Medicare Part D: The Perfect Storm In Healthcare Communications?
Silverlink CEO Stan Nowak examines the confusion surrounding the new prescription drug benefit.
Talk to someone inside the managed care world right now, and things seem somewhat frantic about Medicare Part D. Those accountable for launching their companies' Part D programs say the task is daunting, CMS has issued few clear guidelines, and there is a universal sense of being far behind on the implementation plans that should be well underway now. The first day of the open enrollment period, November 15, is quietly being referred to as "Part D Day," and it is less than 80 working days from today!
Unfortunately, the concerns being voiced in the media and across the managed care world are in large part justified. There is significant confusion about the program, with many people believing that there is only a new benefit for the poor and few realizing that the new subsidized insurance products are actually intended for a much broader segment of the senior population. The legacy of the generally unsuccessful Medicare Drug Card program is contributing to this consumer skepticism and confusion. Furthermore, the Part D program is complex and being offered to a segment of the population that consumes a disproportionate share of drugs, is largely unfamiliar with modern managed care, and is enrolling as individuals rather than as groups. This combination of factors makes the Medicare Part D implementation a virtual perfect storm for healthcare communications.
What makes this benefit so complicated? To start with, program selection will be confusing. In each service area several plans may be competing for an individual's business. MA-PD (Medicare Advantage Prescription Drug) plans will offer a comprehensive plan including medical and drug benefits. PDPs (Prescription Drug Providers) will offer only the drug benefits. Plans from two PDPs in the same region will also differ from each other as well as from the MA-PDs in the area. At the same time, existing employer-sponsored plans and MA plan benefits will be changing in light of the new benefit.
Some industry experts believe the error rate on enrollment forms may approach 50 percent, indicating that the implementation process won't get easier once the marketing process is complete. Many of the seniors that will be eligible for the benefit have never experienced a managed drug benefit and even those recently retired may be unfamiliar with such recent innovations as tiered co-pays, prior authorizations, appeals, and step therapy. Benefits will vary based on income level and time of enrollment and will change based on the amount of drug spend within a year. These concepts are confusing for all of us but getting them in a crash course when you're 75 years old could be overwhelming.
All of this means effective communication at all stages of the program is critical. Critical -- but not easy.
The modes of communication for many sponsors are limited to mass media, mailings/literature, websites, email, and inbound call-centers. These vehicles leave much to be desired in terms of access, efficacy, and cost. There's an enormous amount of information to convey about Medicare Part D, and as is often true in healthcare, it isn't a lack of information but too much information that causes confusion. The trick is to provide prospect- or member-specific information at the right time and in a digestible form. Of the suite of communication vehicles traditionally available, only call centers (and now sophisticated automated calls) allow organizations to deliver the right amount of digestible information. Clearly making live phone calls to 43 million beneficiaries isn't cost effective.
So it really is understandable that the media is predicting mass confusion on the part of our senior population over this new benefit. Fortunately, it is possible for managed care organizations to manage these challenges and develop successful programs. It isn't inevitable that the "D" in Medicare Part D will end up representing "Disaster."
There is still time to take steps to improve the ability to manage these communications challenges. I offer the following seven things here as advice to those still struggling with their Med Part D initiatives:
1. Get organized - Many groups in your organization will have to be involved in designing and implementing your program, but make sure you have centralized control and decision making. Someone should be responsible for the end-to-end member experience.
2. Build inbound capacity - You need to plan for the Part D population to consume two to three times the call center resources as your commercial population. Leverage technology wherever possible.
3. Segment your population - The timelines and messaging is different for your existing MA members, dual-eligibles, and new prospects. Each has unique subsidy qualifications. Don't market to or try to manage them all the same way.
4. Focus on clarity - Confusion is the enemy so distill the message to what's necessary and clear. It may make sense to go the extra round with CMS if they are altering your message and reducing clarity in the approval cycle.
5. Expect the unexpected - Seniors will be bombarded with information (and misinformation) from all sources - government, interest groups, competitors, commentators- be prepared to address issues you don't control.
6. Arm yourself - You'll need a fulfillment house, call center assets, communication technology, and creative shops. All need to be teed up with rapid-response solutions and stand-by capacity.
7. Don't wait - there are 52 working days until enrollment starts, and even fewer working days until marketing to new members starts, and existing members are receiving information now.
Medicare Part D programs are a significant and positive step toward making healthcare more accessible and affordable. There will be significant financial benefits to millions of the qualifying population. Getting from here to there is simply a matter of communication. Hopefully, those charged with offering the benefit will design communication programs effective enough to ensure a positive outcome for their companies and the seniors they serve.
Stan Nowak is CEO and co-founder of Silverlink Communications, a leader in voice communications for healthcare insurers, PBMs, pharmacies and pharmaceutical companies.