#4: When in doubt…Communicate!

When I wrote the title for this Blog, my first thought was that it might be too broad to grab anyone’s attention. As I thought more about it and reflected on the best cultures and practices I have seen at TPAs, the word “Communicate” is central to everything a TPA does or should do. Take the following 10 question quiz and at the end, count up the number of questions where, on behalf of your TPA, you were able to answer affirmatively.

  1. In the past two years, have you updated your Service Agreement to make sure that it adequately reflects the services you are going to provide to your clients?

  2. Is that Service Agreement completely consistent with your standard proposal?

  3. Are you sure that every team member working with prospects and clients explains things consistently?

  4. In my last Blog, I spoke about Implementation. Over the last year, have you completely avoided implementation issues because you appropriately set client expectations and the hand-off from sales to operations was free of inconsistent information and well documented?

  5. In the past two years, has your volume of calls per participant gone down because of the quality of your written communications to those participants?

  6. Do you have a complete, concise and professional welcome kit or communications package for new clients and new covered participants?

  7. Over the past year, have you reviewed your EOB and EOP messages for clarity and accuracy?

  8. Has your organization implemented a successful approach to communicate everything line employees need to know about new procedures, new clients and changes to existing clients? Do you test their knowledge and retention?

  9. Have you set appropriate expectations with vendors/business partners on communication of emerging issues and have you avoided any issues “slipping through the cracks?”

  10. Do you provide a useful set of management reports that promote your value to your clients as well as guiding them with information-based interventions to control costs?

There are few TPAs, if any, who could answer “yes” to eight or more of the questions. One of the biggest reasons for this is the direct and indirect investment necessary. Communications, framed by the series of questions above, takes time and money. What TPAs must realize is that there is a significant return on investment available for taking every step possible to explain, document and make useful tools available.

Imagine if implementations of new clients and changes at renewal went flawlessly, with little re-work and satisfied clients and participants. Imagine if you could grow your book-of-business 10-20% without increasing staffing because you received less calls. Imagine if you could gain an additional 2-3% in fee increases because you communicated the value of your services more effectively with your management reports. The ROI for improved communications internally and with clients and covered participants can be significant. I estimate that PEPM revenue could be increased by $1.50 and operating expenses decreased by $2.00-$3.00 PEPM through improvements in communications.

So where is a good place to start improving communications? In the first Blog in this series, I discussed setting goals for the company, with a possible focus on developing a new product or a major quality improvement initiative. In the third Blog, I discussed improving implementation. Put these together and an interdepartmental focus on improving communication during implementation is a great place to start. At a minimum, include:

  • A Welcome Call from a TPA Senior Manager reiterating the commitment to the new client and soliciting feedback on the client’s interests and goals. Make sure the feedback from the call is distributed across the company;

  • Development and use of an extremely detailed New Client Implementation document, designed for comprehensive data gathering and identification of “uniqueness” not uncovered during the sales process. The Plan aspects of this document must become the central reference point for all Departments, including Plan Building, Enrollment, Claims and Customer Service;

  • Development of an interactive tool to schedule critical tasks in the implementation. This should be used to track responsibilities and measure the impact of failure to deliver. As a communications tool, bigger is not always better. Rather than a 4-10 Gantt Chart with pretty graphics, communicate the 10-15 things that will cause the implementation to breakdown if not completed as scheduled. Examples are enrollment files, sign off on benefits and participant communications materials and banking set-up;

  • An effort to update your Administrative Services Agreement, so clarity exists in the services you will provide and your dependence on the client fulfilling their obligations related to the Plan;

To some degree, linked to the implementation effort is enhancement of initial and ongoing communication with covered participants. Consideration should be given to the following initiatives:

  • Development of a Welcome Package, to include at least Helpful Hints for Your Health Benefits (with contact information and promotion of self-service tools) and information on wellness and other cost control programs;

  • An outbound Welcome Call where enhanced contact information like e-mail addresses and cell phone numbers can be gathered and higher level plan information provided;

  • Invest in your Web Portal and consider an App. As participants become savvier on the Internet and with social media, it is important to keep up. Present data they need in a useful format and look for links and tools that add value to the self-service experience;

  • Utilize simple YouTube videos to drive home important general information about your programs and services. Improvements in technology has driven the cost of these communications pieces lower and lower;

  • Maximize the functionality of your claims system as it relates to EOBs and EOPs and other correspondence. Use a “layperson” test including spouses and children who are not familiar with the industry to read your messages and letters to ensure they are concise and understandable. If there are system constraints that limit the ability to communicate effectively via an EOB or EOP, consider supplemental mail inserts. Remember, mailing cost is easily absorbed in the savings from reducing calls; and

  • Use reporting on call types and call issues to develop materials targeted at proactively reducing calls. These might address plan design issues, participant requirements or programs and services.

One final note with respect to communications is the need to use available management information to “tell a story” about the clients you are serving and the value you are providing to them. I can recall wonderful examples of TPAs that blew away clients with data-supported pictures of plan overutilization, abusively billing providers, inconsistent benefit incentives and poor provider management by networks. Client loyalty and respect is built through delivery of high quality analytics. I will talk more about effective management information in the final Blog in this series.


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