Though the deadline for complying with significant reforms of the affordable care act has come and gone, payer organizations across the country are still adapting to the newfound complexities of the evolving industry. Exercise of greater choice by consumers in decisions related to their health coverage and care is pushing fundamental changes in how front- and back-end processes are run. The efficiency and effectiveness of core operations are now a strategic advantage, not merely an instrument for saving cost. To meet the challenges of dramatic change and remain competitive, payers must be able to handle increased capacity while maintaining the quality and performance standards that their members increasingly expect. More specifically, customer and claims support systems, staff, and marketing strategies all have to evolve and grow to support the millions of Americans required to have insurance.