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Remove the Barriers That Keep You from Scaling Your Medicare Advantage Plans

BY Sohail Malik

Enrollment in Medicare Advantage has more than doubled in the last ten years and is still growing. Currently, more than 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans: that number is predicted to rise to 51% by 2030. Of those Medicare Advantage beneficiaries, 67% have individual plans. That’s 17.7 million people: a market segment to watch.

That’s good news for Medicare Advantage Organizations (MAOs) who know that Medicare Advantage plans benefit from alignment with a given segment’s needs. Targeting different segments with the appropriate benefits and accommodations is the most effective way forward. Not only does such customization better meet plan member needs, it is also more cost efficient. With continued growth expected, forward-thinking MAOs are developing personalized plans.

But expanding the number and type of plans increases complexity and cost in many practical and administrative areas, including materials preparation and organization. As it is now, preparation of Annual Notice of Change (ANOC), Evidence of Coverage (EOC) and Summary of Benefits (SB) can be a cumbersome process, slow and prone to missed deadlines or expensive errors. In particular, when organizations choose manual approaches to creating and/or managing benefit plan materials, scaling up operations seems like an insurmountable task.

In order to address their ability to scale up, MAOs must examine the systems and processes in four key areas which might erect significant barriers:

  • Plan data management
  • Layout and content management
  • Quality Assurance and reporting
  • Accessibility and translation

First, MAOs need a cleaner way to manage plan data to avoid simple mistakes that can lead to errata. Are they manually tracking plan details in multiple places and attempting to use that to update materials? Or do they leverage the Plan Benefit Package (PBP) database as a single source of truth?

Second, they should review their approach to layout and content management. What measures are they taking to ensure the most current CMS model document requirements are being adhered to? Are they using a pre-built template incorporating CMS layout requirements and model content, and modularizing content to enable common components to be shared across documents? Third, an audit of their Quality Assurance process is necessary. How is their current QA process structured and maintained? Can they track who made which changes when or is the process managed via email and Word documents? Do they have version control to ensure everyone is working on the latest revision? Can they reassign tasks to other team members when resources become overburdened? Finally, MAOs should inspect their accessibility and translation process. Are they left to the last minute as an afterthought? Or are accessible documents automatically generated as part of the process? Can translation happen on a component level, in real time?

Such a thorough analysis will reveal any systemic faults, and can point to a better route forward: automation. Automating the entire process will substantially reduce the time, effort, and cost required to update plan materials. It’s critical to know exactly what you’re getting in a system that claims to automate the process. Knowing the details, which steps are automated, how content is managed, what kind of visibility and control you will have, is essential. Some offerings simply shift the burden to a service provider. While that isn’t the end of the world, your documents will still be at risk, and your ability to achieve economies of scale with plan growth is non-existent.

Don’t let the fear of updating plan materials hold your organization back. Check out our ebook to learn about how to address the barriers that prevent MAOs from scaling up, and learn what to look for in an automation solution. Download our free ebook ‘The Top 20 Questions to Ask when Vetting a Document Management Solution for Medicare Plan Materials’.

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