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Conquer the complexity of D-SNP benefit plan materials

BY Sohail Malik

Health insurers should be smiling. With the “silver tsunami” more than 10,000 Americans will enter into the Medicare system every day through 2030, and according to the Centers for Medicare and Medicaid (CMS), one in three enrollees will ultimately select a private Medicare Advantage plan. In fact, Medicare Advantage enrollment is expected to grow from 35% today to 70% between 2030 and 2040 according to a recent report by LEK consulting.

Given the attractiveness of the Medicare Advantage market, competition for new members is fierce. Insurers are clamoring to design and market new plans targeted to this elderly population. In fact, insurers are expected to offer 600 new Medicare Advantage plans this year bringing the market total to 3,700 nationwide. CMS anticipates that 91% of retirees already have access to 10 or more Medicare Advantage plans in their area.

Dually eligible: an attractive, underserved market

But, there’s a subset of the Medicare Advantage market that remains largely underserved – those individuals that are “dually eligible”, meaning they qualify both for Medicare and Medicaid.

In 2003, Congress introduced Dual Special Needs Plans (D-SNP), a type of Special Needs Plan that specifically addresses the needs of the dually eligible. The D-SNP demographic is largely comprised of seniors, with low income, managing a disability or chronic condition at home or in care facilities. These 11 million individuals comprise about 20% of the Medicare Advantage market but less than 30% are enrolled in a Medicare Advantage or D-SNP plan.

Making the market even more attractive, CMS announced in 2018 and 2019 new and expanded reimbursements for a variety of in-home support services that will benefit the D-SNP demographic. While time is needed to translate these developments into market-ready products, no one can argue the significant business opportunities available to insurers targeting the D-SNP market.

D-SNP brings greater complexity to manage

There’s always a catch, of course. Companies contemplating expansion into this market must be prepared for the added complexity required to manage and market D-SNP plans.

The Plan Benefit Package (PBP) filing only provides the Medicare-covered cost-share information, whereas the marketing materials you produce must clearly and accurately communicate what Medicare will cover, what Medicaid will cover, and what the consumer will pay in terms of premiums, deductibles and co-pays. If you only rely on PBP plan data for document generation, the complete cost-share information will not be accurately reflected in the prospective members’  ANOC, EOC and SB documents.

You also need to address the huge scope and volume of changes. How do you manage all these details – across hundreds of pages of documents – and ensure they are accurate 100% of the time? When you house your information in an excel sheet, for example, human  intervention is required to transfer that data into a document template, opening the door to error. And, this process must be repeated across multiple plans and documents – a slow, manual process that increases your risk of errata.

Automated capabilities to tackle D-SNP complexity

There is another way. Leveraging a purpose-built platform like the Healthcare Touchpoint Exchange automates content updates, simplifying and accelerating the process while eliminating costly, error-prone manual changes. Messagepoint pulls your plan data from a single source of the truth – ensuring the D-SNP cost-share information is brought directly into your communication templates, eliminating the need to manually re-enter it and ensuring it is 100% compliant with your bid submission. This automation ensures documents generated within Messagepoint accurately reflect CMS guidelines and, at the same time, display the correct cost-share information to prospective D-SNP plan members.

The solution’s content management, rule management, and version management capabilities also deliver dramatic efficiencies in terms of eliminating manual work and improving content accuracy. By responding to simple questions, your team can enter customized plan information, easily define rules and logic, and can ensure supporting language, such as eligibility criteria, is accurately reflected in all necessary communications.

Best of all, your team only needs to specify this information once. Based on the logic defined, plan information is dynamically applied across a single document or multiple versions and easily proofed – automation that accelerates plan creation, eliminates the risk of error and errata, and ultimately, gives you a competitive edge in this new and attractive market.

To learn more, read about our Healthcare solution or download our case study.

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