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At the heart of UCare lies a simple yet powerful philosophy: always put the member first.

I had the privilege of co-presenting with Sheri Johnson, VP of Member Enrollment and Billing at UCare, at the AHIP Medicare Medicaid Duals and Commercial Markets Forum 2024. Thank you Sheri, for sharing the stage with me as we discussed the critical role of operational simplification in boosting member engagement.

Background on UCare

UCare is a regional health plan covering Minnesota and parts of Wisconsin, serving over 600,000 members with a range of healthcare products tailored to meet the varied needs of individuals across Medicare, Medicaid, and Individual and Family markets. As a People-Powered Health Plan, UCare is committed to making health coverage simpler, more accessible, and always going the extra mile for its members.

A key focus of our conversation was UCare’s strategic plan to not only sustain but also broaden its impact. There’s a concerted effort to extend these people-centered health plans to additional states, with an emphasis on promoting health coverage, enhancing access, and exceeding member expectations at every turn.

Focusing on operations in Minnesota, UCare supports On-Exchange enrollments through MNSure, Minnesota’s State-Based Exchange. UCare holds a 40% market share, with ambitious plans for future expansion both geographically and within the existing regions. Looking ahead, UCare aims to widen its reach into new markets and states, focusing on expanding individual market offerings.

Let’s delve deeper into the key insights from the session and explore how UCare is paving the way for the future of coverage management.

Top Challenges UCare Faced when Entering the Payer Business

What was really fun about doing this session with Sheri was we got to talk about challenges that were both unique to UCare and those we see consistently across payers of all shapes and sizes. A few of them:

    1. A Complex Member Experience: Members often faced difficulties navigating the health plan, leading to frustration and dissatisfaction.
    2. Inadequate Technology Support: The existing technology infrastructure and internal resources were ill-equipped to meet the dynamic needs of the Marketplace.
    3. Manual Processes: Time-consuming and manual processes were the norm, leading to operational delays and employee inefficiency.
    4. Daily Operational Hurdles: Each day began with the daunting task of reconciling systems and files, a clear indication of the need for better process design and automation.
    5. Increased Member Feedback: Frequent calls, complaints, and grievances from members highlighted areas needing immediate attention and improvement.

Sheri, reflecting on her initial days in the payer business, shares that she was hesitant vocalizing the challenges faced. However, after speaking with many peers in the industry, she learned at large most grappled with similar issues. She suggests the broader application of Marketplace best practices across other lines of business can simplify operations across the individual market.

These challenges are not exclusive to UCare but are instead a common thread among national, regional, and community health plans.

Expanding Accessibility and Streamlining Engagement

Sheri’s top takeaway for plans new or struggling in the individual market is to treat the experiences of members and employees as interconnected. You can’t have a great member experience if your employees are struggling. And you can’t have great employee experience if members are unhappy.

“A company cannot expect to deliver a tech-enabled, seamless, and intuitive CX, for example, if everything it does with employees is on paper, slow, and bureaucratic.”  – Harvard Business Review

What Our Employees Wanted

    • Confidence
    • Tools
    • Automation
    • Standard Work
    • Clear Expectations
    • Functional Systems

What Our Members Wanted

    • Confidence
    • Tools
    • Electronic Communication Options
    • Payment Options
    • Simplicity

Enhancing Operations through Strategic Partnerships

UCare was able to transform their operations by forming strategic technology partnerships. Here are some of the common pitfalls of Individual operations that health plans like UCare must overcome.

Lack of a Cohesive Member Journey:

Confusing enrollment and management processes causes members to leave out the back door. Health plans have seen success adopting a “no wrong door” policy that prioritizes a single experience across all Individual lines of business.  

Enrollment and Payment Friction:

Roadblocks to submitting premium payments can dramatically impact retention and effectuation rates. Offering payment options like Pay Now and autopay reduces manual work for both health plans and members.

Reactive Client Service Misses Systemic Issues:

A lack of data visibility and proactive member monitoring limits the support health plans can provide. Members often need support for issues beyond the health plan’s control, so it is important to overly support members to build a baseline level of trust.

Over-Automating, or Automating a Bad Process:

This pitfall is one we see across all shapes and sizes. Automating bad processes or over-automation are common across larger plans who have the IT expertise and capacity to build; the problem is this is often done in silos or without proper thought to the complexities that come with things like growth, regional expansion, or new technology partners.

How Softheon Helps Health Plans Improve Engagement

At the heart of our mission is the commitment to support organizations like UCare and other payers nationwide, including ACA, Medicare, Small Group, and ICHRA markets. By integrating advanced e-commerce capabilities, eligibility checks, enrollment processes, billing systems, payment methods, and reconciliation efforts, we aim to significantly optimize health plan workflows.

If you’re interested in discussing how we can help simplify operations to enhance the experience for both members and employees at your health plan, feel free to reach out to me at tcohen@softheon.com or connect with me on LinkedIn.