Scaling your Workflow

Reading time: 8 minutes · Topic: Payer Operations, Scaling, Workflow Automation Strategy

The first automated workflow going live is a milestone. The 60 days that follow are the harder challenge, and the one most health plans haven’t planned for. This is the moment a pilot either becomes a program or quietly becomes a one-off.

This guide is about what comes after the first workflow. How to scale automation across payer operations without losing the discipline that made the first one work.

The Pilot-to-Program Cliff

Most plans approach the first automated workflow as a project. Defined scope, defined timeline, defined success criteria. The team gets it across the finish line, leadership celebrates, and then everyone goes back to their day jobs.

Three months later, the second workflow hasn’t started. The team that built the first one has dispersed. The vendor relationship has slowed. The institutional knowledge from workflow one isn’t captured in a form that informs workflow two.

This is the pilot-to-program cliff, and it’s where most plans’ automation programs stall. The technology worked. The team adopted. And then nothing else happened.

What Has to Be True for the Second Workflow to Succeed

Before the first workflow goes live, three things need to be in place to make the second one viable:

1. A Prioritized Backlog of Workflow Candidates

The operations team will start asking for the next workflow within 60 days of the first cutover, faster than leadership usually expects. The question is whether you have a ranked list ready when that ask lands.

The backlog shouldn’t be a wish list. Each candidate workflow should be scored on the same criteria that made the first one successful:

• Operational pain: how acute is the problem, in concrete terms?
• Data quality: is the data feeding the workflow reliable enough that automation has something to consume?
• Process maturity: is the workflow mapped, or does mapping need to happen first?
• Operations ownership: is there a leader who’s leaning in, or does the project need a sponsor?

A workflow that scores high on all four is a good candidate. A workflow that scores high on pain but low on the others needs investment before it’s ready for automation.

2. A Core Team That Carries Forward

The most preventable mistake at the pilot-to-program transition: the team that built workflow one disbands as soon as it goes live. The workflow translators go back to operations. The integration specialists move to other projects. The vendor relationship loses its primary contact.

By the time the team for workflow two gets assembled, half the institutional knowledge from workflow one has gone with people who weren’t replaced.

The plans that scale automation well treat the team as a standing function, not a project. A small core (a workflow lead, a data analyst, a vendor liaison) carries forward and gets surge support as each new workflow begins.

3. A Vendor Relationship Designed for Scale

Most first-workflow contracts are scoped as projects, with implementation services priced as a one-time engagement. That’s the wrong model for a program.

By the time workflow two is being planned, the contract structure should support:

• Reusable configuration patterns: what worked in workflow one shouldn’t be rebuilt from scratch.
• A standing implementation partner who knows your environment, not a new team for each project.
• Predictable economics, not project pricing that scales linearly with workflow count.

If your contract structure doesn’t support these, renegotiate before scoping workflow two, not after.

The Three Things That Almost Always Happen After Workflow One

From our experience helping plans scale, three patterns show up consistently in the 60 to 90 days after the first workflow cutover:

1. The Skeptics Become the Champions

The operations team members who were most skeptical going in often become the strongest advocates after the first workflow proves out. They’ll start identifying additional workflows themselves, often before leadership has formally opened the backlog conversation.

This is the moment to lean in. Capture the ideas. Score them against the same criteria. Build the prioritized backlog from this bottom-up input rather than imposing it from leadership.

2. The 80/20 on Exceptions Turns Out to Be 70/30

The exception scoping for workflow one was based on what the team thought they knew. After 90 days of production, the actual exception rate is usually higher than expected, not because the automation is failing, but because the real workflow has more variation than the documented one.

For workflow two, plan for this. Map exceptions more carefully than you did the first time. Talk to the operations team about edge cases earlier in the process. Build in more contingency for the “we didn’t know about this until we saw it in production” cases.

3. The Same Data Quality Issues Show Up Again

The data quality problems automation revealed in workflow one almost always reappear in workflow two: sometimes the exact same issues, sometimes new flavors of the same root cause.

This is why data quality should be treated as a standing function rather than a per-workflow cleanup. The investment pays compounding dividends as more workflows come online.

What a Scaled Automation Program Looks Like at 18 Months

The plans that scale automation well don’t look like the ones that don’t. By 18 months in, here’s the pattern:

• Five to eight workflows in production; not three workflows in various stages of pilot.
• A standing automation function with a workflow lead, data analyst, and vendor liaison, not a project team that gets reassembled each cycle.
• A workflow backlog that the operations team helps populate, ranked on the same criteria as the first workflow.
• A configuration library of reusable patterns from prior workflows that shortens each new implementation.
• Reporting on the program, not just per-workflow: cumulative cycle-time savings, exception trends across workflows, FTE redeployment in aggregate.

The difference between these plans and the ones that stalled at workflow two isn’t the technology or the vendor. It’s the decision to treat automation as a program from day one rather than discovering at month four that they should have.

The first automated workflow is a milestone. The next ten are a program. The plans that scale are the ones that start treating it that way before workflow one is even live.

Where HCIM Fits

HCIM’s engagement model with health plans is built around the program shape, not the project shape. SymKey’s configuration patterns are reusable across workflows, the implementation partnership carries forward beyond the first cutover, and the contract structure is designed to scale with workflow count, not against it. If you’re scoping a first workflow and want to make sure it’s set up for the second one, that’s the conversation we’re here for.

Talk with HCIM about building an automation program that scales →