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PERSPECTIVES: How to Improve Communications with Health Plan Members

October 2nd, 2018 | by Stephen Billias

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Imagine a Medicare Advantage member thumbing through the Evidence of Coverage (EOC) document from his insurance company, struggling to find the information he’s looking for in this 200-page document. Now imagine this member works on building EOCs and other communications for health plans every day, and he still can’t find what he’s looking for.

That MA member/insurance document expert is me.

If someone who looks at these materials day in and day out can’t find the information that’s relevant to him, what hope does the average American have?

When plan members can’t find the information they need or simply don’t know where to find it, they look up the Member Services phone number and call the plan. This can be frustrating to members who wish they could find answers more quickly and easily. It also can tax health plan customer service staff who are answering questions related to information the member could have found elsewhere – if they knew where to look and how to interpret that information.

The healthcare system is not doing a good job of informing members of the benefits and rights they are entitled to by participating in a plan. In fact, a recent report by Accenture found that half of U.S. consumers are unable to navigate the complexity of the healthcare system on their own, and this low level of health system “literacy” costs the industry an estimated $4.8 billion annually in administrative expenses alone.

What can be done to improve communication with health plan members? Here are some areas where improvements could be made:

  1. Simplify language and streamline content in member materials

The Centers for Medicare & Medicaid Services (CMS) mandates much of the content and wording in member materials, including the Annual Notice of Changes (ANOC) and EOC documents. Unfortunately, this material is often unwieldy and not user-friendly.

There is a preponderance of “model language” in both documents that is typical governmental boilerplate—bureaucratic-sounding, confusing and prone to repetition. A particularly difficult chapter is the one on Appeals and Grievances, Chapter 9 in the Medicare Advantage Prescription Drug (MAPD) EOC model, that runs to 50-plus pages and is a convoluted progression through the various stages of the appeals process. Simplifying the language in these materials would make it much easier for members to understand.

In addition, providing members with only truly relevant information would make it easier to find. For example, instead of providing a 250-to-300-page EOC, plans could mail members a 25-to-30-page document that contains benefit information only – essentially the Chapter 4 benefits and Chapter 6 Rx benefits (if applicable) sections of the current EOC. And, omit the lengthy explanations contained in such currently mandatory chapters that no one ever reads, such as “Legal Notices.”

  1. Increase electronic delivery of member materials

Today, almost everyone has access to a computer. Plans could make online viewing of benefit information an “opt-out” option rather than “opt-in,” and require members have an email address to qualify for benefits.

CMS is already moving in this direction. For the 2019 calendar year, it issued a new rule that allows health plans to provide EOCs electronically rather than mailing the document to members. CMS estimates this new rule has the potential to save health plans $54 million a year in reduced expenses related to printing, fulfillment and postage for the EOCs.

Every health plan would benefit from offering an online member portal where members can access their documents electronically. Plans could set up a query system to allow members to more easily search for specific information, such as, “Ending your membership in the plan,” or “What to do if you have a problem or complaint.”

  1. Integrate health plan information and medical history into one system

Ideally, one day we’ll all be able to access a secure, encrypted online portal where we can find all information related to our health insurance and medical history. In addition to viewing our insurance card and claims, we could communicate with our primary care provider (PCP), schedule lab appointments, view lab results and more. This setup would encourage or mandate file sharing between doctors, pharmacies, specialists and insurance plan providers.

I’ll cite a recent example from personal experience that illustrates the value of this concept. I was having a problem with my ankle. I had an X-ray taken at my health care provider’s office. Then I was referred to a specialist, but when I arrived for the appointment, I was told that they did not have my X-ray. I asked if the PCP could email the images to the specialist and then was told they weren’t set up to do that. I had to reschedule my appointment, obtain a CD of the image from my PCP, and physically transport it to the specialist’s office. How much easier would this all have been if I could have simply had the specialist scan my ID card to access the X-rays?

These may seem like pie-in-the-sky ideas. However, we are seeing signs of shifts taking place, moving us closer to some of these realities. As such, CODY is well-positioned to help health plans move with these changes.

For example, Cody’s ePresentment Module™ allows health plans to post electronic documents like ANOCs/EOCs on web portals and the ability manage members’ opt-in and opt-out communication preferences for printed versus electronic materials.

For more information on how CODY can help your health plan navigate the ever-changing healthcare landscape, contact us today.


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