Overview
A top-five Medicare Advantage benefits payer headquartered in the Midwest needed to improve their communications process.
Problem
This health benefits company delivers medical care coverage for one in eight Americans through its affiliated plans. It aims to improve lives and communities and make healthcare simpler for members. However, their process for creating and managing mission-critical Center for Medicare & Medicaid Services (CMS) documents was anything but simple.
Challenges producing regulated documents inhibit payer’s growth. Each year, the small Medicare marketing team worked overtime to update, edit, approve, and generate CMS-mandated documents for hundreds of Medicare and Medicare Advantage plans.
The CMS audits these documents to ensure accurate and timely information for informed decision-making by consumers and re-enrolling members. Payers must meet deadlines and eliminate errors to avoid triggering CMS Errata penalties and sanctions, or lowering the Medicare Star ratings that guide consumer decisions on plans and inform the federal government’s compensation for plan administrators.
In recent years, competition among healthcare payers has grown increasingly fierce as companies introduce more Medicare Advantage plans into a booming market. The provider has kept pace with new offerings tailored for smaller demographics, increasing the number of new plans by 30 to 40 percent each year. But the vendor’s process was not sufficiently robust to allow them to update and create hundreds of versions of the Annual Notice of Change (ANOC) each year.
Specifically, they needed to transform authoring and assembly for two sets of documents over two years:
- 2019: SB, Enrollment Form and Enrollment Receipts, and Plan Guide
- 2020: EOC and ANOC, Drug Lists, and Benefits at a Glance Results
Solution
The insurer partnered with Elixir® Technologies. Together they implemented a new, cloud-based platform, and started taking ownership of their member communications.
This solution allowed them to improve operational efficiency, enhance customer experience, consolidate business units, and introduce shared services across the enterprise.
A project plan to support implementation was designed and resourced by Elixir® project management. It included access to Elixir engineers, cloud deployment specialists and business analysts. Variables like the release date of CMS model documents and deadlines, and practices for timely CMS submissions and approvals were accounted for. Plan and timelines were refined to support the payer’s internal requirements.
2019
Every year, the payer’s product and actuarial teams work together to create plans that meet government regulations for Medicare Advantage. The actuarial team allocates the federal government funding received among the plans. The product team then converts the plans into consumer language—such as premiums, deductibles, co-pays, and out-of-pocket expenses.
Plan documents need to be translated, sometimes into as many as 22 unique languages, and generated as 508-compliant PDFs to meet requirements of the Americans with Disabilities Act. The initial project between the payer and Elixir Technologies focused on the Summary of Benefits (SB)—which required 200 versions—as well as the Enrollment Form, Enrollment Receipt and Auto Form Plan Guide.
The project plan included deployment, configuration and setup of applications, business rules, content and templates for each document in Elixir. To ensure success, Elixir Technologies worked closely with the payer’s team.
Elixir is certified by the Health Information Trust Alliance (HITRUST), which provides a security framework that cloud service providers and covered health entities can use to measure compliance with HIPAA security rule requirements.
Another feature that bolsters security and convenience is single sign-on, which ensures team members logged into their organization’s site can also access Elixir and member plan materials through their browser.
Although many companies keep plan specific information in spreadsheets, larger organizations like this payer typically use databases. Either way, Elixir Technologies can normalize and ingest plan data and content from many sources, without duplication or manual intervention. Using the documents approved for the prior year, the Elixir team rebuilt them in Elixir. This gave the payer a living version of each document to validate, preview and train on.
All assets entered a centralized repository through approval workflows to safely drive downstream change and assembly. Content management began with global changes to master templates, then moved to specific version changes. Elixir integrates with Microsoft Word via a plug-in to give nontechnical business teams a user-friendly interface to revise documents and generate production-ready proofs. Business rules pulled the right content and data into containers and automated versions for assembly based on the parameters configured. Throughout the process, secure role-based access, extensive audit trails and real-time production and change management reporting helped achieve compliance.
The payer ultimately met all critical deadlines for both print and web delivery of regulated communications. The team also automatically generated 508-compliant PDFs using accessibility features programmed into master templates. Control over digital assets and visibility into the overall process and workflows meant a more streamlined and less stressful approach that provided a better experience for employees and customers.
Automations enable pandemic remote work A season’s worth of multi-lingual communications achieved in three weeks during lockdown.
2020
Thanks to the success achieved in 2019, the payer asked Elixir in 2020 to assist with a new set of CMS documents—the Evidence of Coverage (EOC), ANOC, Drug Lists and Benefits at a Glance. But 2020 became even more challenging when CMS released the model documents three weeks late. Healthcare payers scrambled to meet the deadlines, especially larger organizations with hundreds of plans.
Producing the 300-page EOC and 35-page ANOC for each plan—and applying thousands of business rules—required many varied workflows. Like the previous year, Elixir prepared live versions of the documents. Then, using Elixir, more than 100+ users from different lines of business on the payer’s marketing, translation and production teams worked on the documents together— but remotely, due to the pandemic.
Elixir enabled automated approval between teams in real time, a major contributor to better collaboration. For example, in a three-week period, the payer generated, proofed and approved more than one thousand unique translated materials across four languages for enrollment kit materials—and several hundred more post-enrollment forms.
Elixir helped the payer ensure quality, manage risk, and save money while developing and testing a number of new healthcare plans. The easy integration of Elixir with existing programs minimized disruption, and the Elixir team’s domain knowledge and support kept the project running smoothly and boosted speed to value.
Outcome
Over two years, Elixir empowered the payer to automate processes related to their regulated member communications. The payer will be able to achieve an even greater ROI from Elixir with more hands on, self-service, and by sharing the lessons learned with other teams across the organization.
Setting up a Center of Excellence (COE) to manage regulated member communications lets companies scale operations and establish the best technologies, processes, resources, and organizational structures to use for self-service. The COE draws together complementary technologies that work well together, well-defined scalable processes and groups of individuals with the affinity to use both. Over time, the COE will provide self-service capabilities to elegantly enable and support multiple users in every part of the payer’s organization and create an even greater return from automated CCM.
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