Getting Agile in Health: Preparing Insurance Providers for the Move to Agile


Many healthcare insurance providers are making the move to Agile or considering it. For customer-facing systems such as self-help portals, IVR, chat, email responders, and mobile apps, Agile can offer faster time to market, improved quality, and even reduced costs, especially if you have good feedback from customers on what needs to be changed. Reducing the time to delivery and increasing the quality of customer-facing services can be a differentiating factor that retains customers and draws new ones to your healthcare insurance organization. Ultimately, adopting Agile can be the key to delivering a flawless customer experience (CX) in the healthcare space.

So what are the benefits of moving to Agile in detail?


(Image credit: Flickr user 401k 2012)

Improved Customer Experience a Competitive Differentiator in Healthcare

Providing a flawless customer experience can set you apart from your competitors, especially given the following statistics:

  • More than one in five Americans — including 28% of Boomers — were dissatisfied with the experience of purchasing their health plan during Open Enrollment 2016
  • 27% of Americans would rate their satisfaction level a five out of 10 or less
  • Nearly all major health insurance providers in Australia showed declining satisfaction in the year 2015-2016, with 10.4% of customers saying they would either leave their provider in the next 12 months or shop around before they decided what to do

As a healthcare insurance provider, you know your customers have many options to choose from. You need to be able to differentiate yourself from the competition. 


Fast Development Times

The number one reason organizations move to Agile is faster time to market. In customer-facing systems, this is a no-brainer. Your organization is constantly getting feedback from customers about the customer journey. If you have a good monitoring system in place, any issues, dropped calls, or complex journeys are being reported to you. Having an Agile system allows your organization to make improvements on a regular basis: weekly, bi-weekly, or monthly. Rather than having patches to existing software, Agile enables you to make changes as a matter of course, with regular code drops. When regulations or the market environment changes, Agile development allows you to quickly make sure that customers get the information and services they need quickly.

A Streamlined Customer Experience Innovation Lifecycle (CXIL)

Focusing on your CXIL, which is the process of introducing new innovation to your customer journeys, is key. Making sure your customer journeys keep up with customer expectations is critical, and shortening the time to delivery for your CXIL is one of the major advantages of Agile. Most organizations have yet to fully formalize the process of improving the customer experience, and often they don’t call it by the name CXIL. Using an Agile methodology forces you to break down the cycle of customer innovation and look specifically at constructing teams that are customer-journey (customer story) based. In Agile, designers, developers, testers, DevOps, and production maintenance personnel need to look together at how the customer journey is constructed, what tests are appropriate, how to develop the customer stories, and what is and isn’t working in production. By looking at the complete CXIL and streamlining the process, your organization can provide a comprehensive process to optimize the speed, cost, and quality at which you improve and innovate in the area of CX, rapidly moving ahead of the competition when it comes to delighting the customer.  

Improved Quality

Done properly, Agile development improves the quality of the software you deliver to your customer. When it comes to customer-facing systems, quality is crucial. Any flaws in the customer journey can cause immediate loss to your organization — whether that’s a damaged reputation or lost business. One of the most difficult issues your contact center agents face is that the customer reaches them after a frustrating journey through the online interface or the IVR, so that even before they start to give service, the customer is angry about the poor quality of the customer journey. Agile development allows you to improve the quality of the experience your agents deliver through fast responses to issues, the ability to test different scenarios, and the way in which testing is built into the Agile methodology. The reason Agile can dramatically improve quality is that testing is integrated with the entire development process in a way that Waterfall does not allow. In the design stage, the testing scenarios and “what if” cases are considered. During development, the developers are expected to test their own scenarios on a functional level before submitting code to testing. In highly-developed Agile environments, the line between developers and QA is blurred, with both working on the features and the testing together. Testing is automated to a large degree, with regression testing and load testing being performed frequently, often on a daily basis. Finally, code release is contingent on a passing quality score. In Waterfall development, the code is released at the deadline, after QA had a specific amount of time to test the system. 

