Is SaaS an Imperative for Medicare Plan Organizations?

Medicare and Medicare Advantage plan carriers struggle to meet the rigorous compliance demands of CMS-regulated member communications.  SaaS content management solutions can clear plan payer workflow bottlenecks by enabling collaborative, yet centralized, content repositories (versus data and content silos), access-driven, role-based workflows, and superior version control and change management.  Legacy (AKA “mainframe”) solutions have become burdensome in each of these areas.  SaaS solutions are shaping up to be the cure.

A centralized data and content repository, or library, is optimal for generating highly regulated, Tier I documents.  Time wasted gathering data and resources means missed deadlines, penalties, and even the loss of market share.  When there is no “one source of truth,” document assembly necessitates cross-departmental, logistically collaborative, multi-pass process and workflows.  Tier II documents, like the SBC (Summary of Benefits and Coverage) and EOC (Evidence of Coverage), which are required for all healthcare plans, can be even more complex to produce, since plan data may be both formatted and stored disparately.

SaaS solutions help solve challenges for Medicare and Medicare Advantage payers when they include approval-based workflows.  Approval-based workflows are  instrumental for creating compliant communications, if they enable audit trails, reporting, and secure access throughout the lifecycle of document creation and delivery.  Such workflows can be customized to restrict access, so that only people with the right permission touch content and data elements.  Apt approval processes also shorten production time, so documents are delivered accurately and on time.

A third benefit that SaaS solutions bring to Medicare and Medicare Advantage plan payers is the ability to produce multiple versions of a document from a single template, so users do not have to maintain separate pages for every version of an EOC or SBC, for every plan they offer.

SaaS products tend to eliminate expensive and time-consuming on-premise installations, and have lower cost of entry, with all the benefits of a legacy solution without the expensive price.  The future of Medicare and Medicare Advantage communications seems destined for the cloud.

Written by
Maher Zaidi 

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