The Simplicity of Complexity

Enrollment in D-SNPs continues to rise, and with the changes CMS announced in its 2023 Final Rule, plans have clearly focused on improving cost and quality of care for those eligible for both Medicare and Medicaid. But even with these improvements, 44% of Dual Eligibles switched plans for 2023, which creates burden for both the carrier and the member. According to this Deft study, members switched in search of better supplemental benefits to address social risk factors such as housing insecurity and homelessness, food insecurity, and lack of access to transportation. Why did they switch? What couldn’t their health plan do for them?

Let’s consider one of the strongest consumer experiences out there – Amazon. Amazon (the retailer versus all the other units) offers over 350 million products. It is incredibly complex. But purchasing products on Amazon is a daily activity for many people (the Prime truck comes to my house enough that it should have its own garage space). And consumers don’t typically switch from Amazon to another retailer. It’s the opposite – I’ve found myself finding a product and then going to Amazon to make the purchase. Why? Because we know it is going to be a seamless experience – with 1 click/swipe to buy, “free” 2-day delivery, and easy returns – based on their expertise in automating operations among other capabilities. Amazon has nearly mastered the consumer experience, creating a competitive advantage that many retailers, and other industries, struggle to mimic.

Health plans are clearly in a different business than Amazon, but the sheer complexity of serving members across all their needs is on a similar complexity level as Amazon’s operations. And like Amazon, success is going to hinge on the ability to make the complex simple to effectively serve the vulnerable populations. The entire premise behind creating D-SNP plans was to provide a more streamlined, stress-free experience to those members navigating both Medicare and Medicaid.

How can product managers create tweaked or wholly new benefit plans that the health plan operationalizes in a (nearly) automated way? Today’s software can support your health plan through a single source of truth, automation, and integration so you can conduct your business with fewer clicks, less manual interaction, and streamlined processes. Your product designs, bid creation, and filing can be streamlined. Regulatory documents can be generated compliantly with speed, accuracy, and less aggravation. By solving for your operational inefficiencies, you can turn your attention to ensuring you have tailored and personalized plans that take care of your older members and strategies to make understanding and utilizing the plans easy. Your members will be satisfied, giving you an advantage over your competitors.

To Amazon, the simplicity is the backbone behind its scale and profit. For health plans, it is fundamental to the mission to make healthcare affordable and accessible.