Payers, top 6 challenges from legacy sales models

Blog series: How healthcare payer sales models impact revenue growth

By Alex Tolmasoff, Director, KPMG Sales Transformation and HCLS Lead

In our first blog in this series, we talked about the five challenges payer sales leaders may face finding and keeping new members. Now we look at a critical factor that can impact revenue growth – namely, a legacy sales model.

If your organization has a traditional sales approach, there are 6 common issues that typically impact results and could cause the organization to lose revenue or fail to capitalize on growth opportunities.


1. Difficulty executing different go-to-market strategies across market segments

  • Channel mix for mid and up market (e.g., direct vs. consultants) makes scaling difficult and requires constant fine tuning to optimize productivity
  • Stale SMB broker communities have often not been refreshed in years, with unclear segmentation, misaligned incentives, and poor ROI
  • Ineffective inside sales models for Individual, Medicare, or wellness offerings have not received sufficient technology, data, or process investments


2. Challenges coordinating across service and risk lines of the business

  • Different and non-compatible offerings between healthcare services (e.g., home health) and risk (e.g., health insurance, wellness) prevent scaling commercial models, creating above-normal sales costs and sales headcount
  • Complementary offerings gained via M&A are often poorly integrated and culture mismatches prevent well-intentioned teaming
  • Small or disparate commercial operations and customer insights teams lack adequate resources or talent to drive sales and marketing plays to improve coordination and market differentiation


3. Disconnects between growth drivers and sales team incentives

  • Member growth focused incentive structures for sellers can be at odds with a business strategy focus on wellness and ancillaries with better profitability, stickiness, and patient experience
  • While some leaders that push a “not all members are created equal” message and shift toward profitability metrics for their sales teams, this requires a tight alignment between actuary, finance and sales--not an easy bridge to build


4. Outmoded, expensive sales model with new exposure to “hybrid” models

  • Traditional field sales “hunter” and “farmer” type models are expensive with increasingly challenging ROI when compared to hybrid digital models
  • A shift toward digital selling and enablement during COVID-19 increased reliance across all industries on automation, commercial operations and marketing, with leading companies doubling down on their digital investments due to their strong success 


5. Legacy sales talent & model 

  • Many health insurance sales teams have been in their roles for 20-30 years, and generally are slower to sell new products and adopt new technology (e.g., virtual selling, advanced CRM, business analytics)
  • Many of these legacy sellers also tend to focus on maintaining their member / employer base and have a laundry list of reasons that they cannot change accounts or compete for new business
  • Organizations that have not refreshed their talent profiles, career pathing, or competency models can end up with high-cost resources that cannot execute the new nimble strategies with new products, offerings, or customers


6. Lack of modern customer success capabilities

  • Customers (both members and employers) increasingly expect insights that help reduce healthcare costs, increase employee population health, and add value to how they do their business (e.g., monitoring employee health, adding to talent recruiting & retention strategies)
  • Employers now expect sustained attention and support with members, rather than account coverage models that only engage as needed to win the renewal

For many health insurance payers, it’s time for a transformation of their sales approach.

See the next blog in our series on how you can refresh your model.

How can KPMG help?

As you focus on the challenges ahead, KPMG can help you improve the ROI on your sales investments by informing sales strategies, processes, and talent with connected insights. We’ll help you create winning customer interactions.

Contact us

Walt Becker

Walt Becker

Principal, Customer Advisory, Sales Transformation, KPMG US

+1 267-256-7000
Alex Tolmasoff

Alex Tolmasoff

Director Advisory, C&O Commercial, KPMG US

+1 415-963-5100