Managing the Transition to E-Delivery

Consumers are demanding more frequent, personalized, meaningful communications from their health insurance providers, similar to the variety of touches they are accustom to receiving from retailers and other companies they purchase services and goods from. While many plans want to deliver more consistent and dynamic engagement, at the same time they must balance this initative with communications cost. This challenge has made e-delivery adoption a fast growing priority of many health plans as it enables insurers to build and maintain more direct relationships with prospects and members at minimal cost.

Insurers create and deliver a wide variety of outbound documents to prospects, customers, agents, claims partners and others. Welcome kits, ANOCs and policies are heavyweight pieces that go out in high-volume batches that cost hundreds of thousands each year just to mail, never mind produce. Even light-weight ID cards and bills are created and produced in large batches that are costly to produce and complex to manage.

From personalized pre-sale Plan Comparison Guides, SBCs and EOBs, to Medicare Welcome Kits, e-delivery can open the door to new savings and improved member experiences while providing real-time audit trails of every communication delivered across channels, including recipient-level behavioral analytics that print communications cannot provide.

With access to such rich data and behavioral analytics, insurers can gain all new insight into buying patterns, interests, preferences and behaviors. These insights can be used to pinpoint the most optimal message and send time for the individual in order to achieve new levels of acquisition and retention.

While consumer preferences are changing, so too are CMS e-delivery policies. Regulations surrounding electronic delivery of health plan materials are becoming increasingly flexible, further pressuring plans to rethink their distribution strategies. According to section 40.9 of the 2015 CMS Guidelines, plans may provide materials using different media types, so long as they receive consent from the member. When requesting consent, the plan must specify the particular documents that will be sent in that media format and must allow the enrollee to opt out at any time and receive hard copies upon request. If posting documents to a website, plans must also provide instructions via email or print notice on how and when the electronic documents may be accessed.

Materials provided via email or website posting must also be:

  • In a readily accessible format that can easily be printed and retained
  • Housed in a prominent, readily accessible location
  • Consistent in appearance, content and language requirements
  • Identified in a way that enrollees understand their importance
  • Complaint with HIPAA and privacy rules

As electronic distribution regulations continue to change, significant new opportunities to transform expensive, high-volume materials into digital format not only offers great savings, but major improvements in business process management, customer experience and marketing competitiveness.

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