Becoming a trusted advisor for a new Provider-led planmer

Today, 13 percent of all US health systems offer health plans in one or more markets—Commercial, Medicare Advantage (MA) according to a recent McKinsey study on provider-led health plans.1 The study goes on to say that some of the risk involved with health systems deciding to enter the health insurance market is their operational readiness–what key areas do they need additional skills or capabilities: member acquisition, regulatory and compliance, utilization management?

This exact challenge was faced by a new Provide-led plan in the Southwest and the search for a communications provider with Medicare expertise began. As a two part Medicare provider this client was tasked with ensuring members receive program change documents such as ANOCs during the Center for Medicare and Medicaid Services (CMS) mandated time-frame, ending September 30th. The health plan quickly determined that they needed a better way to manage their complex document creation process and improve their member experience-all within CMS guidelines.

That is when RRD Healthcare Solutions answered their call. Our combination of 25 years of Medicare expertise, Managed care specific technology and diverse manufacturing platform made it clear that we could help guide them through their first season-ensuring compliance and all in-home dates were met.

The health plan ultimately ended up utilizing several elements of our Healthcare solution set:

The client delivered their first season of ANOCs compliant and on time- without any erratas. They are now preparing for their 3rd season and our relationship with them has expanded to their Medicare Pre-Sales Kits and collateral, Welcome Kits, ID Cards, Appeal and Denial program and billing statements.

In addition, RRD now supports their Commercial line of business to execute their: Welcome kits, ID Cards, Letter, billing statements and marketing materials. Our program for this client now spans three facilities-one specific to ID Cards, one for kitting and fulfillment and a third that specializes in SLA-driven letter execution.

The professional relationship and teamwork between RRD and the client remain strong and mutually beneficial–in many ways due to the work and support day in and day out from our Navigator on the account. Our Navigator is even included in the client’s on-going marketing meetings to add input and insight and recommend omni channel solutions.

By leveraging our Medicare expertise, open and transparent communication and the high level of customer service delivered by our Navigator, we were able to build trust with this client ultimately resulting in a successful working relationship and our position as a trusted advisor for this Provider-led plan new to the world of Medicare.

  1. Provider-led health plans: The next frontier—or the1990s all over again? McKinsey & Company May 2013

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