Enrollment in Medicare Advantage has doubled in the last decade and continues to grow. Medicare Advantage Organizations (MAOs) that are able to target and personalize their offerings to members in this robust market segment are poised to secure a sizeable revenue stream. Though a positive trend, growing the number of plans under management for any MAO does not come without challenges, especially when it comes to producing the documents the Centers for Medicare and Medicaid Services (CMS) requires for the Annual Enrollment Period (AEP), which runs from October 15 – December 7 each year.
In the spring of every year, the CMS issues updated models for the documents MAOs must provide prospective clients which help to detail plan offerings and changes, including the Annual Notice of Change (ANOC), Evidence of Coverage (EOC), and the Summary Benefits (SB). Each MAO is required to incorporate the changes in CMS’s regulatory models into their own marketing materials before the beginning of the AEP, to allow potential customers the information and time they require to make informed decisions. As an MAO grows the number of plans it offers, it faces an equal increase in the amount of work required to prepare and ensure these intricate and complex documents are updated on time and entirely compliant.
MCS is a leading healthcare services organization offering a variety of insurance plans and managing care for Medicare Advantage and Commercial members throughout Puerto Rico. MCS is the 14th largest Medicare Advantage plan and the 7th largest dual-eligible plan in the United States, servicing more than 207,000 Medicare Advantage and 210,000 Commercial members, including several of the biggest multinational employers in Puerto Rico. By addressing the social determinants of health, MCS provides Complete Health, striving to improve their members’ experiences and the quality of life in their communities.
With 23 plans in the individual market (including six duals plans) and over 30 Employer Group Plans, managing all the iterations with their current system and process was untenable. MCS looked for a better way to produce their ANOCs, EOCs, and SBs.
While the prior plan management software offering MCS relied on had made the document production process a little easier than leveraging Word documents, MCS found they required more from their solution than they were receiving. “It did become onerous at a certain point,” said Carlos De Jesus, Vice President Product Development at MCS. De Jesus identified MCS’s main concerns:
Authoring and editing stifled collaboration
MCS’s original platform used document templates, which meant only the owner of the template could enact changes, which was very inefficient. De Jesus needed multiple people to be able to work on documents at the same time.
Convoluted, opaque audit trails
If compilation errors occurred, there was no simple, efficient way to track down exactly where the problem originated. “There was only a rudimentary way to work through issues and someone made one of our main templates inoperant. We had to rebuild it,” De Jesus said.
Challenging errors in documentation
De Jesus found the support offering lackluster. He later discovered newer customers had purchased extra support packages on an hourly basis. In addition, the product’s documentation was often frustrating. “It’s perfectly acceptable to buy extra support. But get the basics right. When you use the manual as reference, the syntax has to be perfect. Otherwise there is no amount of support that will make up for faulty fundamentals”.
De Jesus knew MCS had outgrown the plan management software solution they had relied on. He found what he was looking for Messagepoint Healthcare Touchpoint Exchange. “At first blush, the Messagepoint interface looked more intuitive. Friendlier.”
Designed to streamline the production of CMS mandated materials, Messagepoint Healthcare Touchpoint Exchange is a complete SaaS solution purpose-built for MAOs. Messagepoint’s integration to the CMS Plan Benefit Package (PBP) database ensures critical plan data is brought directly into the platform and a central content hub, and that plan submissions match plan documents. The solution also enables the MCS team to collaborate while configuring and updating documents efficiently in real time, without any redundant effort.
Collaboration with control
“Messagepoint breaks down these complex documents into modular chunks of content.” This was a major benefit for De Jesus. “You can have multiple people crawling through different parts of the document, solving different problems. It’s a more granular level of control and protection. One person can make a mistake in a message, we are all allowed mistakes. But no one person can break a template. The whole process is just so much more efficient.”
A single point of change for shared content
Messagepoint’s modularized content management approach enables common content to be stored and controlled as a shared content object called SmartText. This eliminates the redundancy of having to open multiple documents and make changes in multiple places to edit a benefit detail for example. By modularizing content rather than forcing a template-centric approach, Messagepoint allows changes to be pushed instantly across multiple materials and plans. “Messagepoint reuses pieces of content or code through our HMOs, HMO-POSs, and our duals,” says De Jesus. “You can change a shared content component once and it flows across the plan materials in 25 places.”
Audit trails that make it easy to see what happened
“The QA Module was so key for us. The detailed audit trail is priceless. We can see exactly who did what and when.” De Jesus and his team vastly preferred this approach to the previous process of email chains and one-off screen captures. “After using the QA Module, we found we were able to rapidly classify issues and apply the fixes to solve issues across the documents. Even our strictest reviewer has completely bought into the power of the capability. From a quality control perspective, it provides a great centralized way to track everything.”
Translation in real-time
De Jesus also found that the team’s approach to translation was able to change. “We used to have to complete the English version of the documents and then translate them. Because of Messagepoint’s modular approach to content management, we are now able to translate each piece of content in parallel, so there are no delays waiting for the Spanish versions of the documents to be complete. In our market, that is critically important.”
Automating large print and 508 compliance
Messagepoint automates the process of delivering large print and 508 compliant documents. According to De Jesus, “The team could not believe the system just automatically generated the documents, without issues or errors. We saved hundreds of person hours.”
Complete Support
De Jesus felt fully supported by the Messagepoint team of subject matter experts. The team not only offered training and assistance, they answered questions promptly, and provided suggestions for optimization. “The team at Messagepoint doesn’t just know the software, they really understand this market and these documents,” says De Jesus.
Messagepoint helped De Jesus and his team create documents to support a new plan offering for the sales team in a matter of minutes, knowing that all elements would be accurately transferred while still allowing for flexibility and customization. He also used the Plan Benefit Package tool to configure the employer groups.
Not only did Messagepoint allow MCS to create more plans, it also vastly reduced the risk of non-compliance from a regulatory standpoint, reducing the possibility that MCS would be saddled with fines or civil money penalties.
The team also found they were able to seamlessly navigate the unexpected model document changes released by CMS in the spring of 2022. “The modularity of the Messagepoint platform and the pre-built starting point both really helped to make the CMS changes a non-issue for us this year. Messagepoint did a lot of the pre-work for us and the rest was reusing functionality that we had implemented last year.”
De Jesus compared his previous platform to Messagepoint in terms of cars. “Sometimes you just need to get from point A to point B. But sometimes you’re traveling more difficult ground and you need a more powerful engine. You can leverage a more powerful tool and become more efficient. It gives our team a sense of security, knowing the power is there to scale our plans and the modular content management model ensures our benefit details are iron clad.”
Speed
Significantly reduced production time. “If you have a team of people who can work in parallel, you can really speed up the process.”
Reduce risk
Eliminated risk of costly errata, and the penalties imposed by missed deadlines.
Increasing efficiency
After the initial setup, incremental changes became instantaneous. Each year MCS became more efficient and spent less time on the production of these documents while sustaining a high level of quality in the finished product.
Increase plans
Seamless iteration meant plans could be created and customized in minutes, allowing for growth.
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For most MAOs, the annual materials preparation process has been largely manual, resulting in increased efforts and risk of error. Many have attempted to automate the process only to find significant lead-times, costs, complexity, and ultimately a different set of challenges.
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