Thorney Advisors Insights
Product & Digital Innovation
Thorney Advisors Insights
Product & Digital Innovation
Digital products that solve customer problems and transform your interactions with them
Health Plan Annual Enrollment Made Easy
Are Healthcare Organizations Measuring Up for Medicare & Medicaid Members?
Revision: June 1, 2019 and September 1, 2020
Original Publication: September 15, 2018
Written by Carol Yvette Thorney, MBA
Like clockwork, every year Payors spend 6 to 9 months pouring through regulatory changes from the Centers for Medicare and Medicaid Services (CMS), state and federal regulatory agencies to ferret out changes that impact current product designs and benefit packages to be offered to members anxiously awaiting yet another round of confusing and every changing options to health plans choices, selection of Primary Care Physicians (PCP) and left exasperated to discover that their Specialist is no longer in-network, moved to another hospital system or closed their practice and moved to that long awaited retirement haven.
Annual enrollment cycles are painful for health plans, providers, hospital systems, members and their caregivers. For health plans it is a painful, tedious but necessary process which requires heavy lifting by all divisions to deliver a package heavy enough to act as a door stopper which members receive by postal service or email or both in the form of glossy marketing materials which include the standardized Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) instructions, ANOC/EOC Errata, and Provider Directory. Now what?
Evidence of Coverage (EOC)
The EOC, along with the enrollment form, is the member's contract with the Health Plan Administrator. These EOC documents explains the rights, benefits, and responsibilities of the member (patient / subscriber) as required by regulatory entities governing each Health Plan. So what is the "ask" and do members understanding their responsibilities? Even more importantly, how many members or their caretakers even take the time or have the time to read through these documents much less understand its contents?
It requires the same tenacity and courage needed to prepare and file your taxes. A necessary duty with the added deadlines for enrollment. So each member will at least attempt to understand using the Summary Guideline:
The bad news is that not even 90% of Medicare Advantage Organizations (MOAs) members ever read those packages which arrive like clockwork by mail and email every enrollment season between September and April. For innovators who are experts in this space like RR Donnelly and Messagepoint, they take the complexity out of managing member materials by helping MOAs streamline annual updates by giving non-technical users full control of content updates, workflows and approvals. By automating 70% of the MOAs processes, organizations like RR Donnelly and Messagepoint claim to improve efficiency and reduce costs by up to 40%.
So what are MOAs doing to improve member experience by providing clearer communication and taking the anxiety out of the enrollment process? AI-powered customer communications management (CCM) solutions which are purpose-built to handle the complexity of regulated, personalized omni-channel customer communications in ways that others can only dream of.
Like RR Donnelly and Messagepoint, other providers like Cierant Corporation help their customers innovate solutions that leverage data to increase marketing effectiveness, enhance operating efficiency, and drive increased customer loyalty.
Are MOAs passing on innovation to members?
Are MOAs offering members more in person support (retail stores), automation and/or easier access via mobile applications, SMS text notifications, Click-to-Chat and realtime TeleHealth services?
The answer is a resounding "YES", however there are still a sizable number of Americans struggling to read or understand their health care information. According to a study completed in 2003 by the National Assessment of Adult Literacy (NAAL) which reported in the National Assessment of Literacy Survey (NALS), nearly 93 million of U.S. adults are functioning at basic and below basic literacy levels or they could master basic reading tasks needed to function in society. This information was confirmed by a 2004 Institute of Medicine (IOM) report, “Health Literacy: A Prescription to end Confusion” which states that of these, more than 90 million people, about 40 million read below the 5th grade.
In 2021 as in 2019, packages will arrive like clockwork to members' mailboxes, and health plans can continue to tweak information to make it easier for members to understand by shading important elements and eliminating jargon wherever possible.
Payors should "run not walk" to partner with companies like RR Donnelly and Messagepoint focused on supporting Payors with platforms that provides efficient and effective member engagement which is key to maintaining existing and expanded into new markets to:
For more information email us at [email protected]
The views expressed in these posts are those of the authors and are current only through the date stated. These views are subject to change at any time based upon market or other conditions, and Thorney Advisors disclaims any responsibility to update such views. These views may not be relied upon as medical advice and may not be relied upon as an indication of medical policy on behalf of any Thorney Advisors consultants. The discussion herein is general in nature and is provided for informational purposes only. There is no guarantee as to its accuracy or completeness.
About the Author
Carol Yvette Thorney, MBA
Executive Advisor, Writer, Healthcare, Insurance, Financial Services, Technology and Digital Marketing Consultant
Carol is a strategic, resourceful healthcare executive with reputation for leading transformation and turnaround operations and IT initiatives driving performance focused on growth, optimizing customer experience while motivating teams. Transformation evangelist working tirelessly to build buy-in, alignment, and support from stakeholders. Strong focus on value generation for the company, customers, and patients.
Carol has over 20 years’ experience as an innovative, profit-oriented executive with demonstrated success in directing global organizations in North, Central and South America, UK, Europe and Asia. Consistently achieve success, meeting aggressive top and bottom line and operational excellence goals while championing Agile and Lean enterprise strategy with deep understanding of strong technology skills and broad business expertise.