Tango+ is Elixir's SaaS CCM platform that hosts super targeted solutions, we call "Apps," for our healthcare payer clients. Check out this presentation of the new world of CMS and ACA compliance. The SBC is no mean feat!

1. Tango
Quick
TourSBC Building
Application:
Tango+
Business Rules
& SBC Updates
Tango+
& SBCs

2. Tango
The Setting

3. Elixir designed certain Tango+ applications
especially for health plan organizations.
How did Elixir learn about what it is like to
work inside health plan document workflows?
The Elixir Professional Service team has been
analyzing document workflows inside some
of the largest health plan organizations in
North America for several years.
Tango
The Setting

4. The Crisis

5. Every year, during the
Medicare, Medicaid, and
Commercial enrollment periods,
plan renewals and updates were
increasing exponentially. These
new documents had to be delivered
quickly, and free from mistakes.
Tango
The Crisis
The Elixir team recognized
common regulatory and
compliance document
production challenges
for health plan carriers.

6. Tango
Struggle
& Stress

7. 24/7
The Elixir Team
witnessed the
struggle and
stress of health
plan payer
employees,
as they worked
through continuous
and growing
renewal cycles
and heavy enrollment
periods.
stressed out
employees

8. Tango
The Challenge

9. The first Culprit
TangoTango
Summary of
Benefits Coverage
template.
Elixir Heathcare
Welcome to
Elixir created real-time solutions for
document workflows by identifying
the issues behind the documents.
Our number one goal was clear:
automating SBC workflows.

10. The Size of the Problem
The passage of the Affordable
Care Act brought with it the dawn
of the SBC.
SBCs are complex
documents regulated to
communicate variable
combinations of plan
benefit information to
consumers.
Health plan carriers are required to
update SBCs for every plan
variation they offer. They must
have current SBCs for all their plans.
Plan carriers are also responsible for
delivering any SBC within seven
days of its being requested.
SBC updates must be done fast for
any and all changes in membership
status, including annual and periodic
renewals, and new enrollments.
Tango

11. The Cost of Compliance
Health plan carriers are
responsible for implementing all
regulatory and compliance
changes for their SBCs (as de-
creed by overseeing authorities)
with little notice.
Plan carriers must also
deliver updated SBCs to
any member who is
affected by an update or
change to one of their
plan benefits.
The cost of compliance can be
staggering, especially for large
organizations with tens of millions
of members.
Tango
The cost of compliance
is a burden, but the cost
of non-compliance can
quickly become
untenable.

12. The Cost of Failure
The Affordable Care Act clearly
placed compliance responsibility
on health plan carriers.
Failure to comply with SBC
regulations can result in monetary
fines, and other penalties.
The amount of a compliance viola-
tion fine varies is usually multiplied
by a factor of the total number of
members and/or plan versions that
include, or do not include, the con-
tent in question.
Tango
The cost of
compliance
is a burden.
The cost of
non-compliance
can quickly
become
untenable.

14. Existing Methodology
Many SBC workflows depend on
third-party vendors, especially
during enrollment and renewal
periods.
This approach put health plans at
the mercy of vendors to prioritize
SBC work and deliver SBCs in
compliance with regulating
authority deadlines.
Some health plan carriers opted to
produce their own SBCs. They
placed the SBC burden onto
established workflows and, in turn,
onto the heads of existing
employees, who had to deliver the
documents fast and error-free.
These organizations were quickly
overburdened during enrollment and
plan renewal periods.
The manual processes health plan
provider workflows depend on for
SBC production involve tedious
updates to individual xml
spreadsheets, for each plan they
offer.
Tango

15. Elixir knew there was a better way
to do SBCs. We knew that
workflow automation w
as the answer.
The automation of SBC processes
had to be easy for business users
to learn and do.
SBC updates and plan changes
meant that Elixir’s solution had to be
dextrous enough to apply one just
one change to a single field, one
time; and also capable of sweeping
changes across the board.
Tango+ applications had to provide
both surgical functionality, for mi-
cro-granular results, and the capaci-
ty to change course in real-time.
Tango+ had to be plastic, never
rigid, easy to use, and highly adapt-
able.
Tango

16. Want to experience the power of Tango+?
Click here to see more and get in touch.
Tango

17. Problem Solved
Tango+ is agile and
scalable. Tango+ custom
applications are keys that
unlock and focus the
raw power of its core.

18. SBC Applications
Elixir development teams exploited
the SaaS architecture of Tango+
to design integrated, configurable
applications for building custom-
ized templates.
Tango+ applications embrace
singularly complex challenges,
like automating SBC templates
and updates.
The complexity users encounter
applying updates and changes
with variable data and content is a
challenge that Tango+ applications
are designed
to meet head-on.
Meanwhile, business users experi-
ence simple, intuitive interactions
with Tango+, like clicking, and
dragging & dropping content or
business rules into preconfigured
hotspots.
Tango+ ease of use and powerful
core services facilitate workflow
automation. Users can quickly apply
changes to a single field, or even
create rules to effect changes
across multiple outputs.
Tango