Case Study: IHP Member Connect – Centralized CRM & Case Management

From fragmented workflows to a unified member experience

Imperial Health Plan (MAPD Health Plan, Southwest U.S.) partnered with Serious Development to replace fragmented workflows and manual processes with a centralized CRM solution. The IHP Member Connect CRM enables over 30 agents across Member Services, Utilization Management, Claims, Appeals & Grievances, Pharmacy, and Provider Network to manage cases seamlessly, ensure compliance, and improve member experience.

PROJECT OVERVIEW

PROJECT DETAILS

Project Type Custom Software Development

Technologies EZ-CAP Integration, Custom Web CRM, Azure AD (SSO), RingCentral/NICE inContact

PROJECT SUMMARY Imperial Health Plan, a Medicare Advantage health plan covering the Southwest U.S., faced fragmented workflows and compliance challenges due to reliance on Outlook inboxes and spreadsheets. To resolve these inefficiencies, Serious Development implemented the IHP Member Connect CRM, a custom web platform unifying member interactions, call handling, and case management across multiple departments (Member Services, UM, Claims, Appeals & Grievances, Pharmacy, and Provider Network). The solution integrated with RingCentral for pop up call details, EZ-Cap for member data, and Google Maps API for transportation templates. With structured case taxonomy, ownership rules, and audit-ready activity logs, the CRM enabled faster call handling, improved SLA compliance, and streamlined cross-department collaboration—laying the foundation for advanced reporting and analytics.

THE CLIENT

Healthcare/Health Plan

Situational Overview Before the CRM rollout, Imperial Health Plan relied on EZ-Cap “incidents,” Outlook inboxes, and spreadsheets to track member interactions. This led to fragmented workflows, lack of ownership, and poor auditability. Inbound calls were not tied to a unified member view, and compliance reporting was time-consuming and error-prone. The lack of centralized context created delays, email ping-pong between departments, and missed opportunities to improve SLA compliance and first-contact resolution.

CHALLENGES

Overview

Split "source of truth" systems – Balancing EZ-Cap as the authoritative member database while creating a new, functional CRM for cases.

Cross-department ownership – Ensuring accountability across UM, Claims, Pharmacy, and other units without creating bottlenecks.

Change management – Overcoming the member sales team’s habit to use Outlook & spreadsheets and moving them into structured CRM workflows.

THE SOLUTION

Serious Development delivered a custom CRM and case management platform that:

Provides a single pane of member interactions with RingCentral pop up details (name, DOB, plan, call logs, recordings).
Enables structured case management across all departments, with routing rules, Primary/Secondary ownership, and automated notifications.
Includes templates (e.g., transportation requests with Google Maps API integration).
Integrates with EZ-Cap via API/file feeds to display historical data while ensuring new cases are created in CRM.
Implements compliance-ready features: Azure AD SSO, role-based permissions, immutable call metadata, activity logs, and audit trails.

Results The introduction of IHP Member Connect CRM delivered measurable improvements in efficiency, compliance, and overall member experience:

Faster call handling – Unified member profiles and call screen-pops reduced manual searching, improving response times and member experience.
Clear accountability – Primary/Secondary ownership rules and automated routing eliminated email back-and-forth, ensuring every case has an owner.
Better compliance – Structured logs, time-stamped actions, and role-based permissions strengthened SLA tracking and audit readiness.
Actionable insights – Case data is now visible by type, backlog, and throughput, creating a foundation for real-time dashboards and performance reporting.
Member Ride Reimbursement System – This custom-built CRM feature automates the capture, tracking, and creation of reimbursement records for member transportation, streamlining the process for the health plan.

"SD built the IHP Connect Member CRM for us in a way that has changed the way we work with our members. We now have a history of interactions and can easily file associated cases to ensure we take care of our members!" Vincent Stubbs - Director of Member Services