Best Practices: COVID-19 Configuration Guidance for HealthRules Payor

The international COVID-19 outbreak has introduced unforeseen changes and uncertainty to all parts of our lives. HealthEdge is taking the health of our employees, customers and communities seriously and like many other businesses across the country, we’ve told our staff to work from home exclusively and replace travel with virtual meetings to help reduce the spread of COVID-19. During this time, we’re committed to helping our customers run their business, and we are ready to assist in resolving real-time, business-critical challenges.

Important Customer Update

HealthEdge’s Commitment to Customers 

The international COVID-19 outbreak has introduced unforeseen changes and uncertainty to all parts of our lives. During this time, HealthEdge wants you to know that we are here for you and committed to helping you continue running your business as you work with your providers and members.  We understand your business may be unusually impacted, for example by the increased need for healthcare services, putting additional strain on your resources. We are ready to assist you. Every day, customers rely on us to help them rapidly resolve real-time, business-critical challenges and COVID-19 does not change our ability to provide those critical capabilities.

Employee Focus

We take the health of the community and our employees seriously and are following the advice of medical experts and local authorities regarding steps we can take to help reduce the spread of the virus, such as social distancing. We have told our staff to work from home exclusively, and this policy will continue to be evaluated. We’ve also directed our employees to replace travel with virtual meetings during this time.

Agility and collaboration have been the focus at HealthEdge in our culture and how we approach our day to day support commitments.  Our staff are all deployed with equipment and toolsets that enable them to work effectively remotely.  Employees are trained in the use of video conferencing tools for virtual meetings to ensure our collaborative work focus for our customers continues.  Our internal support teams continue to support our customers 24x7x365, managing and monitoring any critical events that may occur.

We believe it’s our duty to play a role in reducing the spread of COVID-19, and precautions like these are in the best interest of our employees, their families, and the communities in which they live.

Crisis Management

The senior management team at HealthEdge is meeting daily to assess all aspects of the crisis and ensure that our resources are deployed to help you continue managing your business.  Please address any concerns to your Account Executive as we work through this unprecedented situation.

Postcard from Dallas: What’s Setting Medicare Advantage Plans Apart

Changing CMS regulations, benefits and challenges of narrowing provider networks, tapping front-line staff to share the pulse on Medicare Advantage membership, and innovative consumer-focused benefit plan design top the list of key insights shared at the recent Health Plan Alliance Medicare Advantage Product and Implementation Fly-In. As an HPA business partner and silver sponsor of this event, HealthEdge, along with several member plans, shared insights and best practices drawn from the successful implementation and support of health plans leveraging the HealthRules solution suite for MA lines of business.

While a wide range of topics were discussed during the two-day event, below are the most compelling takeaways we’re actively talking about with health plans:

CMS loosening allowable provider marketing regulations. Plans can now co-brand materials with their provider networks and this is making inroads.  Tapping these new regulations contributed to one plan’s Medicare Advantage business growing by 37 percent last year. Providers can now conduct sales activities, distribute materials, answer questions on plans – including cost sharing and benefit information – and can refer patients to other sources of information, including marketing representatives. Additionally, marketing materials may be distributed and displayed in all areas of the health care setting. In the Fall, Medicare Advantage enrollment windows will compete with a plethora of political messaging in this election year. This will be particularly true if a publicly floated Medicare For All option gains momentum and lands on a political party’s platform.  As a result, loosened marketing rules will mean health plans will work harder and experience a longer duration by which to ensure they are capturing the attention span of people from Labor Day to Election Day, which directly competes with their open enrollment window.

Pros and cons of narrowing or expanding provider networks continues to be debated.  Some data indicates provider networks are indeed narrowing; however, only anecdotal data surrounds this hypothesis. While the average consumer may not fully understand the intricacies of a provider network, health plans with a Medicare Advantage line of business wrestle with the perception that a narrower network may mean longer wait times, less access, and less consumer choice. Some health plans believe a narrower provider network may create cost savings through tighter coding controls, improve quality improvements, and reduce system leakage by pushing providers to use designated facilities. The data suggests most five-star Medicare Advantage plans have narrower provider networks.

Medicare Advantage health plans continue to conceptualize and operationalize innovate, supplement plan design. Involving a cross-functional approach to plan design, health plans are looking to all for input into member pain points. Coders offer insight into how one benefit may seem to be a “sell” only to share it could offset another code, thus being a detriment. Operations and configurations staff are critical in benefit design. Call center representatives and the data points they collect are instrumental. Some plans utilize a member consumer advisory board but struggle with a lack of governance. Others are using a member and provider council with membership strategically selected across demographics and satisfaction levels. Listen to HealthEdge’s webinar, SDoH: A Payer’s Strategic Advantage on-demand to learn about some existing operationalize programs.

Local and regional plans are building relationships with community-based agencies so they can link members to services. Social service coordinating agencies are there to create linkages and yet many health plans are not fully capitalizing on these to create a more positive customer experience. One health plan is considering the Disney Fast-Pass® experience by giving expedited appointments to in-network providers. Health plans are reaching deep into the community to leverage these relationships. Training and education of the customer service call center representatives empowers them to solve problems directly, which correlates to satisfaction levels – the greater the ability to do this, the happier the beneficiary.

Looking for additional Medicare Advantage resources? Check out our 2019 Voice of the Market Survey: Health Plans are Riding the Wave of Medicare Advantage Plans, a survey of over 200 health plan executives working in the Medicare or Medicare Advantage and found insurers are focused on growing those lines of business faster than traditional Medicare.