Healthcare Payer SBCs: Compliance Is Not Your Only Goal

At first glance, how to approach proposed SBC changes may seem to be an additional challenge for a healthcare payer’s Compliance and IT departments. However, there is an upside for sales that should not be overlooked.

(Photo credit: National Weather Service/Robert Hammit.) 

Healthcare payers have grappled with significant compliance challenges when implementing the Summary of Benefits & Coverage (SBC) template required by the Centers for Medicare & Medicaid Services (CMS) since 2012. The latest proposed update to the SBC template (shortening the format from four double-sided pages to two and one half) has caused palpable stress inside healthcare plan organizations. While it is understandable that the pending compliance requirement might occupy the full attention of payers, there are benefits to approaching this change holistically—with a view not only to compliance but also to the implications of seeing this medium as an effective way to connect positively with customers.  Individuals shopping for coverage online on state health exchange sites will depend upon SBCs to compare and choose their plans. This fact makes the SBC more than a compliance requirement—in fact, it can suddenly become an important marketing and sales tool.

The initial 2012 SBC implementation was a conundrum for health plans. The goal of the SBC—to help consumers understand their coverage options—was largely lost in the focus by payers to comply. The size of some payer organizations, their lack of experience or collaboration between departments, as well as the existence of vast data silos were all impediments to successfully gathering cohesive plan data in a standardized format. Therefore, companies transferred the majority of plan data to spreadsheets and processed them manually, one plan at a time. Alternatively, some payers looked to third-party providers to create their SBCs. However, these providers often employed similar manual, time-consuming methods and payers ran the risk of losing control of the process.

With the new CMS update to the SBC template, healthcare payers have a formative decision to make: Either again default to workaround approaches or seek solutions for implementing a level of automation to handle these or future updates to their SBCs (and other compliance documents). Automating SBC processes will deliver a noticeable improvement over manual processes, ensuring efficiencies in the workflow required to produce compliance documents, like SBCs, in a timely and cost-effective manner.

Automating SBC processes delivers more than expected

While CMS compliance (and associated costs) loom large for Medicare carriers and most payers, compliance and related administrative efficiencies are not the only reason for forging ahead with a degree of automation—the potential benefits for marketing and sales efforts are equally compelling and deserve serious consideration.

It should not be overlooked that automated SBC production can significantly enable the efforts of a field sales staff and improve the flow of plan data and information throughout the sales process. It makes sense in our on-demand world to have the ability to access accurate and useful information that a sales person needs to engage customers. If a representative in the field wants to present the new SBC to prospective customer against a quoted plan through a Rating & Quoting system, an automated SBC process will make that available at a keystroke.

Having the ability to produce an SBC on the fly for a side-by-side comparison with the competition provide sales enablement that greatly enhances sales efforts—making it possible to differentiate an offering from the competition in real time, without risking the “cooling off” effect that can happen if documents need to be rerun and presented days or weeks later to the client.

More Efficient and Effective Customer Communications

Automating SBC production is just one example of how healthcare payers can streamline business processes to create more effective customer communications. Payers can also benefit from reducing reliance on IT intervention, off-the-cuff workarounds, and patchwork solutions. Automated processes will empower companies to not only reduce cumbersome processes and the compliance risk associated with them, but also make it possible to offer effective and responsive communications that maximize the sales team’s efficiency and lead to increased sales and customer retention.

Sohail Malik // Sohail Malik is Business Product Manager for Elixir Technologies. He is responsible for solution design and implementation for Elixir’s health insurer customers. Since joining Elixir in 2001, Malik has managed implementations for more than 40 plan insurers for applications that include ANOC, EOC, SBC, RxWrap, Formularies, Provider Directories and Welcome Kits.

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