How Health Plans can Manage Enrollment Systems During This Particular Enrollment Period with Aaron Fulner of Edifecs


In this episode, Briana Contreras of MHE spoke with Aaron Fulner, Senior Director of Edifecs, a global health IT company. The two had a conversation about open enrollment and how private and public insurance markets have been preparing or are now experiencing an influx of new enrollees due to approximately 12 million people losing access to employer coverage from job losses since February.

As healthcare enters another go-around of enrollment season this year, Aaron Fulner, Senior Director of Edifecs, a global health IT company, shares how this unique open enrollment, due to COVID-19, is affecting health plans and what these plans can do to manage their systems.

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Millions of Americans lost employer sponsored insurance or ASI due to the pandemic and many are now going to be turning either to Medicaid or to the federally facilitated marketplace - the ACA marketplace - for coverage.

"So when you combine a very unique of enrollment season, with some of the things we saw earlier in the year with special enrollment periods, it's really shaped up to make 2020 a unique year, for sure, from an enrollment standpoint," Fulner says.

From a health IT perspective, plans are facing many challenges as there are an influx of new enrollees due to millions of job losses.

Aaron Fulner

"What this does is that it constraints health plans and their ability to handle a large influx of new members easily," he says. "It also impedes their ability to execute on strategic initiatives, whether it's, you know, getting into a new line of business, maybe opening up a new state, again, if they're if they're our Medicaid plan. So when plans operate and continue to use, these types of systems are disjointed, very manual enrollment management systems, it really constraints them in many different ways."

To face these challenges, Fulner suggests tips health leaders should consider as they operate for future enrollments.

"Well, since we're so close to this open enrollment period, honestly, there's really not a lot that that they can do from an IT standpoint because we're talking about, you know, some some pretty big changes that would need to be made," he says. "What they need to do is they need to really just kind of come to the conclusion internally that this is our last year, dealing with outmoded enrollment management systems with all of our workarounds and all of our manual touch points and a lack of visibility and lack of automation. They just need to gravitate to that idea, latch onto it, because if they're not making changes, these changes that need to be made to their enrollment management systems; they can rest assure that their competitors are."

"So not only are they going to lose an area of competitive differentiation, but their costs are only going to continue to go up from an administrative cost standpoint. The systems, they're only going to get older, they are going to break more frequently, the manual touch points are going to increase. So, you know, the longer that they hold on to these to these old systems, the more costly it's going to end up being for them in the long run."

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