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The ICM model

In a typical health plan, product development and the actuar- ies design the plan benefi ts. Product works with marketing com- munications/creative services to create the collateral materials for the government programs and commercial plans. The plan benefi t requirements are then vetted through internal compli- ance, moving clockwise around the wheel. IT, operations and customer service play a role in providing ancillary services such as data fi le feeds, website

Debbie Mabari is CEO of Cody Consulting.

For more on Cody Consulting: www.rsleads.com/112ht-206

content, formulary, pharmacy and provider directories. The most important part of the wheel is the member in the middle. The member’s experience is vital. Without a seamless ICM process workfl ow, the member’s experience will be signifi cantly impacted. Department staff will spend less time focusing on the experience and more time pointing fi ngers when deadlines are missed or timelines slip. AEP should be a wake-up call. With an integrated workfl ow process that provides robust reporting capabilities, C-level executives know where member materials are in the process and they can pinpoint their risk. Most payers dread AEP. People burn out and payers miss opportunities to maximize technology. Haste and waste create poor plan designs, delays in template

reviews and submissions, and an inability to reconcile member and provider data. I have watched plans use their ad agency to create evidence of coverage and annual notifi cation of change documents (ANOC) at agency rates. I have seen non-healthcare project-management tools force-fi tted only to be useless to the plan. Even great project-management tools are not designed to deal with health-plan rules and regulations.

I recommend employing a project-management system that encompasses the ICM model. There are fi ve critical questions execs need to ask consultants or software vendors about their solution before hiring/purchasing them:

1. Can the system adapt to the payer environment and link all of the key departments?

2. Can it interface with other critical software applications without signifi cant cost?

3. Is the system adaptable to the plan’s workfl ow with Medi- care, Medicaid and commercial plans?

4. Does the project-management system include templates and version tracking?

5. Is there a library for collateral management? Does it track versions so it can be used for internal and external audits? Make a post-AEP resolution now. Blast open your ICM roadblocks. Use technology to get your members and providers what they need when they need it.

HMT

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