CASE STUDY

UCare transforms Medicare enrollment processing with ikaSystems’ Medicare Advantage discrepancy and reconciliation solution.

In 2009, UCare, one of Minnesota’s largest health plans offering Medicare coverage, was weighed down by the volume and cost of its annual enrollment period. The plan struggled with accuracy and high administrative costs. The infrastructure required dual entry of enrollment applications, and the process was extremely labor-intensive and required hiring and training temporary employees—which increased significantly during the annual enrollment period. As membership expanded, the process did not scale, substantially increasing administrative costs.

UCare knew it needed to change its processes and cost structure to meet the opportunity for growth. The plan’s goals included the following: increase membership; increase productivity by at least 50%; gain efficiency by reducing the time to enroll members, the cost of maintaining the current enrollment population, overall discrepancies, and ROLs; and control enrollment processes more effectively to maintain and increase its Star rating for optimal Centers for Medicare & Medicaid Services (CMS) revenue.

Productivity soars

UCare accomplished these goals with ikaMedicareGateway, a comprehensive solution designed specifically for Medicare plans that provides workflow tools and automates all processes related to enrollment submissions, processing CMS response files, letter generation, and discrepancy identification. ikaMedicareGateway allowed UCare to instantly verify member eligibility, easily track submissions, provide a hassle-free application process, and significantly reduce AEP administrative costs. By the end of the 2011 annual enrollment period, UCare had substantially grown while reducing costs.

  • 102% increase in FTE-based enrollment productivity
  • 0 temporary employees hired in 2011 versus 11 in 2010
  • 56% decrease in discrepancies per month
  • 84% decrease in ROLs
  • 40% increase in enrollment
  • Reduction in FTE count for support for the annual enrollment period (October-April)

A better health plan

Said Beth Monsrud, senior vice president and chief financial officer at UCare, “Just two months after deploying ikaSystems’ solutions, we [had] already eliminated the need to bring on extra help, enabling us to significantly reduce administrative costs.” As UCare continues to grow, the plan will take with it the efficiencies created by ikaSystems solutions, resulting in higher profits and better service for its members.

About UCare

UCare is an independent, nonprofit health plan that provides coverage and services to more than 285,000 members in Minnesota and western Wisconsin. It services over 90,000 Medicare-eligible individuals through its Medicare health plans.