Recommendations to help Medicare Advantage Organizations to effectively address challenges of timelines, quality, and user fatigue associated with Annual Enrollment Period update cycles.
Medicare Advantage (MA) is the fastest growing business segment within the US health care market. Over the past decade, MA enrollment has doubled and in 2021, there are more plans than ever before. Merger and acquisition activity and the growth of available plans have increased operational complexity for Medicare Advantage Organizations (MAOs), forcing them to take a renewed look at how they manage key aspects of their business.
Each year during the Annual Enrollment Period (AEP), which runs from October 15–December 7, the Centers for Medicare & Medicaid Services (CMS) allow beneficiaries to add, change, or remove their MA or Part D membership. This means that MAOs must make key compliance, marketing, and other supporting member communications available before the AEP starts. The key objective for these communications is to educate new and existing plan members about their offerings to maintain and grow enrollment while also adhering to CMS and compliance requirements.
The short window of the AEP coupled with the release of new CMS models for key documents in late May can create monumental challenges for MAOs working to update their plans on time. Within this limited timeframe, MAOs must ensure content accuracy, the precision of benefits information, supplemental benefits details—across the various communications supporting these plans. Each year, the teams working on these materials experience a summer of mayhem pushing them to breaking point. In addition to the above challenges, product teams face increasing business pressure to scale and grow membership.
While the operational pains are widely recognized, examining the underlying contributing factors can enable MAOs to identify strategies that effectively address them.
Plan data
Current landscape: To generate Medicare communications, multiple sources of information are required. The plan benefit information is the most critical. While the Plan Benefit Package (PBP) database contains the filed benefit information, most of the time, this is not used directly. Additional information including the plan profile, contact, branding, state agency, and other key pieces of information are required. The materials management teams typically create and leverage a variety of Microsoft® Excel® sheets, CSV files, or versioning grids. Often just gathering the data is not enough and sophisticated analysis and interpretation are needed to ensure accuracy. Moreover, year-over-year plan benefit data analysis is necessary to accurately identify plan differences and without such analysis, the work must be done manually resulting in issues related to timely work completion, accuracy and quality control, user fatigue, and scalability.
Recommendations: MAOs should create a plan and benefits data repository leveraging the PBP filing information as a primary source with the ability to use exception data where required. They should incorporate a mechanism to load the non-PBP plan and benefits information including the key plan profile, contact, and state agency information. In addition, automating the upstream data analysis and interpretation will enable this single repository to be used to generate all the communications for assured consistency, accuracy, and greater efficiency.
Layout and content
Current landscape: Medicare communications have complex layouts due to the need to adhere to CMS compliance and internal marketing requirements including sophisticated table of contents, dynamic chapters, sections numbers and their references, headers/ footers, pagination, glossaries, and indices.
There is also lots of content and verbiage that is common across different communications–some shared within an individual plan document, and others which are common across multiple plans. Maintaining multiple copies of common content across different document templates and different plans introduces the potential for inconsistencies and errors, not to mention the redundant work effort required to manage, edit, and maintain duplicate content.
In a post-COVID 19 world, with geographically disbursed teams, there is an increased need for collaboration between the teams. The above issues cause the delayed work completion, accuracy and quality control, user fatigue, and scalability issues.
Recommendations: Use a tool that can automatically handle complex layout requirements. Ideally, this will provide a pre-configured application with the complex benefit and change tables already configured, content sharing, and re-use capabilities, and easy change management processes to handle CMS and plan changes. In today’s post-COVID-19 world, it is important to use a SaaS-based solution that supports sophisticated user management, workflow, task assignment, and tracking to ease collaboration.
Quality assurance and reporting
Current landscape: Quality assurance (QA) starts with an efficient requirement gathering process with the work assignment, tracking, and history to ensure visibility and transparency. There are multiple iterations of this work and as part of the QA process, the team needs to identify the changes in the new version to note any regression issues.
When issues are identified, they need to be reported internally for timely remediation. In the absence of a defect tracking system, teams end up creating Microsoft® Excel® sheets to maintain this information. This approach creates challenges in reporting the latest plan status, open issues, and user tasks, as the information needs to be manually gathered and reported. Reporting quickly becomes outdated and this inefficient approach leads to a lack of visibility and planning which causes rework, delays, and poorer quality of the materials.
Recommendations: Use a solution that includes a fully integrated QA module to support requirements gathering, task assignment, and issue and status tracking through all the various stages of the review and approval cycle. This tool should automatically identify version level differences and allow users to annotate comments and open defects for timely remediation. To keep the internal stakeholders updated, status information via real-time dashboards and reporting is essential.
Translation and accessibility
Current landscape: In terms of process, most organizations rely on external vendors for translation and 508c remediation. Typically, the final individual English version documents are sent off for translation and 508c remediation. This serialized approach leads to a lot of redundant work while placing extra time pressure on the materials team to conclude the English documents early so that the translation and accessibility work could be completed on time. These issues create challenges in terms of timeline, quality, cost, and scalability.
Recommendations: The document-level serialized approach is not recommended. Rather, select a tool that can support parallel content object-level translations. These shared content objects can be shared out to relevant documents, eliminating the need to translate them multiple times. In addition, choose a solution that supports the generation of 508c & Large Print outputs natively to save you time and money.
Conclusion
The above recommendations enable MAOs to effectively address challenges of timelines, quality, and user fatigue associated with AEP update cycles. They also provide an approach that supports the efficient scaling of plan offerings and service areas, so that overall membership growth targets can be achieved.
About the author
Sohail Malik is vice president, health care solutions with Messagepoint, overseeing the Messagepoint Healthcare Touchpoint Exchange solution to ensure the support of the complex and ever-changing needs of health plans to scale and grow to meet market needs.
He has more than 15 years experience in customer communications management and SaaS/Cloud-based digital transformation of highly regulated industries. Malik has worked with some of the largest national health care organizations, Blues and smaller community plans to bring digitalization and process automation for client communications and helped them scale and grow their business.