Welcome to the first installment of our blog series, Open Enrollment Readiness: Expert Insights from HealthAxis. This series is designed to provide health plans with valuable real-world insights and practical advice as they prepare for the critical open enrollment period. Our thought leaders at HealthAxis will share their expertise on key areas that can make or break your open enrollment success.
In this edition, we’re featuring Milonda Mitchell, HealthAxis’ Compliance Officer. With 15 years of rich experience in healthcare compliance and regulatory affairs, Milonda’s career is distinguished by her ability to cultivate meaningful relationships with stakeholders and lead significant compliance projects across the healthcare industry, both domestically and internationally.
How can evolving healthcare regulations and increased scrutiny impact a health plan’s compliance and member experience during open enrollment?
Regulations, such as the calendar year 2025 Technical Changes, Medicare Prescription Payment Program, and Interoperability Rules, and changes to the Affordable Care Act, can significantly impact a health plan’s ability to maintain compliance and deliver a seamless member experience during open enrollment. These regulations introduce new requirements for member communication, data reporting, and privacy protections. Misinterpretations or non-compliance can lead to an increase in member/provider complaints and increases in Complaint Tracking Module (CTM), which in the long run can cause financial penalties and reputational damage.
To effectively manage these regulatory challenges, health plans must invest in robust compliance infrastructures, including advanced technology and strategic support. A proactive approach includes regular audits, employee training, and a streamlined process for communicating regulatory updates to impacted stakeholders in a timely manner. This is essential for maintaining compliance and delivering exceptional member experiences during open enrollment.
What processes have you implemented to ensure that regulatory requirements are effectively communicated to both internal and external stakeholders, considering the unique systems of each health plan?
Each health plan’s processes and systems are tailored to their specific needs, but this uniqueness can also hide compliance gaps. For instance, discrepancies in how data is handled across different departments can lead to errors in member enrollment records, claims data, and inaccurate regulatory report submissions. These gaps can result in penalties if discovered during audits and cause frustration for members experiencing issues with their enrollment.
Therefore, it is vital for Compliance Departments to have streamlined processes for communicating information to impacted departments and clients. For example, HealthAxis’ Compliance and Ethics (HXG C&E) team reviews regulatory communications (HPMS memos, MLNS, Proposed and Final Rules) on a daily basis and completes Regulatory Impact Analyses to summarize the requirements, identify impacted departments and determine actions needed to implement the requirement timely. These analyses are reviewed bi-weekly during our Bi-Weekly Regulatory Update meeting to ensure impacted departments understand the requirement(s) and collaborate with the appropriate departments to operationalize the requirement(s) timely.
To ensure effective communication with our clients, HXG C&E sends out a monthly bundle of Regulatory Impact Analyses to inform clients that we know the requirements and are taking the appropriate actions to make the changes. This communication fosters transparency and helps clients consider how to collaborate with HXG and other vendors to meet the requirements.
Lastly, HXG C&E regularly conducts thorough compliance audits on the latest regulations to help identify and mitigate risk and ensure smoother and more accurate enrollment processes.
How can inefficient workflows during open enrollment create compliance risks and hinder a health plan’s ability to process member enrollments accurately and efficiently?
During open enrollment, the surge in workload can expose inefficiencies in workflows that might not be apparent during regular operations. Inefficient workflows, such as manual data entry or lack of integration between systems, can lead to delays and errors in processing enrollments. These issues can escalate into compliance risks if member data is not processed in a timely manner, leading to missed deadlines for regulatory submissions or incorrect member information.
Streamlining workflows by automating routine tasks and ensuring seamless integration between systems can significantly reduce these risks and enhance the accuracy and efficiency of enrollment processing.
Thank you for joining us in this first edition of Open Enrollment Readiness: Expert Insights from HealthAxis. Stay tuned for more expert advice in our upcoming posts, where we will continue to delve into the critical aspects of open enrollment preparation.
If you need immediate support or have questions about how HealthAxis can assist in your open enrollment readiness, connect with our experts today. We’re here to help ensure your success during this pivotal time.
