If it feels like there are more federal compliance requirements for health plan staff these days, it's because there are -- from exchanges to HIPAA to Medicaid to Medicare Medicare Advantage.
It's at the point where just receiving and understanding new CMS regulations is a challenge unto itself for health plans, let alone complying with them, Robert Fauver, managing partner at software company Hoverstate, said at the AHIP Technology and Operations Forum.
For Medicare Advantage, CMS has issued an average of 25 compliance memos per month this year, which can translate into upwards of 250 needed actions, as was the case for July's memos, said Fauver, a former product innovation VP at WellPoint.
"It's growing from month to month and year to year," Fauver, who was pitching his company's new Clockwork Compliance software for Medicare Advantage, created with Clear Vision Information Systems.
Whether or not the regulatory waves eventually settle down in Medicare Advantage or other areas, company leaders should at least give an ear to compliance issues regularly.
For some compliance issues, leadership can be held responsible by CMS, Fauver said, and if the violations ends up in a sizeable fine, those leaders may be held responsible by shareholders or board members -- and many of those violations stemming from documentation could be prevented by improving organizational approaches to compliance.
As one staff member from the Wisconsin Physicians Service health plan said, "One of our biggest challenges is communications" -- receiving and interpreting new regulations or compliance orders, tracking task completion, getting leadership authorization for new product launches and responding to problems as they arise.
"For instance," on a recent product launch, she said, "I didn't know if sales has gotten clearance from regulatory."
Collaborative Excel spreadsheets have worked well in the past for organizational compliance work, although today, the compliance data may be too overwhelming and the organizations too big, argued Fauver. The cloud-based compliance software Fauver's company markets, currently in use by one beta-client, offers some of Excel's collaborative usability, but offers detailed tracking and task assignment, among other features, he said.
Other approaches to scaling the compliance mountain include creating a place in the C-suite for a chief compliance or risk officer, as a Humana strategist suggested, or creating a compliance champions program to reward and share best practices, as a staff member from UPMC Health Plan suggested.