Health Plans Must Modernize Enrollment to Survive a Flood of New Members

By Aaron Fulner, Senior Director, Edifecs
Twitter: @edifecs

The COVID-19 pandemic has driven an incredible shift in the number of American lives covered by employer-sponsored health plans as unemployment creeps up to rates not seen since the Great Depression. With lost jobs comes lost health benefits, and many impacted Americans are evaluating the offerings available through state Medicaid programs and from the Federally-Facilitated Marketplace (FFM) or a state-based Exchange (SBE).

While state Medicaid programs are experiencing increased demand as they expedite coverage for eligible individuals, several of the nation’s leading plans are looking at the Affordable Care Act as a safety net amid a crashing economy.

For example, UnitedHealthcare announced it plans to rejoin Maryland’s Affordable Care Act marketplace for individual health plans in 2021 and is eyeing other expansions to capitalize on the enrollment of healthy members out of work due to the pandemic.

Many health plans are now focused on growing enrollment, but the strain and pressure an influx of new members can put on the back-end IT infrastructure can be debilitating. Health plans must prepare themselves for a flood of enrollment activities and ensure flexibility within their systems to handle special enrollment periods – like now when millions are searching for new options.

This unique time in our healthcare system is no time for a “business as usual” approach – that kind of thinking will not only burn a health plan’s IT team to the ground, but it can also leave a lasting negative first impression in the minds of new members already stressed and frustrated with not having a job and other aspects associated with unemployment.

Legacy enrollment IT systems sitting deep within health plans will crack under this pressure. They’re just not equipped to handle the rapid influx of member data resulting in costly errors during enrollment. What should be viewed as a long-term business strategy, any enrollment period should be a lever for competitive differentiation among plans. There is no doubt the challenges associated with member enrollment are plenty and exacerbated with antiquated technology. In addition to visibility issues, collaboration between enrollment partners and sources across a health plan, administrative and IT total cost of ownership can have severe impacts on the bottom line.

By implementing a standardized, automated, and modernized process to manage and retain critical enrollment information across multiple lines of business, plans have greater potential to expand member footprint and enter new markets. Modern end-to-end enrollment management lifecycle solutions are scalable and designed to address the needs of health plans today and in the future. IT teams can be relieved from sorting through siloed sources of member data. When member enrollment data is consolidated across partners and automated for improved visibility, both the health plan and the incoming member wins.

Low monthly premiums are attractive to health plan members, but just like any paid service, so is customer satisfaction. While the back-end IT infrastructure and enrollment pipes and workflows are hidden from members’ sight during enrollment, they still expect timely communication and issue resolution. The enrollment phase is the perfect opportunity to demonstrate the high-quality experience members can expect from their health plan, all powered through the enrollment platform. An expedited enrollment process, reduced enrollment file fall-out, the delivery of timely member information and ensuring quick access to care are all made feasible through enrollment platforms focused on operational efficiency and collaboration.

Is your health plan ready for the influx? Modern enrollment solutions are no longer “nice to haves.” Healthcare technology innovation is running rampant right now as technology leaders ensure healthcare consumers can get the care they need in the middle of a pandemic. Health plans should be no exception, it’s 2020 and it’s time for health plan enrollment practices to make the shift – break up with your legacy systems and modernize the process so that at a time when having access to medical attention is so critical, millions of new members can enroll quickly and be assured they selected the right insurance plan to care for them.