The upcoming Annual Enrollment Period [1] (AEP) is between October 15 and December 7, 2020 and will be completely different from all the previous AEPs put together. The COVID-19 pandemic has brought unprecedented changes that no man or machine could have predicted.

There will be additional aspects in the AEP this time, unlike what would normally be included from the health plans. Under other circumstances, by now all tele-sales agents have been contacted and face-to-face classroom training would have been started. Key information about new plans, services areas extensions, change in plan benefit packages (PBPs), and training on social determinants of the health (SDoH) & CMS (Centers for Medicare & Medicaid Services) compliance requirements would have been shared. In parallel, the operations teams would have been performing deep-dive sessions with various disparate systems of health plans and reviewing the learning from the previous year’s AEP.

These activities may still happen with this AEP, but they would be done virtually and remotely.  While social distancing is critical in preventing COVID-19, this distancing is also posing critical challenges for health plans.

Member engagement – As we know, since agents/brokers are not going to have kitchen table meetings with beneficiaries, most of the discussion would happen over the phone or video calls. 

• The questions is, are Tele Sales agents trained enough to get the members to fill their application remotely? The need of the hour is a strong communication strategy.

Operations team – Health plans that have partially automated processes and depend on local processes and paper-based checks and balances will have challenges in performing end-to-end enrollment intake to CMS submission scenarios

• Since this will be a digital AEP, health plans must get ready to handle increased telephonic enrollments and also support using chat bots wherever possible. Implementing Bots Automation will drive efficiency and enable operations.

The convenience provided by the ‘AEP command center’ enabling team members to work closely will be missed

• From an infrastructure readiness requirement, remote working solutions along with video conferencing should be made ready

Surge in inbound calls – Since seniors are not going to have kitchen table meeting with agents, they will call the health plans. Health plans need to have adequate tele sales agents to handle this surge.  

• Ramping up team for short-term needs is not easy. Health plans should identify vendors who Hire, train and manage a steady-state Licensed Medicare Sales team covering US markets.

New CMS changes – Interoperability and Patient Access final rule (CMS-9115-F)

• Delivers on the administration's promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it.
• Payer impacted services include patient access API, provider directory API, payer to payer data exchange and increasing frequency of dual eligibility federal-state exchange.

Retaining existing customers through Social Determinant of Health (SDoH)

• Special supplemental benefits for critically ill plans (SSBCI) offering free transportation for non-medical needs, home-delivered meals, food, and produce
• Health plans should come up with personalized outreach program defined based on analytical model identifying vulnerable population. A model based on various parameters such as income, resources, age, zip code and chronic conditions is needed to perform such services.
• Medicare Advantage beneficiaries, being the most vulnerable population to COVID-19, are also impacted by it, both directly and indirectly. As health plans race towards adding new beneficiaries on their plans during AEP, a proactive outreach program to vulnerable population would enable health plans to retain their existing members.

The core of AEP preparedness will start from creating “AEP Command center”, which monitors all the 4 components – People, Process, Technology & Infrastructure. An impact analysis of Covid-19 on each of these components would enable Health plans to be well prepared for the upcoming AEP. Wipro hosted a webinar and discussed these 4 core components as part of  “Medicare AEP Growth and changes in the wake of COVID-19: How to overcome the Challenges!”.

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

Medicare Open Enrolment is also known as AEP.

Every year, Medicare’s open enrollment period is October 15 - December 7.

Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs