The process to create the initial Summary of Benefits and Coverage in 2012 was a technical eye opener for many health plan providers. With the new requirements, healthcare providers had to figure out how to access a wide range of plan information and present it accurately in a newly designed CMS template.

With a fully automated document process not yet in place, many healthcare payers met the new requirements with a workaround approach that often meant building SBCs manually through Excel spreadsheets or engaging third-party providers to create the SBCs using similar time-consuming and often expensive methods. While these methods met the compliance requirements of the market, they were prone to inefficiencies and potential inaccuracies. Another missed opportunity was the ability to leverage the potential for SBCs to serve as a marketing tool in the field.

On Dec. 22, 2014, the Departments of Health and Human Services, Labor and the Treasury issued regulations proposing changes to the SBC and Uniform Glossary requirements and CMS templates to make them more user-friendly. The proposed changes would take effect on or after Sept. 1, 2015. As a result, healthcare payers may have to once again approach these changes to the SBC templates with a workaround solution. It may be just the nudge needed to seek a more effective way to handle these (and future) SBC modifications.

A two-fold advantage

Without an automated approach to content management, healthcare payers seeking to comply with the SBC modifications will continue to face production hurdles. For example, a payer with between 15,000 and 18,000 SBCs may need to engage as many as 200 or more persons to assemble Excel worksheets, perform the necessary calculations and format the documents. Smaller payers with fewer SBCs will face a proportional burden. Additionally, those still using manual processes will experience a recurring struggle each month with the contractual requirement to provide new SBCs for renewals in a timely manner.

Automating the workflow for preparing SBCs certainly provides a long-term solution for these hurdles. However, focusing on automating SBCs for compliance purposes only overlooks the value that automation delivers to other areas of the business—specifically sales and marketing. Having the ability to make immediate and easy-to-implement changes to SBCs makes it possible to generate SBCs on demand for showing real time comparisons. For example, a sales representative in the field may want to change the co-pay or some other attribute of the company’s product and produce the SBC on the spot, placing it side-by-side with a competition's offerings. Having this capability will support sales efforts with the ability to deliver complete and easy “I need it now” information customers expect.

What to look for

Once a company makes the decision to improve internal document processes, a thorough evaluation of what needs to be part of the solution is next. Here are five key considerations to look for during a review:

Typically, critical data for SBCs and related materials reside in disparate parts of the organization. An effective automated, template-based content management approach requires technology that can identify source data, access this data easily, aggregate it and normalize it in a common data schema.

Ensuring the ability to set up a data-driven master SBC template that can be easily changed is essential to avoid cumbersome and expensive manual processes.

It is also important to have the capabilities for batch and on demand generation of SBCs to meet organizational requirements over the long term.

Another consideration is ease-of-use. Look for a content management system that allows even non-technical line of business users to manage SBC changes due to new government, legal or other required language modifications. Having this capability will avoid the time-consuming and costly process of calling upon the IT department or third-party provider to make changes, which may be as simple as adding a period or comma or changing the wording of a sentence.

The master template should also have a rich composition tool with the ability to accurately complete complex calculations and generate all required SBC tables.

If your document processes include these features, your business will not only have the capability to reduce the compliance burden and risk of non-compliance penalties, but will also be able to significantly enhance time-to-market and  provide the critical agility sales teams need to negotiate effectively on behalf of the organization.

Automating the production of SBCs delivers a return on investment that rests in the ability to proactively address the demands of today’s crowded, ever-evolving, information-based healthcare market on more than one front. The ideal strategy for any healthcare payer is to implement easy-to-use automated document processes that enable compliance now, but have the features and scalability to meet an organization's broader strategic goals when the time is right.