For payers that offer Medicare, Medicaid and hybrid government-sponsored plans, the regulations established by the Centers for Medicare and Medicaid Services present significant challenges in generating customer communications that are compliant as well as effective.
In the case of printed correspondence, health plans are required to strictly follow CMS models that define how and where to format information on the page. And the penalties imposed by CMS for non-compliance with published models and delivery dates are costly.
The risk of penalties isn't the only burden. Since regulatory oversight was established long before today's modern technologies, health insurers' predominantly manual workflows for updating CMS models have been adapted over time, which continues to add to even more manual process overhead.'
Many organizations assign a full-time document owner to a specific model or document type. These are staff members that have expertise in the regulations that apply to their model and hold the responsibility for updating the templates, testing all of the possible versions, confirming the physical page layout is correct, and securing CMS approval by the October deadline.
The amount of manual resources needed to prepare even one model version can be extremely large; it may take approximately 40 hours to update one model version, with as many as hundreds or even thousands of versions of the same document needing updating. Add to that the time for the approval cycle and possibly more. If CMS rejects the model, the update process starts over for every version affected. With hundreds of documents under management, each with potentially hundreds of versions, the costs are significant as insurers allocate more and more resources to ensure compliance within mandated timeframes.
In many cases there are hard dollars associated with using outside creative agencies and print service providers to complete the process, and the costs of assigning dedicated internal resources.
Many payers barely have the bandwidth to maintain basic compliance while still staying profitable. This leaves little room for new plan offerings or enhancing customer communications. For payers facing these pain points, the need to improve processes extends well beyond compliance itself. It is a matter of staying competitive and for some, remaining in business. In fact, according to a recent Reuter's survey, some health insurers are expecting member growth in the 20-100 percent range during open enrollment. They report having doubled or even tripled staffing in order to handle applicants. This translates to a need for improved internal operations to remain competitive.
With these time and cost considerations, streamlining workflows becomes a priority. Following best practices for payers wanting to streamline their document workflows begins by looking back at preparing for the latest open enrollment period to determine what went well and should be replicated, and what went poorly and created a bottleneck in the process.
Eliminating the complexity caused by the foregoing manual processes, individual file structures, need for agency coordination and duplication of content has the potential to deliver process improvements in the form of streamlined and automated workflows.
Automating previously manual processes for CMS-regulated communications ensures that customers receive timely, compliant and effective documents that enhance the customer experience and the loyalty it delivers.
There are four questions worth asking: Can I generate all model versions from one master template without manual formatting? Can I centralize content and manage it within a content management system, rather than embedding it in each version? Can I set business rules to dynamically assemble the content for each version and format the physical pages for precise adherence to CMS regulations? Can I transition the management of updates completely to business users without requiring support from IT that might slow the process down?
Doug Cox is chief strategic officer for Elixir Technologies.