey

In part one of this series, “Embracing the Silver Tsunami,” we discussed the fundamental role of CRM tools in revolutionizing Healthcare Organization-Patient relationships. In this second installment, we delve into a specific case study: How Curate Partners’ “Purple Squirrel” team of consultants, from UX experts to Salesforce gurus, assisted a healthcare payer organization in transforming their Medicare business.

The Opportunity and Challenge: Medicare and Relationship Management

For healthcare payer organizations, the Medicare market represents both a significant opportunity and an intricate puzzle. Aging Baby Boomers are not just looking for healthcare plans; they are searching for trust, convenience, and personalized care. The challenge lies in managing an ever-growing portfolio of Medicare supplemental health plans while maintaining and deepening relationships with patients.

Enter the Purple Squirrel Team

Curate Partners’ specialized “Purple Squirrel” team was engaged to elevate the healthcare payer organization’s CRM capabilities. The team comprised UX designers, Salesforce experts, and project managers skilled in Agile methodologies.

Our Solution: From Plan Selection to Personalized Care

Plan Selection Wizard

We started by building a Plan Selection Wizard that utilized patients’ prior claims information to recommend the best-suited Medicare supplemental health plans. This allowed the healthcare payer to convert complex data into actionable, easily understandable insights for both staff and patients.

Patient Relationship Management

Our Salesforce experts customized the CRM to focus on Patient Relationship Management, automating critical touch points like appointment reminders and follow-ups. This resulted in an increase in patient engagement and an uptick in customer satisfaction scores.

Business Growth

We leveraged UX design and CRM analytics to create marketing campaigns aimed at selling more Medicare supplemental plans. By understanding the patient journey, we were able to create targeted messages that resonated, thereby increasing sales. (More in depth details about the CX Track in part 3 of this series).

Metrics that Matter: KPIs

  • Increased Customer Satisfaction
  • Improved Patient Engagement
  • Growth of Medicare Supplemental Plan Sales
  • Improved Employee Efficiency thanks to the streamlined CRM process
  • Reduction in Patient Grievances
healthcare metrics

Bridging the Gap

As discussed in the first part, CRM tools like Salesforce can be a guiding star for healthcare organizations navigating the complexities of the Silver Tsunami. In this second part, we’ve shown how these tools, when coupled with the right strategy and consulting expertise, can drive real results in the Medicare space. The result is a win-win situation: healthcare organizations see tremendous business growth, and aging patients receive the personalized, high-quality care they deserve.

Transforming Challenges into Opportunities

As the Silver Tsunami continues to roll in, healthcare organizations have two choices: to be overwhelmed or to ride the wave to new opportunities. With the right partnership and tools, organizations can do more than just survive; they can thrive. The journey from a challenge to an opportunity has never been more achievable.

Are you ready to revolutionize your Medicare business? Contact Curate Partners for tailored CRM solutions and consultancy services.

Delve further into part three in this series for deeper insights, Breaking New Ground in Medicare CX.

The material and information contained in this resource is for general interest purposes only and is based on our experience; it does not constitute financial, legal, or investment advice.