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Agent Workflows and Pain Points
For: Taha + Ian Source: GRO-84 Last updated: 2026-05-11 Status: Working draft (v3). Refines with James's Agent Discovery Form and key agent partner calls.
TL;DR
Today an agent touches every member's workflow about 8 times across the lead → enrollment → coverage → renewal arc. With AskFlorence they touch it once — review + submit — and earn ongoing PMPM passively after that. The five pain points below are confirmed by James (call 2026-05-05) plus public coverage of the 2024 CMS crackdown and HealthSherpa's product moves. Everything beyond those five stays speculative pending the Agent Discovery Form.
The diagrams below are the punch: sequence diagrams show who's doing the work at each step. In today's row, the agent appears at nearly every interaction. In AskFlorence's row, the agent appears exactly once.
Pain points — confirmed
| # | Pain point | Confirmed by | Why it hurts |
|---|---|---|---|
| 1 | Doctor + drug data doesn't persist across interactions | James (2026-05-05); HealthSherpa shipped filter persistence in 2024 in response to agent demand | Agents re-collect the same info every cycle. Re-typing into HealthSherpa + cross-checking carrier portals is a per-member tax |
| 2 | Renewals + plan-elimination outreach is largely manual | James (2026-05-05) | Disproportionate time sink concentrated in OE. Agent manually cross-references which plans got eliminated → builds outreach list → makes ~hundreds of calls |
| 3 | Form re-entry for life changes + SEP updates | James (2026-05-05) | Member moves, has a baby, changes job — agent re-types overlapping info into the same forms. No portable state |
| 4 | No member self-service | HealthSherpa help center explicitly states clients can't self-service through the platform | Every routine question (deductible reset, find a provider, ID card replacement) routes through the agent. Volume eats the agent's bandwidth |
| 5 | Agent-of-record switching + three-way call friction | 2024 CMS crackdown coverage + James (2026-05-05) | Unauthorized AoR switches happen; CMS-mandated three-way calls add friction even on legitimate switches. Trust-damaging on both sides |
Today's workflow — agent as the load-bearing actor
Touchpoint count: 8 agent interactions spread across the year. Carrier portals are the worst per-member tax — 4+ different UIs with inconsistent data quality.
With AskFlorence — agent appears once, earns passively
Touchpoint count: 1 agent interaction. AI does the data work. The member portal does the questions + life-change work. AskFlorence does the renewals work. The agent's economics shift from billable-hours-per-member to passive PMPM.
Touchpoint reduction — side-by-side
| Stage | Today (agent touches) | AskFlorence (agent touches) |
|---|---|---|
| Lead arrives | — | — |
| Info collection | ✓ Agent (phone) | — (AI handles intake) |
| Data entry to platform | ✓ Agent (HealthSherpa) | — (AI handles) |
| Doctor + drug cross-check | ✓ Agent (4+ carrier portals) | — (AI handles via CMS API + cross-cluster reference) |
| Plan walk-through | ✓ Agent + member | — (AI-guided selection) |
| Application submit | ✓ Agent | ✓ Agent review + submit |
| Coverage card waiting | — | — |
| Routine questions during year | ✓ Agent | — (member portal) |
| Life events + SEPs | ✓ Agent | — (member portal) |
| OE plan-elimination outreach | ✓ Agent (manual list build) | — (automated) |
| Renewal call | ✓ Agent | — (auto-renewal flow) |
| Total touchpoints | ~8 | 1 |
The agent's role compresses from "do all the work" to "be the licensed signatory for the moment of submission." Everything else is automated or member-self-served.
Visual summary
Legend:
| Color | Meaning |
|---|---|
| 🟨 Sand | Agent does the work |
| 🟦 Blue | Member does the work |
| 🟩 Green | AI / AskFlorence does the work |
| 🟥 Red | Waiting (no one's working) |
| 🟢 Dark green | Agent earns passively, zero work |
The punch: 8 sand boxes today vs 1 with AskFlorence. The agent's only touch is review + submit. Everything else either moves to AI (intake, plan prep), member self-service (questions, life events), or AskFlorence (renewals).
Gaps for James + key agent partners to fill
Categories, not questions. The Agent Discovery Form pulls the specifics.
- Real time spent per stage above (the workflow times are placeholders)
- Where the actual bottleneck sits (we suspect lookup + renewals, need a ranking)
- What CRM + admin tools sit alongside HealthSherpa day-to-day
- How agents handle SEP and life-change updates today (what triggers the re-entry — member call? carrier alert? CMS notice?)
- Which carriers have the worst data quality on doctor + drug coverage
- Real-world retention numbers per agent book of business
- Pain points we haven't named here
Cross-references
- Agent Platform overview — auth, MongoDB permissioning, compliance model
- Consumer & Agent Flow — full end-to-end member journey from quote → enrollment
- System Architecture — where the agent portal sits in the stack
- Linear: GRO-84 — origin spec for this doc
