Healthcare payer member communications evolve from Frankenstein's monster to smart robot

The pandemic pushes health insurers to make meaningful strides toward digital transformation

To ease the impact of COVID-19 on members, many healthcare payers waived prior authorizations, increased access to prescription drugs, approved telehealth visits and ensured COVID-19 testing free of charge. With in-person visits no longer possible, online channels became the only touchpoints – and the means to maintain business continuity. Payers explored new ways to interact with members, especially electronically. Some recognized the pandemic as an opportunity to strengthen member engagement, building loyalty and trust by providing information on how best to prepare for and respond to the pandemic and enrolling members in communication portals and apps. Yet consumers aren’t happy. Most have expressed low satisfaction with payer engagement throughout the coronavirus pandemic, according to a JD Power survey.xiii More than half (60 percent) of privately insured U.S. health plan members say their healthcare payer did not contact them with guidance or information related to COVID-19. Nearly half (48 percent) say their payer has not demonstrated concern for their health since the pandemic began. That’s critical, because customer engagement directly impacts customer satisfaction. Payers concerned about large insuretech disruptors need to start by showing members a sincere interest in improving health, reducing costs, and helping them navigate a complex system.

The Pandemic Shift

The Growing Demand for Remote Work

To enable employees to work at home and ensure business resiliency, healthcare payers immediately expanded structures for remote work. In many cases, almost 100 percent of office staff initially worked remotely. For example, Blue Cross and Blue Shield of Tennessee (BCBST) kept only about 4 percent of staff on site after the pandemic began. Even after offices were open again, most than half of employees continued to telecommute. If your workers are like most, they’d like to keep working at home several days a weekeven after COVID-19 is no longer a threat, according to a PricewaterhouseCoopers survey. That could not only benefit your team’s performance but also their morale. Providing engaging experiences is critical for retaining employees, especially as automation enables workers to shift to more specialized and higher value tasks. But that leaves open the question of how to ensure remote work from widespread locations can continue successfully and with the high levels of productivity most have enjoyed during the pandemic.v Leveraging the right technologies, including tools for virtual collaboration and communication, project management, and cybersecurity will play a vital role in enabling workers to continue working remotely – and to scale staffing to match needs while reducing costs.

Then we’ll examine how developing building blocks of business capabilities, also known as composable capabilities, can give you the foundation to interact.

You faced critical challenges when 2020 began, and the pandemic added new and unexpected ones. Still, the steps you’ve taken in response have given you a head start on digital transformation, which is now a mandate for every business leader around the globe. This transition from a system cobbled together like Frankenstein's monster to one with the integrated capabilities of a smart robot can ultimately lead your organization to greater efficiency, increased revenues and world-class customer experiences across every touchpoint. Your goals at the beginning of 2020 no doubt changed radically with the outbreak of COVID-19. As a result, you may also need to consider revising your strategy for moving forward. We’ll take a look at the starting point and how the ongoing impacts of enabling remote work, balancing revenues, growing Medicare Advantage programs and enabling no-touch member interactions created a springboard for digital transformation. Then we’ll examine how developing building blocks of business capabilities, also known as composable capabilities, can give you the foundation to interact physically and digitally with members across every channel exactly when needed – and how that will position your organization to take a place at the center of the upcoming digital health ecosystem options.

Providing engaging experiences is critical for retaining employees, especially as automation enables workers to start shifting to more specialized roles and higher value  tasks.

To ease the impact of COVID-19 on members, many healthcare payers waived prior authorizations, increased access to prescription drugs, approved telehealth visits and ensured COVID-19 testing free of charge. With in-person visits no longer possible, online channels became the only touchpoints – and the means to maintain business continuity. Payers explored new ways to interact with members, especially electronically. Some recognized the pandemic as an opportunity to strengthen member engagement, building loyalty and trust by providing information on how best to prepare for and respond to the pandemic and enrolling members in communication portals and apps. Yet consumers aren’t happy. Most have expressed low satisfaction with payer engagement throughout the coronavirus pandemic, according to a JD Power survey.xiii More than half (60 percent) of privately insured U.S. health plan members say their healthcare payer did not contact them with guidance or information related to COVID-19. Nearly half (48 percent) say their payer has not demonstrated concern for their health since the pandemic began. That’s critical, because customer engagement directly impacts customer satisfaction. Payers concerned about large insuretech disruptors need to start by showing members a sincere interest in improving health, reducing costs, and helping them navigate a complex system.

A top-five healthcare payer experienced similar gains when they implemented the Elixir Tango solution. Every year, the payer increased new plans by 30 to 40 percent. By 2020, the company needed to create more than 400 versions of the 300-page EOC and 35-page ANOC, and translate them into as many as 22 different languages. In 2020, the payer’s employees had to accomplish all this while working remotely. With the Elixir Tango platform running in the cloud using Microsoft Azure, the payer was able to centralize all the content needed. To ease the impact of COVID-19 on members, many healthcare payers waived prior authorizations, increased access to prescription drugs, approved telehealth visits and ensured COVID-19 testing free of charge. With in-person visits no longer possible, online channels became the only touchpoints – and the means to maintain business continuity. Payers explored new ways to interact with members, especially electronically. Some recognized the pandemic as an opportunity to strengthen member engagement, building loyalty and trust by providing information on how best to prepare for and respond to the pandemic and enrolling members in communication portals and apps. Yet consumers aren’t happy. Most have expressed low satisfaction with payer engagement throughout the coronavirus pandemic, according to a JD Power survey.More than half (60 percent) of privately insured U.S. health plan members say their healthcare payer did not contact them with guidance or information related to COVID-19. Nearly half (48 percent) say their payer has not demonstrated concern for their health since the pandemic began. That’s critical, because customer engagement directly impacts customer satisfaction. Payers concerned about large insuretech disruptors need to start by showing members a sincere interest in improving health, reducing costs, and helping them navigate a complex system.

