Streamlining Medicare with a Purpose-Built Technology Platform

Transcription

1 Streamlining Medicare with a Purpose-Built Technology Platform

2 SITUATION User-unfriendly MA enrollment platforms. Large Medicare Advantage carriers invested a median of $11.25 per member per month in marketing in 2015, and spent a median of $17.44 on account and membership administration, according to a Sherlock Company analysis. With that kind of spending, the last thing a carrier needs is for seniors to become confused and frustrated by the enrollment process, but that is exactly what happens when carriers rely on technology that is not up to the task. PROBLEM Pain points in the enrollment process include intake, eligibility verification, enrollment acceptance and validation, and benefit activation and notification. Each is subject to federal regulations with which compliance is paramount, and at each step, consumers can run into problems, become frustrated and abandon the process. Many MA enrollment platforms were initially designed for use by commercial health plans and retrofitted to Medicare, and these patchwork systems make for a disjointed, unfriendly consumer experience. Applicants are dropped or told they are ineligible, benefits are never activated, or the applicant is never notified of acceptance and activation. In the age of Amazon and Apple, this is unacceptable. The MA space is extremely competitive, and seniors who encounter enrollment problems with one carrier are likely to look elsewhere. ISSUES IN MEDICARE ENROLLMENT PROCESS Intake Validation Eligibility Verification Benefit Activation Enrollment Acceptance Benefit Notification

3 SOLUTION A single platform designed to support the full enrollment life cycle. A single platform designed specifically for Medicare Advantage with capabilities to support the full enrollment life cycle offers a better way to deliver return on your plan s marketing investment. A purpose-built system should guide the user with smart wizards that make it easy for customer service and sales teams. It should minimize the possibility that eligible applicants will be rejected and handle reinstatements with ease. It must accept enrollment applications in paper, electronic and telephonic formats, all of which remain important in this market. And it must capture all CMS-mandated information, regardless of the enrollment source. After an application is validated and accepted, beneficiaries must be notified within a CMS-mandated period. The right platform will be able to handle this task, too. It must reduce compliance and quality risk and keep track of ever-evolving Medicare regulations. It should minimize the possibility that eligible applicants will be rejected and handle reinstatements with ease. Once an enrollment application is accepted into the carrier s system, it must be transmitted to CMS for verification. An enrollment module that identifies eligibility verification errors and flags them for repair cuts down on the percentage of applications rejected by CMS a serious problem with patchwork systems. Ideally, avoidable rejections should be reduced to a fraction of a percent, well below the CMS 1% threshold. A purpose-built system offers the additional advantage of bridging integration and interoperability gaps between multiple systems and processes, improving efficiency and the member experience. Systems that include a module for tracking enrollment to the marketing or broker source allow plans to identify problems and further optimize marketing for future growth. MA plans that rely on a patchwork of modules that have been tweaked and cobbled together shortchange the enrollment process, and they risk losing customers to competitors who understand the importance of a smooth, smart and efficient process. An intuitive, compliant, end-to-end system is the solution for a better consumer experience, improved market share and far fewer administrative headaches. First seen on SmartBrief

4 A purpose-built, enterprise Medicare enrollment and billing technology platform with fully integrated modules to better serve health plans and their members.

5 Miramar, by Convey Health Solutions, is a proprietary platform that focuses on efficient and compliant management of members in government-sponsored health plans. Miramar supports the plan with dynamic work flows, highly advanced work queue features, SmartWizards, automated alerts and reconciliation rates that exceed traditional software vendors. By design, Miramar puts more information at the user s fingertips within a secure platform than compliantly handles the Center for Medicare and Medicaid Services processes. With this fully integrated, modular solution that the plans can scale up or down to fit their needs, steps are consolidated and functions are simplified. Miramar s architecture allows for seamless integration between several systems including financial institutions, claims processors, employer groups, and more. Most impactful of the integrations is the dedicated CMS gateway that allows for real-time reconciliation. With an ultimate goal of One Call Resolution, plans will be able to easily understand where any member is in any process, and members will always be communicated with clearly and fluently. Conversely, MA plans that rely on a patchwork of modules that have been tweaked and cobbled together shortchange the enrollment process, and they risk losing customers to competitors who understand the importance of a smooth, smart and efficient process. An intuitive, compliant, end-toend system is the solution for a better consumer experience, improved market share and far fewer administrative headaches. Miramar is our Medicare Enrollment Software one enterprise technology platform with fully integrated modules that can better serve health plans and their customers. Stephanie Jones, SVP & General Manager of Technology Enabled Solutions (TES)

6 Convey Health Solutions focuses on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. Convey provides member management solutions for the rapidly changing health care world. (800) Convey Health Solutions. All rights reserved.