Health Plans: 5 Benefits of Automating your System


The Deloitte Health Plan Retail Online Capability Survey of six health plans concluded that technology investments are no longer an option—they’re an imperative. The benefits are quantifiable and the cost of automation has decreased significantly. Here are the top 5 benefits of automating:

1. Ability to Design Varied Benefit Plans

Sponsors need to try to keep costs low while offering quality services that beneficiaries can enjoy, and health plans should have a strong product line to gain an edge in the market. From a data-management perspective, this edge requires us to consider new variables such as benefit structures, enrollment parameters, and the requirement of a centralized data repository that can interact with different systems. Although these are often considered soft gains, they must be considered. An effective strategy is to ask sales leaders to estimate from 0–5% of an increase  they would expect. Use the number from the low-end of the estimates and ask why they did not say zero, as this provides an effective rationale from an authoritative source. The aforementioned solution must provide flexibility in product definition and business rules.

2. Manage Innovative Distribution Channels

According to Deloitte, distribution, enrollment, and renewal capabilities are the most common areas of investment. The most frequently cited investment capabilities are:

  1. “Using a thorough understanding of the consumer’s purchase process and preferences toform channel strategy and design”
  2. Retention strategies, guided selling tools, CRM integration, and systematic touch points to reinforce a relationshi
  3. A sophisticated system that provides the capability to house different types of hierarchies, payment arrangements, and compensation structures

3. Visibility into True Collected Revenue

Organizations struggle with different methodologies to understand how much revenue they are generating and how to record it. This continuously involves number-crunching, modeling, and analyzing rows of data to understand where the quarter stands. Nothing can be more comforting than a tool that assesses your true revenue and identifies what you are missing and reports it, helping to bridge the gap once missing revenue is recovered. A very common problem plaguing organizations is overpayment on lesser recognized revenue. Understanding revenue and costs will allow your organization to improve margins. Often, understanding requires a basic-value analysis—a system of looking at costs and figuring out where the discrepancy lies.

4. Stay Compliant

Oftentimes, administrators scramble over fragmented systems and consolidating disconnected pieces of information needed to accomplish day-to-day tasks. This process becomes even more stressful when an auditor arrives. CMS has found that in the area of agent/broker oversight, the most common areas of deficiency are licensing, appointment and training of agents, requirements for outbound enrollment verification (OEV) calls, and the complaints process. These areas determine if you are governing your business in alignment with CMS guidelines and the size of corresponding fines. Penalties can range from $20,700 to more than $447,000. Even small plans are not exempt. For example: recently, a small plan in Arizona of 10,600 members was fined $146,000. Through an automated system, you are able to provide appropriate audit reports that eliminate or reduce fines. An effective system will automate onboarding, agent management and compliance, compensation, and enrollment processes.

5. Increase Profitability

When a business has better products and smooth distribution in an increasing market, revenues automatically increase. In combination with automation, the cost of compliance will decrease, leading to an overall improvement in profitability.


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