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How Major Healthcare Payers are Automating Open Enrollment

Advanced digital capabilities take the stress out of the busiest time of the year.

In our experience working with many of the nation’s largest healthcare payers, late summer and early fall are the most bustling times of the year as plans prepare for open enrollment and their partners like Conduent gear up too. One of the biggest challenges during open enrollment is simply the sheer volume of forms. In large commercial businesses, many of those forms are now completed electronically. However, for Medicare enrollments, the process is still largely done through handwritten forms sent via fax.

In 2019, 64 million people 65 years of age and over enrolled in the federal Medicare program. Of that population, approximately 78% (50 million!) people likely enrolled using a handwritten form. That’s a lot of paper to process.  

While the processing gets done each year and healthcare payers always get through the busy open enrollment period, we believe there is a tremendous opportunity to make the process more seamless, efficient and cost effective for health plans and the members they serve.

Managing volume — and the need for speed

The Centers for Medicaid and Medicare Services (CMS) have strict submission guidelines for processing enrollments each year and missing those deadlines can impact a payer’s CMS Star Ratings, which can result in lower reimbursement amounts down the road. That is one of the reasons why processing enrollment forms promptly is of enormous importance to payers.

Managing the sheer volume of enrollments quickly, efficiently and without errors requires sophisticated technology and an experienced workforce. Over the years, we’ve applied advanced technologies that have improved straight through processing (STP) by several percentage points. In fact, we’re now producing OCR rates in excess of 99% while achieving STP of 94% or higher typed and handwritten documents, and we continue to make enhancements to deliver maximum speed and accuracy for our clients.

Machine learning and AI have changed the game
There’s no doubt that today’s most innovative and transformative technologies have had a major impact on an organization’s ability to manage paper documents, but strategic and effective implementation is crucial.

By integrating cutting-edge machine learning, OCR, ICR and ADR capabilities into our document management automation platform, we’ve enabled unprecedented speed and accuracy in handling semi-structured and unstructured documents. This is critical during open enrollment as well as other times of year when document volume might be lower but quick processing is still desirable. In times of lower volume, the technology still proves a hero, ensuring the accuracy of document processing and creating opportunities for other business efficiencies and cost savings too.

Reducing open enrollment labor requirements and overall costs
While healthcare payers are constantly evaluating their operations to create efficiencies, open enrollment processing has historically been an area ripe for change. It has typically required a large uptick in temporary labor staffing to manage the open enrollment processing volume, and then significant labor reductions when the busy period ends. Conduent manages these cyclical staffing needs on behalf of our clients through our scalable staffing models — and the efficiencies we create are passed along to our customers.  

By bringing greater automation to the open enrollment process, organizations can decrease their labor requirements and spend while realizing a greater return on investment. In fact, one of the major healthcare payers we work with has seen overall processing times increase 15-fold (from 6 transactions per hour to 90!) during open enrollment. They also saw full-time staffing requirements decrease by more than 80% — which is good news all the time, but perhaps more significant at this time of pandemic when hiring resources to work in an office is more challenging.

Flexing to remote work
Speaking of onsite resources, there’s never been a better time to hire remote workers than right now. More and more businesses have quickly transitioned a large population of employees to work from home roles, and healthcare payers can take advantage of that opportunity when it comes to enrollment processing — as long as the right infrastructure and governance are in place.

For work-at-home to be effective, it’s important that STP rates are very high. For example, at Conduent we’ve always had STP rates above 90%, but with recent technology upgrades, we’ve increased STP accuracy even further so that we now require less than half the staffing (on average) to be physically onsite compared to two years ago. Having fewer people scanning and verifying enrollment documents has resulted in tremendous efficiencies, and has enabled us to hire more associates in work-at-home roles.

When automation and workflow technology is accessible from anywhere, the potential labor pool exponentially expands along with the available hours in the workday.

Want to learn more about the ways that document management and automation can drive your business forward? Visit our website and check out our eBook: How Automation is Powering
Agility in Document Management