by Tina Opp, Michael Valitchka

The Essential Shift from Surviving to Thriving

Medicare’s Open Enrollment Period (OEP) is a hectic time of year for health insurers—and a pivotal opportunity to create value for members, employees, and the business. But too often, the hard work of preparing for and executing the OEP leaves little bandwidth for the innovation essential to efficient growth.

The challenge is to finesse core OEP operations to ensure a smooth enrollment period, while also building the capacity to innovate so that product and service differentiation isn’t stifled by an inability to execute. This parallel effort is essential at a time when health insurers must think beyond their core product offerings to compete and grow market share.

So, how do you make the shift from surviving to thriving?

Point B’s Perspective

The answer is rooted in strong fundamentals: having a clearly defined OEP operating model, minimizing process variability, and starting to assess and enhance operations early—long before open enrollment begins.

Think year-round and cross-functionally

A streamlined OEP begins with recognizing that the “season” never ends. The evaluate-and-improve phase needs to follow closely on the heels of the OEP. That’s the time to assess all aspects of the operating model and debrief against the key performance measures set at the start of the season. How did you do? What needs improvement? Evaluate and improve operations when the lessons learned are fresh, and new ideas are top of mind. Engage the day-to-day team executing core processes and managing OEP to optimize operations.

We encourage leadership to think about the OEP as one part of a continuous cycle, and to dedicate people, processes, technology, and governance accordingly. By investing in operational effectiveness across the OEP value stream, health insurers can provide the clear, consistent experience that makes it easy for consumers to choose to become or remain your customer. Operational readiness also reduces employee stress, that, when unchecked, can run very high in the second half of the year. It also eliminates non-value-adding work and increases the capacity to focus on innovation and other high-value differentiators.

This work involves a myriad of cross-functional interdependencies including marketing, operations, sales, product and network. Individual involvement may ebb and flow at various junctures in the annual cycle, but everyone needs to be aware of the big picture, accountable for their roles and responsibilities, and understand how their role and scope impacts the big picture. It helps to have a dedicated cadence with the arms-length stakeholders across the organization to plan for what’s essentially a prolonged “go-live” year after year.

Manage new initiatives separately and in coordination with OEP

It’s a given that every year will see regulatory changes, strategic tune-ups and product introductions that complicate OEP readiness. Minimize disruption by having clear operational models and action plans to manage these initiatives as unique workstreams but in conjunction with standard OEP operations. It’s critical to make this distinction; adding the extra burden to OEP management (with “new projects”) muddies the waters and adds significant variability to your repeatable critical path.

For example, health insurers are investing in digital solutions for new member-engagement channels. Success requires understanding the relationship among all digital initiatives and having a separate, dedicated action plan for how they’ll be used to engage with members during the OEP. This plan should cover impacts to marketing, regulated material distribution, and engagement with member groups. It should not however, interfere with execution of core OEP milestones and overall timelines, and should not be an expectation of the OEP team to manage.

Continuously improve, not recreate, year-over-year

Like everything you do, and we do, this work is a human enterprise. People are at the center of OEP success. The call to “optimize” OEP operations can feel overwhelming due to the many functions impacted and the depth of work involved. We recommend a continuous improvement mindset that views each season as an opportunity to refine and improve. 

Start by defining the “bookends” for each phase of OEP readiness with a clear view of the start and end points. Where will you invest time and money to improve your outcomes, and in what phases? How do these phases connect to adjacent processes in the lifecycle? If you invest in technology that your team isn’t trained to use or expect different inputs or outputs, or the technology won’t deliver the benefits of the investment to the full lifecycle, your teams will be frustrated, and your risk of rework will increase.

Define the critical path and elements that are high risk and define the standard operations. Consider regulatory impact, direct member impact, long lead-time SLAs and processing times. Identify key inputs and outputs along the way. Be sure everyone understands their roles and responsibilities. Provide opportunities for teams to ask questions and offer a mechanism to respond in a timely and consistent way.

The iterative spirit of continuous improvement keeps people engaged and invested in progressively better outcomes. It lets you harness the investments made and continue to shrink time required to plan, execute, and manage OEP, giving you time to improve on strategic outcomes, such as profitability and market share, with shorter, more effective cycles every year.

Mobilize playbooks to create repeatable OEP operations

An OEP playbook will collect dust unless it clearly articulates the baseline critical path along with all value-added activities and interdependencies. Putting it into action takes the right management team, right collaboration, and the right eye to the end results at stake—whether that’s product adoption, improved sales and marketing conversion or operational efficiencies. From there, it takes diligent deployment and adoption to make each year better than the last. Assign ownership to a leader accountable for maintaining and executing the standard operations and acting on the year-over-year progress.

A year-over year perspective informs the continuous improvements that drive progressively better outcomes and prevents rework. Our work with a multi-state insurer through two OEP seasons is a case in point. In season one, we managed readiness and operations—defining the critical path, establishing tactics and routines, and detailing cross-functional requirements. When the season closed, we created a guidebook along with tools and templates for managing OEP. In season two, we applied those tools and templates, condensing what had been multiple weeks of preparation work into only a few weeks. Our client is now equipped to keep streamlining their critical path, referencing prior year OEP evaluation and improvement lists as a starting point, which increases their capacity to innovate in ways that differentiate their brand and strengthen their market position.

The Bottom Line

Market leaders possess the desire to innovate while finding ways to create bandwidth for innovation to happen among the people closest to the daily operations, numbers and processes. If those people are bogged down fixing day-to-day problems because OEP operations aren’t running smoothly, they won’t have the mindshare to drive innovations that move the company forward. Make your OEP operations smooth, scalable and repeatable—and you’ll free up precious bandwidth to innovate your way to greater market share and profitability.