PAINS

   Low enrollment
   Broker management issues
   Low customer retention
   Inaccurate reporting
   Quoting and underwriting delays
   Marketing campaign issues
   Competitor tracking
   Low productivity
   Increasing claims costs
   Increased expenses
   Billing issues
   Profit losses
   Merger difficulties
   Multiple offices and branches
   Internal communications
   Excessive paperwork
   Decrease in service quality
   Other

PAIN DESCRIPTION:

No one knows more than health insurance executives about the need for healthcare without boundaries, while being at the crossroads of dataflow between employers, brokers, providers, and members. In addition, they must handle both administrative and clinical information from many disparate systems across large geographic regions.

The success of health insurers depends on how well you can manage and act on data flows to and from multiple sources to feed multiple processes: quoting and pricing, group enrollment and renewals, rate setting, marketing, claims payment, care management, prescription benefits, eligibility verification, clearinghouse transactions, and referral management. Paper is no longer a preferred medium for these processes.

A study by researchers at Harvard Medical School and Public Citizens found that health care bureaucracy last year cost the United States $399.4 billion. The study estimates that national health insurance could save at least $286 billion annually on paperwork alone.

PAIN ANALYSIS:

Not many Sales and Marketing reps at your Managed Care Organization are excited about all the paperwork they have to do on a daily basis. Navigating between numerous forms and applications can be very frustrating, even for experienced reps.

Only marketing materials include a wide range of aids used to communicate with beneficiaries before and after enrollment in a managed care plan. Pre-enrollment materials are essentially sales materials and include summaries of benefits, application forms, telemarketing scripts, and slide presentations. Post-enrollment materials, more commonly called member materials, include letters confirming enrollment or disenrollment, notices about a change in providers, benefits, or premiums, letters with claim information, lists of covered and non-covered services, co-payment schedules, and subscriber agreements.

The following documentation is necessary for enrolling a group: application, new case installation paperwork, and enrollment forms; some additional information may be also required. Enrollment can be completed as fast as one day. However, all paperwork, which must be done by an HMO, usually takes several weeks to process.

The benefits of a centralized sales and marketing system are enormous. Approximately 70 percent of healthcare transactions today are paper-based, resulting in administrative costs of up to 20 cents of each dollar spent. In the U.S. marketplace alone, the yearly cost of processing and administering claims is about $90 billion. The current practice of moving paper around and making telephone calls to track and confirm information, compares unfavorably with the seamless efficiency of the banking industry's automated teller machine (ATM) system. Some healthcare industry analysts believe administrative costs could be slashed to $5 billion or less by moving from a paper-based system to a coordinated and integrated digital system.

Saving $85 billion a year would be just one of the benefits to emerge if industry standards were used to unify healthcare's disparate systems. The HMOZ benefits span the field:

• Sales and Marketing reps have cut overall paperwork by 74 percent, gained at least 15 - 35 percent per day in productivity, and improved their performance by 120 minutes per day for every employee. This is helping the company streamline its own costs while providing better service to its clients.
• Providers and health insurers could proactively address the requirements of HIPAA and turn them into competitive advantages. The more paper your MCO uses, the harder it is to be HIPAA compliant.
• Clients served by Sales and Marketing specialists can obtain quotes and the status of their applications faster, as soon as the information is transmitted from the underwriting, instead of waiting weeks under the old systems.
• Eliminating paperwork cuts the cost of office supplies and paper storage. A simple calculation: 5 million pages of data, which is about 150 gigabytes (the size of one computer hard drive), could easily fill a high school gymnasium.
• A lot of the paperwork is mishandled or lost at the health plan. With HMOZ, you have fewer errors and data corruption, and no lost data. Sales and Marketing reps can focus on selling and not on data verification.
• Paper records are hard to search and navigate; they can be accessed by only one person at a time. HMOZ enables you to work in the team environment.
• Paperwork is one of the major factors that influence people to decide between HMOs and PPOs. No one likes paperwork. Clients are unhappy because they have to fill out many forms and applications; reps have to process them. Physicians refuse to do paperwork and drop HMO patients, and HMO specialist lists become smaller, which is not attractive when you sell plans.

• Paper documents preservation is costly. They have to be stored in an acid-free, humidity-controlled environment. Your paper documents need protection from a variety of elements which contribute to their deterioration, namely: light, heat, humidity, acids in papers, plastics, and adhesives, other objects, pollutants, and pests. No surprise, many Managed Care Organizations have mice in their buildings. Moreover, dust accumulated in paper files causes an unhealthy environment for employees. By reducing paper usage, you contribute to an ecologically healthier planet, save trees, prevent fire, and avoid papercuts.
  

ADVICE:

HMOZ replaces the paper-based system, slashing the time required to update client records, and increasing employee job satisfaction. Not only does it provides real-time access to the computerized customer record, reducing time spent on documentation and eliminating dependency on paper, HMOZ also enhances communication among managed care reps to help them quote, sell, and market more efficiently.

MCOs deploy HMOZ, concentrating on centralizing data from multiple legacy systems into a single repository for clients, brokers, competitor information, contacts, opportunities, and leads. Sales representatives have access to critical data for on-the-spot up-selling and cross-selling, a critical step for increasing customer satisfaction and revenue, while reducing paperwork.

One Demo is better than a thousand words, and one Solution Audit is better than a thousand demos. We encourage you to follow our CRM proverb and take advantage of this opportunity.

Click on one of the three links below to continue your HMOZ research.