The Medicare Advantage market is heating up – a trend that’s expected to continue, according to a new Kaiser Family Foundation report. In 2019, there will be 417 more MA plans than this year. Fourteen new carriers will offer plans in 26 states, with only five carriers exiting the market.
As market competition in MA becomes fiercer, it is increasingly important for payers to stand out with a better consumer experience. One way to do that is with an integrated billing platform that can streamline the process for both payer and consumer.
Pain Points for Payers
Health plans face a variety of pain points with their MA billing platforms, and they are still struggling to get it right. Many platforms were designed for other markets with substantially different customers and compliance concerns, and retrofitted to Medicare. Instead of being integrated systems that take applicable rules and regulations into account, they are disjointed and make for an error-prone consumer experience. The result can be unhappy customers, frustrated customer service representatives and lost business.
One significant challenge for payers is tracking members’ eligibility and subsidies. A member may qualify for certain subsidies today but not tomorrow, and government regulations can make tracking these changes a complicated process for payers.
Keeping abreast of regulatory and coverage changes can be a challenge as well. CMS’ recent move to increase coverage of supplemental benefits is just the latest example of the kinds of shifts plans must integrate into their billing platforms.
Finally, Medicare Advantage plans need to provide a smooth, easy-to-understand consumer experience at every step of the process to achieve high star ratings. Star ratings assess a plan’s quality in various areas, including member experience and customer service, such as its handling of member calls and questions. For plans that cover prescription drugs in addition to health services, the rating also covers billing information submitted to Medicare. Data from Navigant indicate a 1-star improvement correlates to an 8% to 12% enrollment increase, which means good billing management and good customer service around billing can be important factors in payers’ future revenue.
Benefits of a Medicare-specific platform
These challenges and pain points are best addressed by a Medicare-specific billing platform. A seamless, personalized process that is integrated with enrollment can streamline payer operations while improving the consumer experience.
This is especially important now as expectations around customer service are rising. McKinsey has found that more than half of consumers see great customer service as important for healthcare companies, and they expect these companies to make tasks easier and meet expectations while providing a high-value service.
Good digital tools can help plans meet those goals and are quickly becoming a standard consumer expectation. According to McKinsey research, an “overwhelming majority” of consumers want digital tools to be available along the entire healthcare process. And Deloitte data show that by 2015, one in three medical care users had already paid a medical bill online, and more than twice that number expressed interest in doing so.
Billing modules that offer self-service tools can further streamline the experience for members. A configurable, integrated billing module allows for personalized messages, alerts, reminders and calls to action, improving engagement and plan utilization. It also provides a single record source for member management and reporting, with financial considerations related to SSA, RRB, SPAP, LIS, LEP and Good Cause automatically coordinated.
Another major benefit of MA-specific platforms is multi-state integration. No matter where the member is, the platform will track low-income subsidies, state pharmaceutical assistance programs and late-enrollment penalties. This allows for real-time premium adjustments based on retroactive coverage effective dates. Member premiums for basic and supplemental coverage are consolidated with these subsidies and penalties.
That information is then programmed into the payer’s system and is available instantly. This helps customer service representatives provide more informed answers to members and reduce call times.
Compliance is another important consideration for plans, and MA-specific platforms help payers adhere to CMS guidelines, further boosting star ratings and HEDIS scores. This is key after payment is received, as reconciliation can be complicated for payers if members do not pay the full balance due. Partial and arrears payments must be allocated according to both CMS and payer rules. An automated, configurable billing engine performs this task quickly and accurately.
The right billing system
MA enrollment is expected to hit an all-time high of 22.6 million next year and the market is already extremely competitive. Seniors who encounter a sub-optimal billing experience with one carrier have plenty of other choices.
Plans can position themselves as the right choice with an MA-specific billing system that improves the consumer experience while driving widespread operational improvement.
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