Cost Savings

The benefits and savings of Agile versus traditional methods can be quite profound; an Agile system has the ability to show a cumulative 10 to 1 return on investment and a reduction in the risk of scope creep ranging from 80% to 10%. In two recent large-scale surveys, Agile was shown to:

  • Improve time to benefit by 69%
  • Reduce costs by 57%
  • Reduce effort by 62%
  • Reduce critical defects by nearly 80%
  • Reduce overall defects by more than 60%

However, if you are looking to reduce costs based solely on a move to Agile, beware. Since it takes time and money to do so, the transition should be seen as an investment rather than a quick cost fix.


Other benefits of Agile include the ability to break down silos within your healthcare insurance organization, respond to customer needs quickly, and introduce new services. 


Cautions: Pitfalls in Implementing Agile

While the case for Agile is clear in customer-facing systems, it’s still not a straightforward choice.

Management Buy-in

Management support is the most important success factor in implementing Agile as a development methodology. The financial investment and change in culture involved mean that your management has to recognize the benefits and be willing to make the long-term investment in training and also make the cultural change themselves. Agile development means that the development teams will have a much higher level of autonomy than in the Waterfall environment. Some management teams may feel they are losing control of the software and the customer-facing systems. Therefore, management needs to be willing to undergo the cultural change, embrace a faster-paced environment for development, and give more autonomy to people throughout the organization. This is the most commonly cited reason that organizations fail in implementing Agile.

Legacy Systems

Healthcare insurance providers in the United States routinely have dozens of legacy call-in systems for customer care, with this number being even higher if the organization has ever acquired another. When making the transition to Agile, it’s important to be realistic about what systems can be addressed using Agile methodology. All transitions are gradual, usually working with a small system that will not impact others, and then moving on to larger systems and projects within an organization. Typically, newer systems and services can be transitioned in a 12- to 18-month cycle, with more complex systems taking 2 to 3 years. However, legacy systems that are entrenched and have a large code base probably will have to be phased out or continue under the Waterfall methodology.

Technical Debt

Just like legacy systems, systems with a high level of technical debt cannot easily be transitioned to Agile teams. Technical debt occurs when software has had a large number of features and patches added without the team spending adequate time on the infrastructure, resilience, and scalability of the system. Unless you make up the technical debt, moving to Agile will either fail to produce working code or further destabilize the system.

Resource Training

Training of the team is absolutely essential, whether it’s by bringing in an Agile coach, using more formal training methods, or both. Having team members who have been in Agile environments helps, but it is not adequate. Because every Agile team is different, your team will need to agree on its own methodologies, so prior experience, while helpful, is not an adequate substitute for having formal Agile training and consulting.

Shift in Testing Paradigm

In an Agile environment, testing is built into the design, development, and deployment. While systems, regression, and load tests are still performed by dedicated experts, testing is also performed all the way through the innovation lifecycle. When planning customer journeys, the QA team help the designers think through all the potential cases and design the tests along with the features of the customer-facing system. Developers create functional tests and are required to submit clean, working code according to testing standards. As a result of this approach, code is cleaner, but also, the group works together more seamlessly to deliver the feature set. This shift in the testing paradigm also means that automation is essential. Using a tool for a unified language around test cases and defects is important for communication within the team and across different responsibilities. Everyone on the team needs to see quality as their job, unlike in the past, where QA was seen as 'grunt work' that has to be done. The paradigm shift for Agile requires everyone to value the thought processes and be invested in the quality assurance of every feature and product.

Changes in Culture

Making the cultural change from the hierarchical, control-based method of Waterfall to an Agile, autonomous mode is not an easy task for any healthcare insurance organization. It’s important to recognize that it will take time for individuals and teams to make the transition.


The Agile methodology is a great fit for customer-facing systems. It can dramatically shorten the CXIL and keep healthcare insurance providers competitive. At the same time, it’s important to be realistic about the time and cultural changes required to make the switch, and consider the right systems to bring to Agile methodology. Used appropriately, Agile can provide a competitive advantage for healthcare insurance organizations and provide customer journeys that serve you and your customers.

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