Transforming Medicaid Managed Care Plan Member Communications

New York's Medicaid Managed Care Plans are required to offer the option of Electronic Noticing, Opening Doors to Multichannel Member Communications in the Government Sector.

Effective December 1st, 2022, the New York State Department of Health implemented critical new requirements for Medicaid Managed Care Plans regarding Enrollee Electronic Notifications. The mandate requires New York's Medicaid Managed Care Plans to notify members electronically of coverage determinations, complaints, grievances, service authorizations, adverse determinations, or appeal processes when these members have opted into these alternative methods of communications

Amidst the ever-changing landscape of the government space, the introduction of electronic noticing heralds a paradigm shift in Health Plan communication strategies. This holds the potential to not only streamline Health Plan operations but also position electronic noticing as a pivotal member benefit.

Envision the efficiency of sending all member documents electronically. The reduced cost of printing, mailing, and postage with a greater adherence to compliance requirements adds immediate value to a Health Plan organization. Imagine satisfied members with access to their health plan communications anytime, anywhere, and through their preferred channel.

The positive impact of electronic noticing extends across all areas of Health Plan operations. Reduced returned mail, fewer calls to member services, and additional touchpoints for communicating plan benefits and advice will enhance member engagement and satisfaction.

New York’s experience is setting the course as each state establishes its own approach to electronic noticing. While the task of developing an electronic communication platform may seem daunting, the benefits will grow exponentially each year. As the government space undergoes this monumental shift in member communications, electronic noticing will revolutionize Health Plan communication strategy, enhance efficiency, and elevate member satisfaction.

NAVIGATING CHALLENGES

New York Health Plans are facing technical and operational challenges as they implement the new electronic noticing requirements. Considering delegated vendor mailings, software integrations, and staff training, the multi-faceted challenges faced by Plans require careful planning across all areas of business. The experience of New York Health Plans to address these challenges is creating a prototype implementation model and approach, leading to a defined workflow and the development of industry-wide best practices.

CHARTING THE COURSE

Health Plans have various options available to satisfy the new electronic noticing requirement:

• UTILIZING EXISTING TOOLS: Many Health Plans already offer electronic noticing in a limited capacity. Members often have the option of accessing common items such as ID cards or plan materials through an existing online platform.
• HEALTH PLAN APP: It is now common for Health Plans to provide members access to their materials via an app. Adding authorizations and clinical determinations becomes an additional step.
• WEB-BASED PLATFORM: The most common approach is a web-based platform, centralizing all communications with members. This robust web-based platform determines which documents require electronic noticing based on member preference and generates an email, SMS, or fax directing members back to the platform. Typically, this platform resides on the Health Plan's website.

As per New York requirements, a comprehensive and effective electronic noticing solution must address the following:

• Delivery Preference: Capturing a member’s delivery preference can be accomplished through a dedicated mailing to current members or by including a letter with the Member’s ID card or welcome package.
• Electronic Delivery Methods: Email, SMS, or fax
• Approach for delegated vendor communication and integration (i.e. Single Sign-On and API Connectivity).
• Caretaker/Designee Access
• Management of undeliverable electronic communications
• Security (i.e. Multi-factor Authentication (MFA))
• Language Preferences
• 508 Accessibility and Alternative Formats

While New York is the first state to require electronic noticing as an option, as the population ages and technology becomes the preferred method of communication across all sectors, the expectation is that other states will soon implement similar electronic communication requirements. Proactive planning is the key to successful implementation, transforming a challenging requirement into a major benefit and market differentiator.

View Article on managedcarealliance.org