There is little question that healthcare payers, like all healthcare organizations, have mounting challenges when it comes to meeting regulatory compliance standards developed to improve the security, clarity and transparency of healthcare insurance information.
In fact, a recent survey of more than 300 insurance organizations regarding their most pressing regulatory and risk management concerns indicated that "concern over compliance and risk management remained high," with 64 percent of respondents stating that maintaining compliance with changing regulations was a top concern. Moreover, survey responses revealed a significant trend among insurance carriers to invest in increased resources in order to address significant compliance and risk management concerns.
While compliance is a pressing concern, payers can ill-afford to allow the need for compliance to overshadow the equally looming need to improve their customer communications in an effort to keep members loyal. Technology and the dynamics of the health insurance marketplace are changing rapidly, and payers face an urgent need to meet the demands of a growing, consumer-centric environment.
One important example of the hurdle payers face when it comes to balancing the demands of compliance with the business imperative to provide customers with effective, informative information can be found in the Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements.
While the goal of the SBC regulations was to make them more user-friendly, the process to create the initial SBC in 2012 was a technical nightmare for many health plans, forcing healthcare payers to figure out how to access a wide range of plan information and present it accurately in a new CMS template. If an automated process was not in place, many had to opt for a workaround approach. This often meant scrambling to build SBCs manually through Excel spreadsheets or engaging third-party vendors to create the SBCs using similar time-consuming and expensive methods.
The departments of Health and Human Services, Labor, and the Treasury have issued new rules regarding the SBC and uniform glossary that must be provided to employees under the Affordable Care Act (ACA). The new rules were published in the Federal Register on June 16, 2015. However, revisions to the SBC template and the uniform glossary included with the SBC, along with new coverage examples, are not anticipated to be finalized until January 2016, after the departments complete consumer testing and receive additional input from the public, including the National Association of Insurance Commissioners. The revisions will apply to SBCs for coverage beginning on or after Jan. 1, 2017.
As a result of the current proposed changes to the SBC, healthcare payers again have to make a decision whether to approach these documents with a workaround model--or finally put in place an automated process to handle these and future modifications more efficiently.
At first glance, the decision to automate the SBC process may seem an issue for an organization's Compliance and IT departments. However, the implications for the marketing department are significant as well.
Focusing solely on SBCs as a mere compliance requirement risks overlooking their tremendous potential as a marketing tool. Having in place an automated, master template-based content management approach to SBC production will make it possible to leverage the power SBCs hold for marketing.
Automating processes will certainly ensure efficiencies in the workflow required to produce SBCs. However, automating production can also support field staff in their negotiations with customers by enabling them to generate SBCs in real time for comparison to competitive offerings. For example, a representative in the field may want to change the co-pay or some other attribute of their product at the request of a future customer. Having the ability to produce the SBC on the fly for a side-by-side comparison with the competition provides the sales team the capability to enhance sales efforts by making it possible to differentiate from the competition on demand.
SBC automation is just one example of how technology can help bridge the divide between the need for compliance and effective customer communications. Regardless of the application, payers will benefit from adopting solutions that allow business users to manage the entire lifecycle of content. Whether it involves compliance, marketing or other critical business functions, organizations today need the ability to collaboratively create and manage variable enterprise correspondence, without requiring complex technical toolsets. The end result will reduce compliance risk while, at the same time, enhance communication effectiveness and provide a customer experience that puts members' needs front and center.
Sohail Malik is the business product manager of healthcare at Elixir Technologies.