With the 2021 open enrollment period in full swing, this year is unlike any other. Although it’s long been predicted, the unprecedented strains on the healthcare system from Covid-19 mean there is no turning back on modernizing enrollment processes.
Spurred by dramatic and continued cuts to individuals covered by employer-sponsored health coverage due to widespread layoffs, some of those who found themselves suddenly uninsured have turned to individual coverage found through the Federally Facilitated Marketplace. Even on the low end of unemployment projections, millions of individuals are predicted to purchase plans through this channel – a figure that is sure to cause a backlog among health plans that are unprepared. In an already stressful time for many, health plans need to be the solution, not the extra burden. It’s been said for some time that outdated enrollment operational models don’t work – and that will only become more apparent given the current, and future, state of healthcare.
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Aaron Fulner Aaron Fulner is a senior director at Edifecs focused on insurers involved in commercial, managed Medicaid, Medicare Advantage, and dual eligible programs. His expertise also spans insurers of all sizes and types ranging from small, regional plans, large, national plans, and Blue Cross/Blue Shield organizations.
While many health plans are focusing on expanding enrollment, the strain and pressure an influx of new members can put on the back-end IT infrastructure can be debilitating. Health plans must prepare themselves for a flood of enrollment activities come every open enrollment period and ensure flexibility within their systems to handle special enrollment periods throughout the year too.
Unlike interoperability mandates driven forward by the Centers for Medicaid and Medicare Services (CMS), enrollment technology guidance has been out of sight, out of mind for many health plans. But under the pressure of an influx in open enrollment sign-ups, legacy enrollment IT systems sitting deep within health plans will crack. They are just not equipped to handle the rapid influx of new and changing member data, resulting in costly errors during enrollment.
By implementing a standardized, automated, and modernized set of processes to manage critical enrollment information across multiple lines of business, plans have greater potential to expand member footprint, enter new markets and drive competitive differentiation.
Modern end-to-end enrollment management lifecycle solutions are scalable and designed to address the needs of health plans today and in the future. IT teams improve efficiency by not having to sort through siloed sources of member data. When member enrollment data is consolidated across partners and automated for improved visibility, both the health plan and the member win. Low monthly premiums are attractive to health plan members, but just like any paid service, so is customer satisfaction. While the back-end IT infrastructure and enrollment workflows are hidden from members’ sight during enrollment, they still expect timely communication and issue resolution.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
It’s time health plans take a hard look at the cracks in their existing infrastructure and begin to lay the groundwork to demonstrate the high-quality experience members can expect from their health plan, all powered through the enrollment platform. An expedited enrollment process, reduced enrollment file fall-out, and the delivery of timely member information are all made feasible through enrollment platforms focused on operational efficiency and collaboration.
The warning call is too loud to be ignored now – without investing in a comprehensive, modern, automated enrollment system, many health plans will continue to struggle to efficiently enroll members impacting satisfaction, plan costs and growth initiatives. It’s time to face the fact that legacy enrollment management doesn’t work anymore, and a modern enrollment solution is a necessity moving forward.
Photo: turk_stock_photographer, Getty Images
Aaron Fulner is a senior director at Edifecs focused on insurers involved in commercial, managed Medicaid, Medicare Advantage, and dual eligible programs. His expertise also spans insurers of all sizes and types ranging from small, regional plans, large, national plans, and Blue Cross/Blue Shield organizations.
