Silverlink In the News

These days it’s hard to get through a periodical without bumping into an article about the upcoming implementation of the federal government’s Medicare Part D. Mostly, the news is not good. Almost daily, articles paint a grim picture of the seemingly inevitable chaos on January 2, 2006, the effective date of the Part D benefit.

Talk to someone inside the managed care world right now and you’ll hear that things are frantic. There’s a universal sense of being far behind on the implementation plans that should be well underway now. This does not bode well for the CIO or health care IT executive whose systems will bear the brunt of the stress of the open enrollment period, which begins on Nov. 15, and is quietly being referred to as “Part D Day.” CIOs need to be prepared for the increased toll on their systems, starting on that day.

Why will information systems and call center applications be under so much stress? Because the concerns being voiced in the media and across the managed care world are in large part justified. The Part D program is complex, and it’s being offered to a segment of the population that consumes a disproportionate share of drugs. This segment is largely unfamiliar with modern managed care, and individuals rather than groups are enrolling. A large volume of questions during the enrollment period could overload current e-mail, call center and voice mail systems. Without significant improvements, current systems will not be able to scale up as quickly as needed. 

However, another approach - automated inbound and outbound communications - can ultimately reduce reactive measures. 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, Web sites, e-mail and inbound call-centers. These vehicles leave much to be desired in terms of access, efficacy and cost. With an enormous amount of information to convey about Medicare Part D, sponsors need to be concerned about too much information causing 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. But making live phone calls to 42 million beneficiaries isn’t cost-effective. 

So what can CIOs and health care IT managers do to help their organizations manage these challenges and develop successful programs? In large part, success will hinge on effective modification of existing business processes. As a CIO addressing business process issues, your job will be to alter processes that involve patient input -- namely enrollment, claims processing, disease management, patient self-management and financial products (HSAs) -- so that they meet the needs of the business managers accountable for Medicare Part D.

CIOs and health care IT managers should be aware that all of these business processes can be made more effective through proactive automated inbound and outbound communications. The most successful organizations are concentrating their efforts in seven key areas. I offer them here as advice to those still struggling with their Medicare Part D initiatives:

1. Get organized. Many groups in your organization will have to be involved in designing and implementing your program, so make certain you have centralized control and decision-making. Someone should be responsible for the end-to-end member experience.
2. Make the most of limited time. Few technology solutions can be spun up quickly and at the scale you may need. The right automated outbound call solution won’t require a hardware investment, a software installation or any custom programming. Don’t settle for one that does.
3. Leverage the work you’ve already done. Most health plans have made significant investments in CRM, data warehousing, and data analytics. The solutions you choose to help with Medicare Part D should integrate with those technologies so that you make the most of your member data.
4. Build inbound capacity. You need to plan for the Part D population to consume 2-3 times the call center resources as your commercial population. Leverage technology wherever possible.
5. Segment your population. The timelines and messaging is different for your existing members, dual-eligibles and new prospects. Each has unique subsidy qualifications. Don’t market to or try to manage them all the same way.
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 standby capacity.
7. 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.

Medicare Part D programs are a significant and positive step toward making health care more accessible and affordable. There will be significant financial benefits to millions of the qualifying population. Getting from here to there is in large part a matter of building effective communication strategies into existing business processes.  

Mr. Nowak is CEO and co-founder of Silverlink Communications. The company’s business is health care communications, offering automated voice solutions to health care organizations that need to reach out to patient and member populations.

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