Our point of view

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Solving the Health Insurance Industry’s Biggest Challenges

Our Point of View

“The only thing that is constant is change.” While we don’t think Heraclitus was talking about the U.S. Health Insurance industry specifically, it certainly resonates.

For example, changes in mandatory coverages, emphasis on payer’s Medicare businesses, the never-ending stream of government regulations, and demands to lower overall costs in the healthcare delivery chain.

Therefore, we believe the future of the healthcare industry will be heavily focused on:

Digital health enablement

Digital health enablement

Preventative healthcare

Preventative healthcare

Harnessing the Power of Data

Harnessing the Power of Data

Digital health enablement solution
Digital health enablement
What’s trending?

Even though the industry began taking steps towards a digital-first approach to engage with their members throughout their wellness journey, the pandemic has certainly accelerated the demand of digital transformation in the healthcare industry.

According to research conducted by HIMSS, stakeholders plan to continue investing millions of dollars in digital health. Clinicians and Patients both agree that digital health is here to stay and will even grow exponentially over the next few years.

Most patients, including both younger adults and the elderly, prefer to have the option of visiting their physicians virtually for regular check-ups and minor health issues. Employers/Groups and Individual Subscribers are prioritizing health plans that offer Telehealth and provide efficient digital engagement options.

health insurance industry trends
use of digital health tools

71% of respondents agree that “I will continue to use the digital health tools to the same or greater extent when the pandemic is over

use digital technologies to support or augment clinical decision making

43% of respondents will use digital technologies to support or augment clinical decision making

use virtual reality for medical training

43% of respondents will use virtual reality (e.g. for medical training)


We at Apexon, leveraging the experience and platform expertise of our Salesforce Practice, can help health plans bridge the gap between legacy applications and the need for a modern member and provider engagement platform, with core capabilities like:

Digital Health Enablement Services

Digital Health

Preventative Healthcare Services


Harnessing the Power of Data in health industry

Harnessing the
Power of Data

With the Salesforce Health Cloud curated for the needs of the Health Insurance industry, we will:

find the right provider and facilities for the specialty care

Enable your member services teams and care coordinators to help your members find the right provider and facilities for the specialty care they need

tools to schedule the right appointment

Provide you with the tools to schedule the right appointment with the right provider at the right time and location. These tools seamlessly integrate with the provider’s EHR (Cerner, EPIC etc.) or other scheduling platforms (e.g. Skedulo, Calendly etc.)

enable telehealth option

Enable your members with a telehealth option. This will allow them to safely meet with their physicians via video conferencing and stay a step ahead in their wellness journey

user-friendly, self-service portal

Empower your members with a user-friendly, self-service portal with capabilities to satisfy their needs as well as the needs of their families

Preventative healthcare solutions
Preventative healthcare
Current State of Healthcare Expenses

Healthcare spending in the United States is roughly $3 trillion a year, straining the budgets of families, businesses and taxpayers alike. The price of medical care is the single biggest factor behind U.S. healthcare costs, accounting for nearly 90% of total healthcare spending. (Source – CDC)

These expenditures reflect the cost of caring for those with chronic or long-term medical conditions; an aging population; and the increased cost of new medicines, procedures, and technologies.

Healthcare reform law has also expanded access to insurance for millions of Americans, regardless of age or health status. Many individuals who are newly insured need ongoing medical attention, too. It is becoming increasingly challenging for Health Plans to provide the quality coverage their members need while simultaneously keeping insurance premiums and out-of-pocket expenses affordable.

Three Key Factors Driving U.S. Healthcare Costs:

prescription drug prices

Increased Spending on Prescription Drugs Between 2010 and 2025, prescription drug prices are expected to increase by 136%.

Cost of Treating Chronic Diseases

The High Cost of Treating Chronic Diseases Chronic diseases and conditions—arthritis, obesity, cancer and heart disease—are among the most common, costly, and preventable of all health problems.

healthier lifestyle

Lifestyle Choices How we live affects healthcare costs. A healthier lifestyle can prevent many chronic diseases and reduce the overall cost of care. Indirectly, healthy living also reduces insurance premiums and enables health plans to offer better benefit packages at a much more affordable price to a larger population.

(Source – BCBS)

How Apexon can help


Seamless Member Acquisition & Faster Quote-to-Card for All Business Lines

With Salesforce Healthcare Industry Cloud’s Group Sales solution suite, Apexon can help you excel in the medical and supplemental plan markets by digitizing marketing, product management, and sales process.

Our healthcare-focused Salesforce experts deliver a complete digital solution for carriers and third-party administrators in the health insurance industry. We provide a unified customer experience that accelerates time to value and offers a 360-degree view of stakeholder information, complex relationships and related interactions. The low-code/no-code environment of the Salesforce Healthcare Industry Cloud’s Group Sales solution suite empowers payers to achieve greater sales productivity, agility, conversion, and retention.


Simplify & Automate Complex Back-office Operations

Let us help you reduce your back-office operations cost and achieve a faster turnaround with pre-defined industry standard process libraries to manage complex business processes such as:

Product catalog and benefit configuration

Product catalog and benefit configuration

Benefits onboarding

Benefits onboarding (group setup)

Benefits rating

Benefits rating

Member services (preconfigured workflows)

Member services (preconfigured workflows)

modern day rule-based quote and shop experience

Benefit marketplace (modern day rule-based quote and shop experience)

employer engagement portals

Self-service member and employer engagement portals

Document management and generation

Document management and generation

Intelligent document automation

Intelligent document automation (Convert, organize, and extract data from member-related documents that have been faxed or emailed)


Set Up Care Plans to Help Patients & Members Reach Their Goals

Customizable care plans represent an action plan for improving a person’s health. These care plans help your patients or members take practical steps to improve their health every day. You can manage chronic conditions, provide preventive care, or apply health and wellness protocols with care plans.

