Challenges in implementing a Mobility solution in Medicare Advantage Plans

Healthcare poses challenges and never ceases to surprise with a new one.

Haven’t we all been faced with a new regulation in the IT product or services for our clients (plans or providers)?

HIPAA, CCHIT, Obamacare, HL7, DICOM, X12 formats, ICD9/10 are just a few of the regulatory compliances that rule the healthcare world. We know how important it is to implement new products without affecting the customer’s existing process. We also know that this has to be done adhering to the compliance standards set by Government. All health plans strive to improve their beneficiary’s experiences by introducing solutions which flawlessly handle their onboarding, workflow, business processes and compliance management.

Even in today’s digitally connected world, health plans still use paper and manual processes. This could be attributed to the age of their beneficiaries, who are always over the age of 65.

However, the value stream of member enrollment from an application to ID card still presents avenues for automation and new innovations. In such scenarios solutions built using mobile technologies stand out.

There are challenges in implementing mobility solutions for Medicare, especially Medicare Advantage Plan (Part C), a type of Medicare health plan offered by a private company that contracts with Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.

Challenges that need to be addressed before planning for a product for this niche market are as follow:

A Cloud based solution may not integrate with the health plan’s existing IDM & SSO
Risk of security violations for offline apps storing PII/PHI data
Highest possible encryption has to be ensured for data at rest and data in transit as well as for web services
Constraints in terms of storing Health Plan’s data outside of geographic location
Need to remotely erase data in case of offline mobile apps The business model has to have the ability to cater to high volume enrollments
Healthcare is one industry which still uses on premise hardware and works mostly on mainframes

In addition to the technical challenges mentioned above, people with a blend of domain, technology and knowledge of CMS (Center for Medicare & Medicaid Services) play a key role in designing and development of such solutions. Managing and retaining such highly skilled human resources also adds to the challenges.

Niche markets are always going to pose challenges. The question is - are you ready to transform these into opportunities?

To know more about Wipro’s Medicare portfolio, please visit https://www.wipro.com/en-BR/healthcare/medicare-advantage-360-platform/

Reference and note

https://www.medicare.gov/

As per Medicare.gov, in the Medicare advantage plan one can get Medicare benefits through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.

Who can join a Medicare Advantage Plan?

You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with end-stage renal disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan.

Annual Enrollment Period

https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html

About the Author

Santosh Gundurao Gurlahosur
Consultant, Medicare
With over 17 years of experience in Healthcare Information Technology, Santosh brings in unique blend of Domain, Technology and Delivery experience. He has managed and grown large customers and focuses on building products , end to end customer management and nurturing robust & efficient teams to manage complex Medicare advantage products for the senior market. Santosh is also AHIP certified.

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