What if your last open enrollment could have gone smoother? Imagine a mid-sized payer’s contact center buckling under a deluge of calls about plan options, worsened by a recent formulary update. Wait times balloon past 10 minutes, members hang up in frustration, and SLAs (service level agreements) falter. Finance scrambles to approve emergency overtime that inflates budgets. At the heart of this breakdown is the disconnect between demand forecasts, finance, and HR — an operational gap that drives long wait times, missed SLAs, inflated emergency labor costs, and employee burnout. This costly reality, familiar to payers everywhere, highlights how any seasonal spike exposes disconnected planning.
Industry data reveals 96% of revenue cycle leaders cite staffing shortfalls as a direct hit to reimbursements, member satisfaction and retention. Outdated spreadsheets and reactive scheduling lead to overstaffing in lulls, shortages in peaks, and burned-out teams. Smarter, integrated planning is essential for finance and HR leaders to retain members and protect margins — year-round.
The gap workforce management can’t close
Workforce management (WFM) tools excel at short-term scheduling, optimizing shifts up to 6-12 weeks out. But they are insufficient for long-range capacity planning, translating forecasted volumes and SLA targets into the right mix of headcount, skills, languages, locations, and budgets over time. For payers using business process outsourcing (BPO) partners, vendor coordination adds complexity. And without true finance-HR integration, syncing hiring budgets and training timelines to demand remains out of reach. The result is a drop in first-call resolution rates during policy changes, triggering compliance risks, costly rework, and poor customer satisfaction score (CSAT) that’s hard to win back. Unified planning, tied to demand and budgets, is critical — no matter the season.
To understand the limitations of current tools, consider the following challenges:
Vendor coordination issues: Inconsistent BPO performance disrupts scheduling and quality.
Limited forecasting horizon: WFM lacks multi-quarter visibility into volume drivers.
Finance-HR disconnect: No alignment between demand forecasts, hiring cycles, and budget planning.
These gaps underscore the need for a strategic, cross-functional approach.
A unified solution for contact center planning
Anaplan’s contact center planning solution unites finance, HR, and operations planning on a single platform, empowering payers to forecast demand, align capacity and costs, and simulate scenarios well ahead of peak periods — then adapt as conditions shift.
Watch the video: Discover how South Central Ambulance Service NHS Foundation Trust uses Anaplan to save lives and manage demand surges.
The solution bridges operational and financial goals and rests on these foundational pillars:
Workload forecasting: Predict interaction volumes by channel and intent, blending historical trends with external drivers like enrollment windows, regulatory changes, or marketing campaigns.
Capacity and cost planning: Convert SLAs and handle times into headcount and skills capacity requirements across sites or vendors, including BPO roles, with hiring and training plans and finance-aligned budgets.
Scenario modeling: Run “what-if” analyses on digital deflection, vendor disruptions, or benefit changes, weighing service and cost trade-offs.
SLA and vendor performance oversight: Benchmark internal teams against BPOs on quality, speed, and cost, enabling data-driven sourcing and renegotiation.
This framework helps ensure proactive, defensible decision-making.
Payer-specific use cases
Payers face unique seasonal pressures that demand tailored strategies to optimize staffing and costs. By leveraging Anaplan, organizations can address these challenges with proven approaches, such those shown in these illustrative scenarios:
Open enrollment readiness: A regional payer can forecast channel spikes by market, align staffing to first-contact resolution goals, reduce overtime, and maintain strong SLA performance.
Prior authorization waves: A healthcare payer could anticipate backlogs from clinical policy changes, reallocate specialized agents to streamline processing, and ease member frustration.
Benefit and formulary changes: A payer can project surges from formulary updates and test deflection strategies, such as enhanced self-service portals, to keep agents focused on high-value or complex interactions.
BPO mix optimization: A national payer could balance in-house and outsourced resources, optimize vendor shifts by skill and cost, and improve efficiency while maintaining service levels.
These scenarios highlight your ability to adapt with Anaplan — whenever your next peak hits.
Outcomes that transform payer operations
Contact center planning with Anaplan helps you to reshape payer operations, enhancing both financial stability and member experience.
Read the datasheet: From in-house teams to BPO partners, take the guesswork out of capacity and demand planning to control rising costs, and optimize performance.
You can expect transformative outcomes that drive long-term success, including:
Fewer fire drills, steadier SLAs: Proactive planning ensures hiring and training occur on schedule, delivering consistent service that strengthens member loyalty.
Lower labor volatility: Rightsizing by skill and shift reduces overtime and idle time, cutting shoulder-period overstaffing by double-digit percentages.
Happier teams, lower attrition: Poor staffing links to 30–40% turnover, but balanced workloads combat burnout and strategic planning preserves morale.
Finance-grade predictability: Capacity plans sync with budgets, making quarterly business review trade-offs, such as digital channels, clear and defensible.
Smarter vendor spend: Granular performance insights enable confident renegotiations, enhancing member satisfaction.
Seamless integration with your tech stack
Keep your WFM tools for short-term scheduling — Anaplan complements them by identifying long-range staffing gaps and aligning decisions across finance, HR, and BPO partners. Because WFM can only schedule staff already on the roster, Anaplan helps get them there by planning ahead, prioritizing how to fill the gaps, and ensuring those decisions flow smoothly into execution.
Plan with total confidence
So, where do you begin? Why not start by building a peak-season readiness model for one business line — such as Medicare Advantage or commercial plans? From there, you can gradually expand across channels or vendors, weaving it into your broader workforce strategies. With per-population pricing, this approach offers the flexibility to scale at your own pace, making it an easy next step toward transformation.
Whether your next surge is open enrollment, a formulary rollout, or a regulatory deadline — don’t wait for the fire drill. Build risk-mitigation scenarios, strategic “what-if” plans that stress test staffing, costs, and SLAs, before the pressure hits.
