Posted by
Stephanie Castro
on
11/30/2011 at 12:21 PM
On November 17, 2011, the Departments of Health & Human Services, Labor, and the Treasury (the "Departments") issued an FAQ document that addressed the concern of many health plans about being able to meet the proposed March 23, 2012 deadline for the summary of benefits and coverage (SBC) requirement that is part of the Patient Protection and Affordable Care Act (PPACA).
The document states that health plans are not required to comply with the regulation until final regulations are issued. As of today, the Departments have not yet issued final regulations, and there is no word on the final release date. While the Departments’ FAQ may have eased concern over the tight deadline, they may have raised additional questions for health plans on how they should implement given an extended timeframe.
Most health plans have come to the same conclusion about the SBC regulation: as one recent prospective VUE Software client put it, “This is a software issue”. Plans have recognized that in order to comply with various aspects of the SBC, an automated solution is necessary. Previous to the deadline extension communication, many health plans were scrambling to find a vendor who could assist, feeling pressured into making hasty decisions on important investments.
Now, plans have more time to figure out how to go about acquiring the right software for the SBC. Many who were considering building a solution in-house may have the time to do so with a looser deadline. Still, with no final regulations, many development efforts may be wasted trying to hit a moving target. And, since the Departments have stated neither the final regulation release date, nor the duration between time of issue and new deadline, health plans who wait to begin implementation until after the regulations are issued may find that they still don’t have enough time to meet the new deadline.
With such uncertainty, smart health plans will take the extended deadline lightly, and move forward on implementing a flexible infrastructure that will allow them to comply with the final regulations, no matter what their final form. For more information on VUE Benefit Summary Tool, which functions both as a flexible infrastructure for storing plan data and creating benefit summaries – and comes out-of-the-box with the current format for SBCs and includes free updates to future formats – register now for an informational call with a product consultant.
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Posted by
Stephanie Castro
on
7/28/2011 at 12:19 PM
One area where many health plans can vastly improve their administrative efficiency is in the generation of health plan summaries of benefits and coverage (SBCs, or benefit summaries). These summaries are primarily member education and pre-enrollment documents that explain the benefits of plans with variable product options. The process is complex, since each benefit option multiplies the number of benefit summaries possible. For example, a new product roll-out to the small group market of five plans with five prescription drug options each would yield 25 different benefit summaries.
Typically handled by the marketing, product development, sales or operations departments, health insurance companies vary widely in the processes used to create SBCs. While some larger companies have invested in costly internally-developed systems to automate the process, companies with smaller IT budgets have been forced to create documents manually using word processing software.
A manual approach has various sources of disconnection; for example, different versions of the statements may float around on different computers, making updates and uniformity difficult. Even plans with internally-developed systems may struggle to make changes to summary formats, including the changes needed to implement upcoming NAIC rules for compliance with the Affordable Care Act’s readability standards for SBCs.
Making use of a web-based benefit summary tool allows carriers to maintain a database of plan elements to be combined into a particular package, eliminating the need to re-enter this information upon generation of each new summary. Plus, newer systems will already contain regulation-compliant formats and templates. A streamlined Benefit Summary Tool is one defense health plans have on their side in the struggle to improve administrative efficiency in the face of regulatory reform.
To learn more about the solution, visit the Benefit Summary Tool product page.
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Posted by
Joseph Westlake
on
7/12/2011 at 7:10 AM
Our VUE Software representatives attended AHIP’s Institute 2011, held in San Diego June 15-17th. The conference had a broad focus on improving America’s healthcare through intelligent insurance information technology. The conference illuminated many areas of focus for today’s health insurance IT.
Several sessions stressed improving the efficiency of data exchange between carriers and healthcare providers. Insurers can help by sharing actionable information with providers, allowing doctors to reduce costs and offer more effective care. Additionally, IT investments are being pursued to continue quality improvements for claims and service activities.
Since VUE Software partners with insurers on marketing, service, and sales, we naturally gravitated toward sessions that focused on issues related to insurance distribution. Throughout AHIP’s distribution-focused sessions, we noticed the following three areas mentioned consistently as areas of flux.
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Segmentation: Health insurance companies have historically focused less on the individual market in favor of more profitable groups. But with the Affordable Care Act’s individual insurance mandate taking effect soon, insurers will do well to invest in capturing share of the growing opportunity in the individual market. Demographics of both potential policy-holders and agents are also changing. With a younger pool to draw from, insurers will need to meet potential customers and agent recruits where they are, including social platforms, for effective marketing, sales, and recruiting. And with the proliferation of games in popular culture, forward looking insurance companies are also brainstorming ways to gain traction with America’s i-crowd through gaming.
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Distribution: In addition to progressive social marketing strategies, the changing marketplace also demands that health plans redesign and invest in their distribution processes. Although there are still questions about the role of the agent post-reform, the agent role will not vanish. Instead, insurers must devise how to keep agent-related costs low by streamlining on-boarding, self-service, quoting and individual enrollment. VUE Software partner Microsoft reported an increased demand for a health plan sales solution tied to CRM, which, when combined with partner systems, can extend these capabilities to agents and increase automation in these areas.
