For Medicare Advantage Organizations (MAOs), the summer months have historically been defined by the high stakes, tight turnarounds and document management challenges of the Annual Enrollment Period (AEP). From the first Monday in June to late September, employees of MAOs clear personal calendars to carry out the demanding responsibilities of modifying all plan documents to reflect a variety of updates, including those for each individual plan offering, as well as the model document language and formatting required by the Centers for Medicare & Medicaid Services (CMS). As a season that generally requires all hand on deck, the summer months are typically spent working around the clock to ensure all plan documents—such as the Annual Notice of Coverage (ANOC), Evidence of Coverage (EOC) and Summary of Benefits (SB)—are updated, approved and ready for delivery.
The demands and deadlines of the AEP place an enormous amount of pressure on MAOs, many of which end up paying exorbitant fees to outsource these tasks to third-party vendors. Tired of huge bills, long wait times and the employee burnout that accompanies the use of word processing tools and traditional document management tools, many MAOs are looking for more specialized solutions.
Technology is changing the game by offering innovative means to address the challenges of content management, quality assurance, regulatory compliance, translation and beyond. Rather than requiring MAO teams to spend time making manual updates, these healthcare-focused solutions guide users step by step through the process of creating, tailoring and ensuring the compliance of each document. However, buyers must beware of what they are actually getting with plan management platforms that claim to offer automation, only to be stuck updating documents one at a time.
Not all communications and document management solutions are created equal
When considering investing in technology to manage the inherent challenges of complex member materials, it’s critical to first fully vet a solution to understand its scale and capabilities. These seven key considerations will help determine if a solution is thoughtfully designed with capabilities that truly transform how you manage Medicare plan materials:
1. Does the solution provide pre-built touchpoints for core documents, including the content and formatting requirements from the annual CMS model updates
An ideal solution includes pre-built touchpoints for key documents and includes all the CMS model updates embedded in the platform. To drive efficiencies across your materials, these pre-built touchpoints should comply with the CMS layout requirements, yet also allow for small modifications that meet your specific corporate requirements. Teams save significant time when headings, tables, glossaries and indexes are already pre-configured separately from the content.
2. Does the solution integrate with the PBP database
A comprehensive document management solution should directly leverage the Plan Benefit Package (PBP) database that you file with the CMS each year. Rather than updating a myriad of spreadsheets and making manual updates—which is common practice with some approaches and systems—you only need to reload the dataset with this approach.
3. Does the system manage content for complex benefit scenarios
Details around cost-sharing, periodicity, maximum benefit amounts, number of visits, etc. require specific language for accurate plan representation. Typically, these scenarios are authored and managed separately for each plan, resulting in duplication of effort and content across plans. It is important to evaluate how the system supports benefit scenario content with the ability to leverage reusable, data-driven content components that can be configured with each plan.
4. How non-PBP plan information is managed in the system
Each plan requires additional information that is not available in the PBP database, such as D-SNP plan information, state agency details, contact information, premiums, material, document IDs and more. This information is often stored and managed in various locations in different formats. Advanced content management capabilities should support a plan information data repository that enables you to centralize and gain greater control over this information.
5. What support is offered for quality assurance and approval workflows
It’s imperative that your system allows you to configure a streamlined, QA process including audit trails, resource assignment, collaboration capabilities, reporting and a trackable approval workflow. With a configurable approval workflow, you can avoid the email attachment chaos associated with a traditional content approval cycle and ensure everyone gets the access they need.
6. How are multiple languages and translations handled
A modern automation architecture should enable modularized content management so you can translate shared content components just once for reuse in multiple documents and even do so in parallel with English content authoring. The result is that you don’t need to wait until after the entire English language versions of documents are complete to begin translation efforts. With a fully automated system, you can reduce redundancy and equip teams to be more agile when faced with last-minute CMS changes.
As importantly, advancements in AI-based translation and translation accuracy checks can have a substantial impact on the process of supporting multiple languages. AI can translate content in a fraction of the time, and accuracy checks validate the semantic similarity of texts, ensure that the right data is in place in translated documents and overall can ensure that humans in the loop are focused on exceptions rather than the heavy lifting of translation and proofing.
7. Does the solution automate 508-compliant versions of materials and support large print
Plan materials must meet the minimum 508 compliance requirements for accessibility. Be sure the selected platform supports the tagging of all page elements at the object level, meets the requirements for the logical reading order across all page elements, supports the dynamic generation of bookmarks and automates section references. An advanced system also allows users to configure alternate text for required images, as well as other objects used in the document, and automatically generate large print versions.
Advanced automation transforms Medicare and Medicaid document management
With due diligence and by asking the right questions, MAOs can find a purpose-built automation system that alleviates the heavy burdens placed on teams during the AEP season. Rather than settling for partial automation that will still require significant manual input, MAOs can realize the many benefits of technology-driven enhancements.
From automated tracking and reporting to integrated translation services, true automation tools offer a suite of features to help MAOs achieve operational excellence, even in the most demanding of circumstances. These affordable, easily integrated technologies will greatly improve productivity and morale for long-term employee retention, reduce overall costs, and enhance member experiences.
About Sohail Malik
Sohail Malik is Vice President of Healthcare Solutions at Messagepoint, a provider of customer communications management software. Malik oversees the development of Messagepoint’s healthcare solutions to ensure they support the complex and ever-changing needs of health plans to scale and grow to meet market demands.
