Better Documents for Healthcare

By Christopher Nicholson Print this article Print

New software enables Humana to communicate more effectively with members by using colorful, highly personalized documents to present individual statements of benefits.

Humana, one of the nation’s largest publicly traded health benefits companies, provides coordinated health insurance to employer groups, government-sponsored plans and individuals. Each year, the company sends more than 20 million explanation of benefits statements (EOBs) to its members, but it learned that they found the forms difficult to understand. The Louisville, Ky.-based company resolved this problem by transforming the traditional EOB statement to a colorful, visually enhanced personalized document that helps members make informed decisions about how to best manage their benefits. Christopher Nicholson, Humana’s director of strategic communications, discusses how the company accomplished this.

Explanation of benefit statements have been Humana’s predominant form of communication with members to show the status of a benefits claim. Although an industry standard for 15 years, EOBs have traditionally been very bland, multipage black-and-white documents with large amounts of text and little, if any, graphics or white space to enhance readability. There was little or no personalized messaging, so members often found it hard to determine how to interpret the status of their health claims and whether any action was required.

We needed to ensure that our members felt confident managing their health care benefits, and our ongoing research continued to highlight the need to change this communication vehicle. Additionally, the increased popularity of
consumer-directed plans, coupled with the need for family health care budgeting and increased transparency in health insurance plan design, necessitated that health insurers find a more effective way to communicate with members.

We formed a team to transform the EOBs from point-in-time transactional documents to a consolidated summary-level communication that provides relevant and actionable guidance that is easier to read and understand. While the new design was well-received, we eventually discovered that we didn’t have the personalization technology we needed to produce the redesigned statement for the volume of members we serve.

Time for a change

Because we send out more than 40 million EOBs and statements each year, we needed a solution that would allow us to integrate multiple data sources with tools that make design and document composition more flexible. We also wanted to increase member satisfaction with the newly designed EOBs, so we sought a solution that supported highly
personalized output.

Early on, we realized that we needed to move away from several of the incompatible and inconsistent software tools we had been using for years because they did not offer the scalability, flexibility or personalization options we sought. To address these requirements, we chose Hewlett-Packard’s Exstream, which was broad enough to present customer documents and communications in a variety of ways, including print and Web. In addition, it was easy to integrate with Humana’s existing databases and corporate systems. 

Using the new solution, we began producing our redesigned EOB statement, SmartSummary. This highly personalized document combines carefully planned white space and full-color images with targeted messaging that helps our members make more informed decisions about how to manage their health care benefits.

To produce the SmartSummary, the HP Exstream software draws data from our member databases. It then incorporates colorful icons, images, tables, graphs, charts and other design elements to visually communicate information such as benefits usage, co-pay amounts, medical articles, health and wellness coupons, and suggestions on how to lower monthly spending. 

This article was originally published on 2010-08-17
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