‘Tis the Season … for Term Letters in Healthcare

Nothing says “happy holidays” like a year-end coverage termination notice. It’s particularly awkward this time of year, because it overlaps open enrollment for commercial, Medicare Advantage and Exchange members. In this column, we’ll look at five seasonal drivers within healthcare, and how marketers can prepare for term letters, open enrollment and more.

Nothing says “happy holidays” like a year-end termination notice. It’s not unusual for healthcare organizations engaged in contract negotiations to send term letters to patients in mid-November. The notices fulfill contractual and regulatory obligations to provide advance notice to patients while also ratcheting up the pressure to reach agreement before a January 1 effective date.

This would cause headaches for marketing and communication professionals under the best of circumstances, but it’s particularly awkward this time of year because it overlaps open enrollment for commercial, Medicare Advantage and Exchange members. This is just one of the external factors that creates seasonality in healthcare communications.

In this column, we’ll look at five seasonal drivers within healthcare and how marketers can prepare.

1. Termination Letters

Term letters are usually sent 45 days in advance of a contract’s renewal or end-date. While these can occur at any time, a common scenario is a termination letter sent by a health plan about six weeks before the end of a calendar year. The letter goes to patients of physicians/medical groups or hospitals covered under the contract in question.

In some cases, you may not know the term letters have gone out until you begin to receive frantic calls from patients wondering if scheduled appointments or procedures will be covered. This puts you in a terribly reactive situation.

Proactively, marketers should schedule quarterly meetings with their organization’s contracting department to discuss commercial, exchange and governmental agreements that are coming up for renewal. Your contracting team is likely to focus on the financial framework of the agreement, while your concern should be on how to manage the fear and uncertainty a potential disruption has on individual patients.

Coordination with your customer service team, as well as impacted physician practices, are also critical because they will be on the front line of inquiries. You will need to understand your state’s Continuity of Care guidelines, the terminating plan’s grace period (if any), and work cross functionally to help guide patients to in-network facilities or providers if the agreement ends.

This is a labor-intensive, detail-oriented process because of the number of potentially impacted people, and emotionally draining for the patient’s family. Communicate your awareness of the situation, provide updates often and be prepared for significant push-back and one-on-one problem solving.

2. Open Enrollment

Although open enrollment for major employers, general business, Medicare/Medicare Advantage and Exchange business differ, the main season occurs in the fall and early winter. Some organizations invest all their awareness efforts during this time, when in fact this is when you should be converting prospects based on the awareness, goodwill and brand desirability you’ve cultivated all year long.

The foundation for a successful open enrollment season is based, in part, on decisions made by upstream parties during the spring and summer. As 2018 approaches, be sure to build in strategies to reach large employers, brokers, physicians and health plans.