Case Study: Implementation of a single source solution and management of process workflow for annual Medicare enrollment period.

The Health Plan

Major managed healthcare company in southeastern U.S.

With the addition of its new private fee-for-service (PFFS) plans and the expansion of marketing nationally, the insurer (client) projected an increase in lives from 40,000 to well over 400,000.

The Challenge

How to prepare client for tenfold membership growth and manage the production and distribution of Medicare-required materials simultaneously

  • Current print and fulfillment vendor was too small to control the increased volume.
  • Weak infrastructure and inadequate staff resources limited ability to successfully implement and manage a new vendor.
  • With only two staff members available for the production and management of membership marketing materials, resources were spread too thin to manage the increased volume.
  • Postage for membership kits was too costly.
  • Collateral materials lacked file names; no integrated file naming system existed.
  • No inventory management system existed.
  • Data transfer processes of TRR files were inefficient.
  • Unusually high volume of replacement member I.D. cards was being requested.

The Solution

Using our customized approach, multiple solutions were identified and implemented.

  • Conducted the RFI/RFP process for a single source vendor. Managed the vendor implementation and served as a liaison for the insurer.
  • Managed and supervised the production and distribution of annual mailings, pre- and postenrollment materials for the enrollment cycle.
  • Developed a file naming convention for all materials, which assisted in our development of kit matrices, I.T. grids, crosswalks and inventory management controls.
  • Evaluated and made recommendations for several departments including Marketing, Enrollment, Disenrollment, Operations and Member Services.
  • Recommended the redesign of interdepartmental process workflows to streamline the production and distribution of member-informing materials.
  • Identified internal errors and developed, implemented and documented new procedures to reduce the volume of requested replacement member I.D. cards.
  • Utilized alternate distribution methods for member mailings.
  • Redesigned collateral materials to greatly reduce mailing costs.

The Results

Measurable, continued success.

  • Implementation of the single source vendor was a success. The client continues to use the vendor and has expanded its relationship into additional programs.
  • Total program costs were reduced by 65%, resulting in a net savings of $250,000.
  • Through utilization of alternate distribution methods for new member kits, costs were reduced by 60%.
  • All member-informing materials were produced and distributed as required by CMS.
  • By implementing the inventory management control system, the client saved well over $100,000 in lost or misplaced inventory.
  • By implementing a new I.D. card file verification process, member card requests were reduced by 75%. This resulted in reduced Member Services calls, processing time for requests and mailing costs.