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AUTOMATION: A Practical Solution for Health Plans

Although the big five providers in the Medicare Advantage (MA) market have embraced technology, many of the smaller plans distributing products through a small sales force (200-1000 agents) juggle the tradeoffs of revenue, the demands of CMS marketing guidelines, limited bandwidth of critical resources, and costs in order to realize profits.

For the last half decade or longer, these smaller senior care providers have been plagued with limited revenue, CMS monitoring rules, MARx automation, and a patchwork of manual and weak automation solutions as the political fate of Medicare Advantage hung in the balance. Well, the seniors have spoken. Despite strong political adversaries, it is clear that Medicare Advantage plans are here to stay. Predictions of even increased participation, a gradually increasing number of enrollees, innovative product lines, new regulations, and the needs of the sales force in an “automation – less” world, poses serious regulatory and customer service repercussions.

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The five MA leaders—with huge market shares—as well as the smaller plans, are facing challenges. For example, Humana, with 3+ million enrollees in their MA offerings struggled with compliance and enrollment-management issues. The Louisville, KY-based insurance giant reported an expected 21.2% decline in net income in the third quarter of 2014, as investments in healthcare reform-related programs overshadowed the positive effect of additional members.

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