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Delivering the flexibility needed to compete

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  By Michael Charest,  October 8, 2013

Learn how comprehensive archival processes reduce risk, improve compliance efficiency and make customer communications management more effective.

It is no secret that U.S. healthcare provider and payer organizations face a number of significant and complex challenges as a result of healthcare reform, the ongoing transformation of health information technology (HIT) and the need for new business models to address the millions of new healthcare participants in a shifting market that is increasingly consumer driven.

For any insurance provider in today's fast-changing, rapidly consolidating market, having a market advantage means improving efficiency, reducing costs and getting products and information to market faster. In this highly competitive environment, effective communications play a key role in engaging stakeholders.

Staying in control

More and more, healthcare organizations are looking to increase their control and accountability over customer communications, such as explanation of benefits (EOBs) and medication therapy management services (MTMs). This is an effort to ensure compliance with a matrix of federal and state regulations and restrictions, privacy and security requirements, and auditing and reporting obligations in order to avoid costly penalties. With increasing regulatory scrutiny and the need to demonstrate responsiveness and transparency, finding ways to simplify communication workflows and reduce the risk of non-compliance have become mission-critical tasks.

One way healthcare organizations are looking to achieve the goals related to complying with regulatory mandates when it comes to customer communications is by keeping exact copies of communication documents in an archive. Many healthcare companies outsource the print function of their customer communications to a third-party print service provider (PSP). However, relying on the PSP to archive customer communications holds a number of risks. First and foremost, archiving is not the primary task for a print service provider, so there is the risk that it may not be accomplished with the diligence and accuracy needed for regulatory compliance. Additionally, responding to audit requests or a regulatory inquiry may be slowed by the fact that the healthcare organization is not in control of the archive and must rely on the responsiveness of an outside organization to obtain its data.

Keeping a carefully indexed digital archive of each communication in house – even though the actual printing and delivery may be outsourced – helps avoid these potential pitfalls. It also holds the potential to improve customer service, because call center representatives can immediately access relevant customer data exactly as the customer sees it on their statement or EOB. These considerations have led a number of healthcare organizations to bring the entire customer communication function back in house or, at the very least, keep the document archiving in house if they wish to continue working with a third-party print provider.

Benefits of integration

Organizations have experienced significant value in having a tight integration between in-house component content management (CCM) systems and an in-house archival solution. The benefits of integrating these functions in house include:

  • Having a robust and scalable CCM system provides a simple and cost-effective way to overcome potential infrastructure hurdles such as aging structured output systems, maintenance costs of templates and content, data silos and poor integration with underlying transaction and customer service systems.
  • An in-house CCM system supports the rapid movement to on-demand and interactive transactions and can improve the customer experience with variable, personalized messaging and multichannel delivery.
  • Leveraging the same CCM workflow process, exact copies of critical customer communications can be indexed and stored in the archival system and, when customer information is updated, the update can be recorded not only in the archive but also routed to update relevant underlying systems in the organization.
  • Tying call center correspondence, including voice recordings, into the CCM system will make it possible to capture and accurately store customer interactions and build out a complete customer experience history.
  • Having the entire CCM workflow behind the healthcare organization’s firewall enhances security.

The end game of integration

The ultimate goal would be to create a truly unified document management system that includes the creation of personalized, relevant customer communications, the capture of information and documents in real time and the automatic archiving of each document to reduce risk, ensure compliance and create a more efficient document workflow.

Moreover, a unified system can result in significant cost savings by reducing the labor and other costs associated with collating, indexing, storing and retrieving paper-based document files. It will also enhance compliance and control, because permissions can be established for viewing records, encryption can be assured for security, document history can be tracked and relevant documents can be easily identified and retrieved for review.

Taking this approach to managing customer communications will allow a healthcare organization to unify its document creation and archiving, while at the same time simplify its processes. Of course, for every healthcare organization, the true end game is the ability to better serve – and retain – the customer.

About the author

Michael Charest is the vice president of healthcare, financial services and insurance for GMC Software Technology, an award-winning provider of multichannel and highly personalized document outputs for customer communication management. For more information, please visit www.gmc.net.


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