Reducing Churn: How to Win During Open Enrollment

Reducing Churn: How to Win During Open Enrollment

As we move into the middle of 2016, it is time for many individuals, healthcare providers and other healthcare related organizations to plan for the Open Enrollment period for Medicare and Medicaid benefits for 2017. While the Affordable Care Act has opened up the ability for individuals to be able to sign up for healthcare, the reality of churn for all parties involved with healthcare has translated into difficulties in determining reliable levels of coverage due to issues related to stable levels of coverage.

According to the National Institutes of Health, Medicaid and Medicare churning is defined as the constant exit and re-entry of beneficiaries into the healthcare system as eligibility changes. For both healthcare organizations and recipients, churning is a particularly problematic area at the state and federal level as individuals and states make determinations related to financial income for recipients, driving higher levels of administrative costs to help navigate coverage levels. Open Enrollment

As evidenced in the report from NCBI and NIH, the ongoing issues related to determination levels for coverage have shown that the ACA provided substantial federal funding to states to modernize the computer systems that determine Medicaid eligibility. This modernization was designed to increase efficiencies in eligibility determination, particularly by enabling verification of income with electronic data from other federal and state agencies. Moreover, eligibility will be renewed administratively (without enrollees needing to provide documentation) if enrollees’ Medicaid records match electronically with other agencies’ verification data that indicate continuing eligibility.

However, even with greater use of electronic data linkages, failed matches and data inconsistencies will sometimes trigger dis-enrollments of eligible people. Moreover, because monthly income changes frequently in lower-income households, states’ ability to electronically verify income every quarter will lead to churning unless states choose to develop mitigating procedures.

To help states be able to better handle the influx of information from Medicaid and Medicare, there have been several pilot projects at the state level that have been created to show how data and technology can be implemented to drive process improvement at the state level.

A case study conducted by the state of South Carolina and highlighted by the Kaiser Family Foundation showed how data and technology can be used to improve Medicaid processes and increase enrollment in certain situations. South Carolina initiated a data-driven decision making process to identify potential simplifications to its Medicaid enrollment process. This effort was in response to administrative and legislative directives to better utilize technology to reduce bureaucratic waste and improve customer service in Medicaid by eliminating unnecessary “hassle factors”.

Using data analysis, the state identified significant churn in its Medicaid program—each year, about 140,000 children were losing coverage, with 90,000 returning within the year, 60,000 of whom were returning within one month. This repeated movement into and out of coverage was creating burdens for families, administrative staff, and providers.

The data and technology program implemented by the state included an “express lane” renewal component to reduce churn. The result of the program that included express lane renewals and additional renewed coverage for about 80,000 children in just nine months. Another benefit of using data and technology was that South Carolina became one of seven states that earned performance bonuses in 2011 for the first time, earning $2.3 million of the $296.5 million awarded to a total of 23 states.

For PBMs, healthcare providers and other organizations related to healthcare, RxEOB offers a full spectrum of products that are designed to use data and technology to simply the entire healthcare management process. From member engagement and reporting to workflow/web service delivery, RxEOB can reduce churn and drive better outcomes for providers and patients.

RxEOB works with a number of healthcare organizations o lower overall healthcare costs and to drive better patient healthcare outcomes. To learn more about how RxEOB can assist your healthcare organization to reduce churn and manage your data and technology requirements, please contact us at 888-648-0989 ext. 226, or email us at info@rxeob.com.