Partnership

Fulfillment as a Core Vendor — Why Finding the Right Partner is Critical to Healthcare Payer Success

Toni Bonde has spent her entire career working in healthcare. She was Chief Operating Officer and head of IT at multiple health plans, designed and implemented business and technology solutions during more than 5 years at Change Healthcare, and is now an industry consultant. In her 25+ year career, she has worked across the entire healthcare payer spectrum as a leader with plans and vendors. She has seen the industry from all angles, giving her a unique perspective, especially when it comes to the impact of fulfillment solutions.

“Core vendors — whether they be IT, accounting or fulfillment — are critical to the very survival of a health plan,” comments Bonde. “That’s why when you’re evaluating core vendors, you should think about how they will impact your overall business success.”

With some services, like IT, impact assessments are easy. Today, if a high-profile company’s server goes down, or it experiences a data breach, it’s headlines news, a public relations nightmare, and will surely be followed by multi-millions (billions) in litigation. But what about fulfillment? What happens when fulfillment goes wrong?

 “Quite a lot actually,” Bonde explains. “ Healthcare fulfillment vendors can potentially engage with virtually every aspect of a payer organization — claims, EOBs, welcome kits, utilization reviews. The impact a fulfillment vendor can have on a healthcare payer can extend across its entire operations."

When you have a problem or delay with a core vendor, it can lead to compliance issues almost immediately. From a regulatory standpoint, this makes core vendor relationships high profile and that’s why it's so important to find a true partner with committed people at all levels of the organization that you can reach out to in the event of a problem, who will resolve it now. Or ideally not have a problem in the first place. Being able to anticipate issues before they happen, having a stellar track record of up time and consistently meeting Service Level Agreements (SLAs), proving to clients that they proactively avoid problems, while being prepared to immediately and professionally address those few issues that do occur. Your fulfillment vendor should have API reporting and other tools to readily and authoritatively convey member correspondence traceability. These are all hallmarks of a world class, core fulfillment vendor.

“While the services your vendor provides are key, trust is what turns an average vendor into a partner,” continues Bonde. “Knowing that there is a person or persons you can call at any time, who will resolve your issues and put your mind at ease, is beyond value."

Some may wonder with all the risk involved with outsourcing, why do it at all?

“All personnel at all levels at health plans are swamped, busy, stressed and stretched to capacity,” Bonde explains. “To add anything else to the mix just doesn’t make sense. Stick to the knitting, is what I say. Do what you’re good at and find a trusted fulfillment vendor to provide its expertise in that critical area that they know best."

A well-managed fulfillment program will have a significant positive impact on everything from call center volume and member satisfaction to compliance, enrollment numbers and profitability.  

“Fulfillment is complex, time intensive and, for healthcare payers, very time sensitive, but it’s simply not a core competency of these companies. But it IS critical to their success, which is why it’s so important that they choose the right partner,” Bonde adds.

What’s her advice when choosing a fulfillment vendor? Choose a vendor who will do the work better than you would have in-house. Be sure to ask about the company’s uptime record, API and technology infrastructure, data integration experience and track record, if they’ve made any significant changes to its systems in the past year, and definitely check references. Also, if you’re planning to consolidate many services under one vendor, make sure it can perform them all equally well.

“The best fulfillment vendor you can hope for is the one you never have to think about or call because everyone is happy,” says Bonde. “If the materials are going out on time and the job is getting done correctly, you’ve got yourself a good fulfillment vendor. When you start to see a positive impact across all aspects of your operations —enrollment and member satisfaction are up, compliance issues, call center volume and costs are down — that’s when you know you have a truly great fulfillment partner."