Takeaways from AHIP for Improving Health Plan Member Engagement

AHIP Institute 2016 was humming with a variety of hot-topic discussions concerning the future of healthcare. One side of the conversation we heard was in regards to enhancing the member experience and engagement through communications. As we talked to various healthcare payers and leaders in the industry, we continued to hear about the pressure coming from both regulatory bodies and members to improve the state of the customer experience. Here are just a few of the interesting pain points we discussed when it came to member communications:

1. The coordination of both CMS requirements and payer changes to member communications can be cumbersome and leaves payers open to compliance risk.
2. Payers have been known to employ hundreds of temporary workers to offset the workload related to member communication updates, particularly with Annual Notice of Change (ANOC) but certainly with Welcome Kits, Explanation of Benefits and more.
3. Managing the communication process to increase both speed and compliance is challenging in a highly-regulated industry.

So how can payers properly manage the processes around member communications to tackle these pain points? To set a tone for improvement, here are the main pillars that Blue Relay focuses on to help payers succeed with member communications:

Intelligent Automation

Identified as a top 5 trend for 2016 in health by Accenture, intelligent automation will empower organizations to deliver more valuable services and communications. To do so, automation must be comprehensive. There needs to be the automation of processes from human to human, human to platform/environment and vice versa as well as platform/environment to platform/environment. It’s not just one way or the other. The automated hand-off needs to be based on business rules and must be meaningful and robust to handle different scenarios. Intelligent workflow automation brings efficiencies to better allocate current resources and reduce the need to bring on additional resources. Let’s work smarter with what you have.

Holistic Visibility

The key to improvement in communication workflow management is having insight into where you are going and how effectively you are getting there. Think about the last time you drove with a GPS. Having full visibility into traffic patterns, detours and quicker routes helped to better inform your arrival time and provided some efficiencies along the way. Imagine having the same insight into your work processes such as being able to see upcoming work, content changes and bottlenecks. Having visibility here allows you to make changes to ensure you continually deliver the right materials accurately and on time.

While working with our payer clients we’ve discovered that having a simple way to achieve full, real-time visibility into member communication processes empowers you to be proactive. Payers need to understand workload and inefficiencies to begin reducing errors and increasing accuracy in support of compliance. As we discussed at AHIP, a more holistic dashboard-style view of the member communication development process is a welcome enhancement that enables an organization to be more efficient and proactive for now and the future.

Flexible Technology

As part of our technology solution, we promote the importance of interoperability – that is, the ability for the different parts of our solution to operate seamlessly within your existing system. Cumbersome processes can be more easily broken down and re-organized into simplified, streamlined workflows. Payers can better organize data from multiple environments into a centralized hub for better decision making. Ensuring you have a platform that interfaces with other systems is essential to long term gains. By having this, payers are better equipped to manage all material development processes resulting in both increased speed and compliance in delivery. Add to this the fact that digital workflows can be fine-tuned over time for greater efficiency and alignment with internal processes means it is easier to adhere to new regulatory changes so you are quick, compliant and always in good standing.

I’m sure it doesn’t need to be said, but it’s important for payers to be agile in the face of today’s fast-paced digital era coupled with higher member expectations and regulatory demands. Our clients need the ability to meet the requirements of each business need through a variety of customizable options. Automation, flexibility, configurability and interoperability in technology solutions ensure you are well equipped for changes. Agile organizations and workflows help to keep up with changes like those needed by CMS.

It’s clear there is a need for a simplified way to improve member communication turnaround times while increasing efficiency and accuracy. With visibility, automated workflows, and flexible technology, payers can start to move towards a more efficient process when it comes to the life-cycle of their communications. There is a way to achieve significant improvements in productivity and costs while reducing compliance risk. We are moving there and it is happening.