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Service: The traditional approach to health insurance customer service has centered on addressing policy and claims needs. The modern approach focuses on quality, including training customer service reps in marketing and sales skills. This approach can increase the odds of cross selling, upselling, and obtaining renewals, which will be increasingly important as the competition for the growing individual market increases. Systems for customer relationship management (CRM) become crucial to organizing customer data and allowing service reps to gain immediate insight into a customer’s records.
Did you attend this year’s AHIP conference? Share your takeaways as comments to this post.
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Posted by
Joseph Westlake
on
6/15/2011 at 11:59 AM
The Patient Protection and Affordable Care Act (PPACA) has created an anticipation of growth for small group and individual health plans that offer cost-effective and customer-oriented products. With new potential customers flooding the market, health plans possessing easily adaptable sales processes will come out on top. Also, health plans will do well to consider how their systems will interoperate with state Health Insurance Exchanges to best provide their coverage plans to uninsured Americans.
These issues are important for health plans to consider before performing organization-wide technology updates. The AHIP Institute 2011 conference is especially timely for insurers needing information and answers. The sessions at Institute 2011, to be held in San Francisco between June 15th and 17th, will offer ideas and solutions to some of your most complicated questions.
The Institute helps in your understanding of how states are creating the IT infrastructure to support an interactive portal, the thoughts of the employer community, and strategies to prepare for operational aspects of Exchanges. The Institute's Exhibit Hall also offers the newest products and services focused on reform implementation.
You can also attend a health care reform implementation workshop where you’ll have a better understanding of the impact of the Affordable Care Act. Get exposed to topics that include long-term care, disability income insurance and wellness.
At the Institute, VUE Software will provide a free opportunity to AHIP attendees to register for a webcast “CRM for Insurance – Increase Revenue and Agent Productivity”. The webcast will be presented in association with Microsoft and Insurance Networking News. Prominent speakers, Don Desiderato Principal, Novarica and Alan Dulin, U.S. Director of Insurance Microsoft will share how CRM for Insurance, built specifically for the needs of insurance organizations, can improve revenue and member retention.
Click here to Register Now.
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Posted by
Stephanie Castro
on
7/22/2010 at 3:22 AM
It was exciting to be a part of the 2010 Microsoft Worldwide Partner Conference. The recognition as a finalist for the Microsoft Partner Awards in the Microsoft Dynamics Financial Services Partner of the Year award category was a momentous occasion for the company. And the honor of being selected Microsoft 2010 U.S. Public Sector Health Plan Partner of the Year was a highlight of the week, serving as Microsoft’s recognition of our most successful year ever.
We especially enjoyed the sessions on opportunities with the “Cloud”. In his keynote, Steve Ballmer, CEO of Microsoft, discussed the key dimensions of Cloud Computing(which for all you non-cloud-converts is defined by Wikipedia as “Internet-based computing, whereby shared resources, software, and information are provided to computers and other devices on demand”).Mr. Ballmer challenged partners to reinvent the way they develop and market their solutions to take full advantage of the Cloud, which he believes is the future of computing.
John Roskill, the new corporate VP of the Worldwide Partner Group, who succeeded Allison Watson in this role, spoke to partners about the industry transformation that is underway with the emergence of the Cloud, and the opportunities it creates. He detailed new tools and resources that Microsoft is delivering to advance Partners’ Cloud adoption.
Bob Muglia, President of the Server and Tools Business at Microsoft, outlined how Microsoft is planning to provide an integrated service and server platform, the Windows Azure Appliance, and how it will allow customers and partners to deploy a secure Cloud dedicated to their own business use.
As one of the leading Microsoft partners, VUE Software has already invested in bringing its sales performance management solutions to the Windows Azure platform, in addition to its on-premise offering, to provide deployment choice to customers.
In a presentation about moving health plan technology to the Cloud, Hector Rodriguez, Senior Strategist for Microsoft’s US Health Plans team, presented the challenges and opportunities for technologists to provide compliant, low cost products to address the unique business concerns of health insurers. And our own VP, Joseph Westlake, shared VUE Software’s experience with the decision to “Go Cloud”.
Another piece of exciting news for our business was the announcement of the expected beta availability of the next version of Microsoft Dynamics CRM. With insurance companies focusing more on developing customer relationship systems, we anticipate that the additional features in this version of CRM will further expand its data utility and analytics functionalities and extend the business value of the solution.
Thanks John Roskill and Microsoft for organizing a great event in Washington and good luck to Allison Watson in her new role as the corporate vice president of the Business & Marketing Organization for North America!
We’d love to hear your thoughts! Partners, what are your key takeaways from WPC? Insurers, do you have any initial thoughts about Cloud technology and your business? Please add your comments in the section below.
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