The annual AEP preparation is a complex, human intensive and costly process for MAOs. To handle these challenges, MAOs employ a wide variety of approaches and solutions for managing their plan materials.

The Annual Enrollment Period (AEP) for Medicare runs from October 15th through December 7th each year. During this period, Medicare subscribers can make alterations to their health plans and prescription drug coverage to best meet their needs in the year to come. Medicare Advantage Organizations (MAOs) must ensure that all the information for next year’s plans is available for both existing and prospective subscribers by the beginning of October.

Updating Medicare Advantage materials before the start of the AEP is a major undertaking for MAOs. Each year, the Centers for Medicare & Medicaid Services (CMS) release new model documents and every MAO must follow the federal agency’s requirements precisely. In addition, the annual CMS bid filing by MAOs requires changes to dozens of benefits details across multiple documents for every single plan, and all the updates and amendments must be accurately completed under a tight timeline.

The annual AEP preparation is a complex, human intensive and costly process for MAOs. To handle these challenges, MAOs employ a wide variety of approaches and solutions for managing their plan materials. While some still heavily rely on manual processes and Microsoft Word or third-party service providers, others use the document generation software. Teams looking for new solutions need to scrutinize available offerings. While document generation software products can provide some benefits, many vary widely in the level of efficiency and cost reduction opportunities they offer.

In recent years, many MAO’s have recognized the substantial benefits that can be gained by using a solution that is purpose-built for these complex communications and is not dependent on a manual or one-off implementation approach. Achieving the right balance between cost, risk, and an organization’s ability to meet both CMS’ requirements and member needs requires the right mix of business process and technology. When considering a switch, think about the scope of the processes that will be automated by the new solution and how those will impact costs and ultimately, ROI.

How much is your vendor really automating?

MAOs with smaller numbers of plans will often directly manage plan documents using Microsoft Word and Adobe products. They create an individual file for each document required for each plan and edit and manage those documents as separate distinct assets. The process is the same whether they manage the whole process internally or sub it out to a third-party service provider that may or may not use Document Generation software as part of their approach. All of these approaches require humans to manually copy and paste content into the document templates and email files around for edits and review. Plan information is copied and pasted from various sources. This heavy reliance on manual work creates a major human capital burden, while also introducing lots of room for human error, missed deadlines, burnout, and an inability to scale. While technology costs are relatively low with this approach, MAOs reliant on any variation of these methods only have one lever pull to scale their plans and that is to “throw more people at the problem.” No economies of scale can be had and this risk-prone, costly approach creates a number of challenges all around.

Solutions that have moved away from this document-centric content management approach to one that leverages a modularized content model enable the sharing and re-use of common content components across plan documents. This is an important driver of efficiency as most plans share a lot of common content that should not have to be redundantly entered, updated, and managed across many separate files. For example, member/customer service information is used more than 100 times in the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents. By using a modular content object that is reusable to house the member service information details, you only need to create this content object once and it will appear across all the required communications. Modularized content not only accelerates authoring, but also ensures accuracy of information which is important for compliance purposes.

It is also important to look at key processes such as translation, quality assurance, and ensuring 508 compliance. These are time intensive activities that most servicers and solutions don’t handle well, even when document generation solutions are in place. Translation and 508 compliance efforts are often treated as after-thoughts that are manually addressed after the standard English versions of documents are created. This adds both unnecessary time and cost into the process. Quality assurance processes are typically manual with no tracking, task allocation, or reporting in place, requiring PDFs or Word files to be emailed around for reviews and edits.

What to look for to realize significant ROI

By adopting software designed to automate the process of creating Medicare plan materials, substantial savings and ROI can be achieved. Look for these key drivers:

  • Integration with the Plan Benefit Package database and streamlined processes for non-PBP data handling to eliminate redundant data entry processes and errors
  • Pre-built starting point leveraging CMS compliant formatted templates already populated with CMS model content to eliminate starting from scratch
  • A modularized content management approach to enable content sharing efficiencies that eliminate redundant content edits and updates
  • Use of modularized content to streamline translation processes and avoids the repetitive translation of common content blocks and objects across documents
  • QA capabilities that support collaboration and visibility into editing cycles
  • Automatic generation of 508 compliant documents and large print formats
  • Business user authoring capabilities to avoid time-intensive coding by costly technical resources – either internal or external to your organization
  • Centrally managed content that can be leveraged across all channels of communication including printed files, PDFs, Web sites, emails, and SMS to avoid redundant content entry and management
  • Cloud-hosted solutions to lower total cost of ownership

Automating plan materials management with the right solution offers several clear advantages. MAOs can save money while producing compliant materials on-time. In addition, content management redundancies are eliminated, QA processes are streamlined, project visibility is exponentially increased, and MAOs can take advantage of economies of scale to grow their plan offerings and their business.

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.