Preparing for Medicare Open Enrollment with Impactful Insights

A Medicare health insurer wanted insight into how members were reacting to the organization’s communication related to benefit changes during the open enrollment season. Specifically, they wanted to understand how members were reacting to changes indicated in the Annual Notice of Changes.   

Authenticx in Action  

Authenticx analyzed 26,000+ conversations with our AI-powered solution. From those conversations, 626 were sampled as calls that focused on the coverage changes during open enrollment. While negative sentiment was expected, the reason for negativity was different than anticipated.  

47% of calls contained member questions about upcoming benefit changes, despite the insurer’s proactive effort to share information. The most common emotion identified was confusion, not about the benefit changes, but about the documentation itself:  

• Callers were overwhelmed by the documentation and expressed uncertainty about how to maintain their status with the plan they were currently enrolled in  
• Callers misinterpreted what was missing from the Annual Notice of Changes as benefits they would no longer receive  
• Callers and agents had difficulty understanding what each other was referring to when discussing a ‘Letter of Correction to the Annual Notice of Changes’ 
• Callers were unaware that their prescription drug coverage bill would increase due to the Medicare Coverage Gap (a federal regulation that impacts out-of-pocket prescription expenses for members) 

Specifically, Authenticx focused on how agents responded to and educated callers on the coverage changes. They found inconsistencies in how agents were navigating caller inquiries and explaining the coverage options shared within the documentation.  

Results  

It was determined that members needed to be better prepared and equipped to understand how the documentation works. As a result:  

• Regulated documentation (Annual Notice of Changes, Evidence of Coverage, and Letter of Correction) was reviewed to see how the contents of the documents could be clarified and how the process for maintaining status could be clarified 
• Agent training was updated to help agents better clarify benefit changes noted with the documentation to assist and manage member expectations 

The health insurer team took recommendations for internal review, with a priority to map out a plan for the following year’s open enrollment communication strategy.  

Medicare coverage is heavily regulated with many different components that oftentimes lead to confusion and inconsistent messaging. Authenticx insights helped pinpoint tactical actions the health insurer could make to improve their communication strategy. If the health insurer didn’t utilize Authenticx to listen to conversations, then they wouldn’t have been able to drill down into specific reasons why callers were expressing negative sentiment and take action to improve the open enrollment process. 

As Medicare updates plans annually, stay informed of news regarding changes, alterations, and stoppage of coverage. To keep up-to-date, please refer to Centers for Medicare & Medicaid Services (CMS) for information. For reading more about the Annual Notice of Changes (ANOC), see this resource. For Part D plans, more news can be found here. To understand the key differences in plans, check out this resource.

About Authenticx

Authenticx was founded to analyze and activate customer interaction data at scale. Why? We wanted to reveal transformational opportunities in healthcare. We are on a mission to help humans understand humans. With a combined 100+ years of leadership experience in pharma, payer, and healthcare organizations, we know first-hand the challenges and opportunities that our clients face because we’ve been in your shoes.

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