Less Is More

By Christopher Nicholson  |  Posted 2010-08-17

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. 

With a clear view of who paid what, members can easily see what they are responsible for and what their plans paid toward the medical expenses. The SmartSummary also displays a detailed explanation of how plans work, so members can see what they’ve spent toward their deductible—both in-network and out of network—and what they have paid out of pocket for medical and prescription claims. 

We can also use one of our flexible design templates to communicate with members across a variety of plans, whether individual or group. For members with families, the household view within the SmartSummary combines family data in one statement for the current period and year to date, allowing families to view spending totals (in-network and out of network) and cost details by family member. 

On average, a family of five that was previously receiving more than 139 pages of traditional EOB documentation annually now receives 39 pages of SmartSummary pages over the course of the year. Even though the EOB has nearly 70 percent fewer pages, it provides more usable information in a format that is easier for our members to understand. 

With the flexibility of this solution, we also developed the SmartSummary Rx, a monthly benefits statement summary tailored to Humana’s Medicare members. As a result, Humana became the only company that does not use the traditional black-and-white EOB for Medicare beneficiaries. The SmartSummary Rx provides Humana’s 4 million Medicare enrollees with a comprehensive record of prescription claims that includes helpful information, such as full-color pictures of pills, dosage, previous refill dates, and prescribing doctor and pharmacy information.

With these tools, Medicare enrollees can more effectively communicate with their doctors and pharmacists about medications to help avoid potential harmful drug interactions and also receive guidance about lower-cost medications that their plans cover. SmartSummary Rx also gives an enhanced level of control to each member by helping them track how much they’ve spent on prescription drugs, enabling them to budget for future health care and prescription spending.

Improved Member Satisfaction

By personalizing and automating the production of customized EOBs for our 4 million Medicare drug benefits members and our 1.1 million commercial members, we are able to communicate more effectively with them. Our initial research compared retention rates of members who received the newly designed statements to a control group of those who did not. Members who received the new statements were 14 percent more likely to say they would renew their Humana plan. They also reported that they were 7 percent more likely to recommend Humana.

We also tracked calls to a dedicated member-service phone number for inquiries about our new statements. For members receiving the SmartSummary, calls to that number lasted 390 seconds, on average. That’s 15 percent less than calls from members receiving the older EOB statements, which lasted an average of 420 seconds. Decreasing the demand on our support center is significant because Humana’s member-service department receives about 80,000 member-service calls per day.

We also are managing white space and blank pages better in order to deliver valuable and relevant content. We are able to combine communications into a single document when it makes sense to do so, cutting production costs by up to $250,000 per month. If a prescription drug comes off patent, rather than mail a separate notice, we can now include the notice in our SmartSummary Rx. By integrating these types of communication in our EOBs, we’ve saved several million dollars a year, primarily in postage costs.

Today, we continue to transition other document-production workflows to the HP Exstream environment, as our business success depends on how well we communicate with our members. In five years, our SmartSummary statements have allowed for an industry-transforming innovation that changes decades of bland document delivery with a communication that is personalized, more informative and highly relevant to our members.

Our brand promise is to provide guidance to our members when they need it most. By transforming the composition and information contained in the EOB, SmartSummary and SmartSummary Rx not only deliver on that promise, they also redefine how we communicate with customers who for years have been requesting more personalized and actionable communications guidance from us.

Christopher Nicholson, director of strategic communications for Humana, has a background in telecommunications, retail and health care. He has an MBA from the University of Louisville, Ky.