The Top Challenges Faced by Health Plans and How to Solve Them

As a communications professional working for a Health Plan or Pharmacy Benefit Manager, you routinely face an abundance of challenges, including regulatory and policy changes, fluctuating staffing requirements and limited timeframes to meet stringent deadlines. These problems consume your team’s time, budget and put your member experience at risk. That is where technology plays an important role. Automation tools combined with real-time reporting can simplify even the most complex processes and reduce or eliminate these pain points.

Here is how you as a health insurer can overcome those obstacles.

Regulatory Changes

Complying with government requirements, notably including guidance from The Centers for Medicare and Medicaid (CMS), is a top challenge. Healthcare institutions are in an era of uncertainty as the future of healthcare in the United States remains questionable under the current Administration. Healthcare reforms (aka the Affordable Care Act, PPACA and ObamaCare) can bring mountains of change to a health plan’s processes, including the addition of creating new communications for members and the need to review, comprehend and adopt all of the shifting deadlines and requirements.

Typically, when the notice for change from CMS knocks at your door, you must move fast, efficiently and often work overtime to meet stringent requirements.

Tip: Preparation is key. Use automation tools such as Blue Relay to ensure these tasks are prioritized, visible and that every member of your team is aware of their responsibilities.

Training Challenges

Hiring new personnel is an inevitable part of any business. This is especially difficult when CMS’ changes affect the roles and functions of employees and old training materials must be altered.

Health plans must spend valuable time training new members of their team and acquainting them with complex and volatile business requirements.

The solution? Integrate Blue Relay into your process. With integrated checklists throughout every step of the process, your entire team can ensure that all documents are filed accurately, and rework is eliminated.

Increased Competition

A study by Accenture found that a quarter of health insurance customers had no loyalty to their insurer.

With the saturated healthcare market, many providers are finding it more difficult than ever to keep up with the accelerating pace of change in the industry. Many have even dropped out of the individual health insurance marketplace or merged with another provider to keep pace with the competition.

One strategy to remain competitive and retain your members for the long-term is to deliver consistent, high-quality experiences throughout every stage of the customer journey.

A simplified client onboarding experience can help retain your members for the long-term.

Finding the Right Business Process Management Solution

As your members, files, and workloads increase, so too does the number of tools required to run your business. Finding a solution that increases efficiency and drives costs down will be top of mind for health insurers this year.

Tip: Look for a tool that is secure, interoperable and has features such as intuitive dashboards, compliance checks, and status tracking.

Conclusion

How can health plans overcome the challenges mentioned above, improve quality and reduce cost? Invest in automated tools to control the cost of compliance and increase efficiency throughout the challenging Medicare and Medicaid process.

Easily manage your processes, member materials and teams with Blue Relay.

What challenges are you facing as a health insurance professional? We want to know!