Due to the pandemic, your members have deferred elective procedures, chronic care, and even emergency visits. As a result, healthcare payer profits in the second quarter of 2020 almost doubled that of 2019, according to the New York Times. Given that insurance profits are capped under the Affordable Care Act (ACA), reduced spending may create issues with medical loss ratios that could require health payers to return the excess to members in the form of rebates – or to offset profits by delivering quality improvement activities that provide better member experiences and outcomes. Many employers face decreased revenues and increased healthcare costs due to COVID-19. Even if employees keep their jobs, employers may revise their benefits. Not surprisingly, most employers are offering new virtual care offerings Part 1: Accelerate Transformative Thinking as part of their 2021 healthcare strategy. Based on unemployment figures, nearly 28 million Americans may lose employer-based health coverage and won’t be able to afford COBRA. The future of the Affordable Care Act (ACA) is clouded by litigation and uncertainty looms. Displaced employees may move from commercial group lines into managed Medicaid and ACA individual exchange coverage. These two programs and Medicare Advantage have become substantial sources of membership volume and profits for most payers. Medicare Advantage, in particular, plays a major role in healthcare payer profitability. The Rise of Medicare Advantage Medicare Advantage contributes to a large portion of big-name health insurers’ success.x Over the past decade, enrollment in Medicare Advantage has nearly doubled as Baby Boomers age into the Medicare program – a guaranteed market segment with more money than most. In 2019, 34 percent of all Medicare beneficiaries – 22 million people – were enrolled in Medicare Advantage plans. Around the country, Medicare is abandoning fee-for-service models and transitioning to value-based care. That’s in line with the U.S. healthcare system as a whole, which is moving away from treating people who are sick and toward proactively keeping them well – like an HMO rather than a PPO. The Centers for Medicare & Medicaid Services (CMS) described this national shift as “part of our larger quality strategy to reform how health care is delivered and paid for.” Rather than simply focus on services delivered, the strategy aims to improve outcomes for individuals.

CCM solutions provide substantial savings

• –53% Savings in licensing and services in year 1
• –55%+ Savings in years 2 and 3 through wider adoption cycles
• –20% Savings from operating cloud instead of on-premise technologies
  
  

The true ROI from CCM occurs when you can use it to handle the needs of teams across your enterprise through a Center of Excellence (COE). Gartner describes a COE as “a physical or virtual center of knowledge concentrating existing expertise and resources in a discipline or capability to attain and sustain world-class performance and value. By setting up a COE to manage regulated member communications, you can scale operations and establish the best technologies, processes, resources, and organizational structures to use for self-service. The COE will draw together complementary technologies, well-defined scalable processes, and groups of individuals with the affinity to use both. Over time, the COE can handle documents in every part of the organization, creating an even greater return from CCM.

A few examples

As an example, a leading healthcare plan payer in Minnesota achieved self-service during the first year the company used Elixir Technologies’ CCM solution. Growth and learning empowered a new internal COE for Medicare-mandated materials, resulting in a 460 percent ROI during the first three seasons. The healthcare payer spent $133,000 less for defect resolution cycles, $39,000 less in over-production costs thanks to error-handling automation, and $189,000 less in human resources. <br>

The Takeoff Point

CCM technology improves operational efficiency, empowers remote work, supports exceptional productivity, and provides business flexibility, agility, and resiliency. With these advantages, you can add product lines, scale up or down quickly, grow membership, and increase market share – all without significantly increasing costs for go-to-market.

Even more importantly, CCM provides a way to gain a quick win for your organization while making an incremental start toward full-fledged digital transformation. Your organization can empower employees from disparate teams to collaborate in real time, automate mundane processes, leaving time for strategy, and serve diverse audiences with distinct needs and expectations. You no longer keep pace with competitors – you ride the wave toward the future by differentiating experiences.

Automation trends

We’ll examine how developing building blocks of business capabilities, also known as composable capabilities, can give you the foundation to interact.

CCM technology improves operational efficiency, empowers remote work, supports exceptional productivity, and provides business flexibility, agility, and resiliency. With these advantages, you can add product lines, scale up or down quickly, grow membership, and increase market share – all without significantly increasing costs for go-to-market. Even more importantly, CCM provides a way to gain a quick win for your organization while making an incremental start toward full-fledged digital transformation. Your organization can empower employees from disparate teams to collaborate in real time, automate mundane processes, leaving time for strategy, and serve diverse audiences with distinct needs and expectations. You no longer keep pace with competitors – you ride the wave toward the future by differentiating on exceptional experiences that provide unmatched value and satisfaction for your members.

A top-five healthcare payer experienced similar gains when they implemented the Elixir Tango solution. Every year, the payer increased new plans by 30 to 40 percent. By 2020, the company needed to create more than 400 versions of the 300-page EOC and 35-page ANOC, and translate them into as many as 22 different languages. In 2020, the payer’s employees had to accomplish all this while working remotely. With the Elixir Tango platform running in the cloud using Microsoft Azure, the payer was able to centralize all the content needed. The actuarial and product teams had already developed a database that held the plan-specific information they’d determined. Elixir Tango was able to normalize and ingest plan data and content from many sources, without duplication or manual intervention. Assets entered a unified cloud repository through upstream approval flows, starting with changes to master templates, then moving to specific version changes.