Manage a patient or member using a single care plan or multiple plans can be created to address conditions individually. Either way, you have the flexibility to manage your patients or members efficiently—from those requiring relatively simple care to those needing more complex, ongoing care.


Build Relationships & Personalized Journeys with Wellness Campaigns

Wellness campaigns are an effective method to help patients and members stay engaged with their care teams and committed to their care plans. We can use data to track patients through their health journeys to determine the effectiveness of their care plans. The results will inform wellness/lifestyle campaigns to educate patients and members on their health situations.


Reduce Medication-Related Errors with Patient Medication Manager

Medication-related errors affect millions of people around the world every year. Patients and payers alike suffer from undesirable health outcomes and increased costs because of these mistakes.

The Patient Medication Manager component in Salesforce Health Cloud gives you a comprehensive list view of all the medications associated with a patient. This list view makes it easier for the trained eyes of your Care Approvers to spot conflicting medications during approvals of Drug Requests from Pharmacies, which in turn helps you reduce medication-related errors for patients.

Harnessing the Power of Data solutions
Harnessing the Power of Data
Harness the Power of Data to Boost Productivity

The healthcare ecosystem produces copious amounts of data at several different interaction touchpoints: census data provided by employers; contracts; EHRs; data captured in labs and imaging; pharmacies; data from claims processing; and the Social Determinants of Health gathered through population health surveys to name a few. But historically, that data has remained siloed in disconnected systems of engagements. Until very recently, there weren’t many options to harness that data and utilize the insights for decision making.

Health insurance companies are quickly realizing the immense value of leveraging data and analytics. Data has given these agencies the opportunity to identify wasteful spending, promote faster responses to changes in the market, predict future trends, lift profit margins, and even improve the healthcare experience for patients.

Data has given these agencies the opportunity to:

Identify wasteful spending

Identify wasteful spending

Promote faster responses to changes in the market

Promote faster responses to changes in the market

Predict future trends

Predict future trends

Lift profit margins

Lift profit margins

Improve the healthcare experience for patients

Improve the healthcare experience for patients

How Apexon can Help

At Apexon, we can help you to manage every area of your business with intelligent insights in one convenient place. With the combined expertise of our matured Salesforce and Data Analytics practices and experience working with key players in the Healthcare Industry, data-driven decision making is possible. Illuminate new and existing market opportunities, address gaps in care when developing new plans and benefit packages, or identifying key utilization trends, all with data.

Here are a few core areas where health plans can benefit from realizing the value hidden inside their massive databases:


Consolidate View of Member Data (a.k.a. Member 360)

Stop toggling between multiple systems and applications to access patient data. Let Apexon configure your Salesforce Health Cloud by pulling the most important information from a person’s health plan, medical records and past claims. Conditions, medications, contact information and more are all consolidated in the Health Cloud console and available right at your fingertips.


Curate more targeted plans & benefit Packages

With the help of artificial intelligence and data-driven actionable insights, Apexon can develop your new plans and benefit packages for both groups and individual markets. Provide your members with healthcare plans that are curated for their specific demographics, equipped with targeted services, and estimated with proper cost of care. Utilize these insights to negotiate more efficiently with your provider network to keep the overall cost down and reduce issues with claims reimbursement in the long run.


Automate Care Plan Enrollments

Securely consolidate the health intervention data from EHR, findings from imaging, and diagnostics service providers into a healthcare data lake using MuleSoft’s Healthcare API (supporting Interoperability rules and FHIR compliant). Utilize the power of artificial intelligence to determine the rudimentary preventative health and wellness programs in which each member should be enrolled. This will ensure patients can maintain their health parameters to acceptable limits and avoid acquiring chronic illnesses like diabetes, hypertension, or arthritis.

Automating care plan enrollments allows your care coordinators to focus on more value-adding tasks like caring for complex patients. Automation will also mitigate errors in the care plan enrollment process, resulting in healthier populations and fewer expensive claims.


Reduce Administrative Overhead on Basic Care Authorization

Health Plans are constantly trying to strike a balance between providing better care for their members and reducing the cost of care. Apexon can help payer organizations connect utilization management and care management. Let’s empower your organization to:

Automate decision making of care requests

Automate decision making of care requests based on medical policy, monitor service-level agreements (SLAs), improve decision making, and reduce manual intervention with Tableau CRM Analytics for Healthcare and its Utilization Analytics capabilities

Achieve optimal patient outcomes

Achieve optimal patient outcomes and contain medical costs through comprehensive support

Reduce administrative costs

Reduce administrative costs by delivering more appropriate care to members

Improve the member and provider experience and earn trust

Improve the member and provider experience and earn trust

U.S. health insurance industry
Changing the Health Insurance Industry for Good

Heraclitus’ theory on change being the only thing that is constant is certainly food for thought, especially when applied to the U.S. health insurance industry. This field is a revolving door of revisions, which makes it difficult to keep your head above water. But digital transformation can be your life preserver, literally.

We at Apexon know that digital health is here to stay. Therefore, we are committed to bridging the gap between existing systems and the means necessary to remain relevant in the future. Salesforce Health Cloud solutioning is the catalyst of this initiative. Armed with the expertise of our Salesforce Practice, we can help pave the way towards a bigger and brighter future for the health insurance industry together.