The process to create the initial Summary of Benefits and Coverage in 2012 was a technical eye opener for many health plans; forced to figure out how to access a wide range of plan information and present it accurately in a new CMS template.
Already in its second version, the SBC will likely see ongoing changes from CMS however, the process to manage future versions can be much easier. Plans now have deep insight into their biggest workflow challenges and can use that as a roadmap for improving this next round, and the others that are bound to come.
Here are three areas that surfaced as bottlenecks in the SBC workflow:
Difficulties in Accessing and Associating Plan Data
When it comes to preparing data for the SBC, many organizations have two challenges – identifying source data and mapping the calculations to the SBC template fields. The sources needed for SBC calculations are typically contained in a variety of systems across the organization. As a result, it can be a challenge to identify the location or owner of the particular data required. Once the data is identified, there are business rules and calculations that must be applied before mapping it to the appropriate fields in the SBC template. Without a proper staging process, managing SBC data is at the least a difficult task in the short term – but can become nearly unmanageable in the long term. A flexible data model and a centralized data mapping system is essential to effectively prepare and manage SBC data as plans or CMS requirements change over time.
Word Processing Applications Inadequate
One of the greatest benefits of SBC communications is also one of the biggest challenges – data presentation consistency and accuracy. The SBC template is a standard information structure and the physical data layout is specific, including the number of pages and the type of information required on each one. When presenting SBC information, these formatting characteristics apply whether the plan is a simple one or has large amounts of data to be summarized. Many plans use word processing software but, because the application cannot dynamically format pages, they must manually design and organize the content for each SBC. A rules-based formatting process would accurately generate pages and eliminate manual layout and its associated risks.
High Degree of Manual Processes
Manual steps are the norm for many health plans as they assemble and format a wide range of plan details, pricing information, and CMS-provided content. There are numerous points where manual reviews and comparisons are required and at each point, both a bottleneck in the workflow and a chance for error.
Workflow automation can provide significant improvement for SBC generation for this year and once in place, allow plans to easily manage updates year over year.