Learn about the strategies BlueCross BlueShield NC uses to build positive relationships, goal alignment, and a problem-solving approach among the three departments.

The compliance, sales, and marketing departments each play a critical role in a health insurer’s member acquisition and retention. But the lack of overlap in common objectives among the departments can make it feel as though they are separate teams, causing conflict and adversarial relationships, according to Naomi Irvin, manager, divisional compliance-sales, marketing, & communications, BlueCross BlueShield of North Carolina, who presented at the session, Getting Compliance and Sales & Marketing on the Same Side, during RISE’s virtual AEP Medicare Readiness Summit 2020 earlier this month.

“Compliance is known as the group that says no,” she said. The good news is there are actionable strategies organizations can take to bridge the gap.

Objectives don’t always align

The objectives for compliance are very different than those of sales/marketing. For compliance, Irvin said, the focus is on three areas: prevention, detection, and corrective action.

  • Prevention includes well written policies, robust oversight, and training and education.
  • Detection concentrates on the ability to notice when something goes wrong and resolve the issue as quickly as possible using resources including a reporting hotline, monitoring and internal reporting, and non-intimidation.
  • Corrective action involves an investigation and remediation process alongside disciplinary policies.

Each feature is important for an effective compliance program, but sales and marketing typically have a different agenda, said Irvin.

Sales and marketing aim to:

  • Grow membership
  • Grow revenue
  • Enhance the prospect experience
  • Protect and build the brand
  • Prevent rework and manual processes

Despite the different aims of the departments, there are objectives they can share, noted Irvin. For example, the departments share the desire to do the right thing for the beneficiary, achieve company success, minimize risk, and maximize outcome.

Setting clear strategies to achieve the common goals can help align the departments in a problem-solving approach, she said.

Strategies for success

Irvin swears by four tactics to better align compliance and sales/marketing:

1. Document and track slow growth using data to build your business case for a growing team in need of an embedded compliance area. The data will validate the increase in work over a set period, which is key to funding and support, said Irvin. Be sure to communicate the value proven through the data and the team’s performance, she said. “If you don’t promote yourself, no one is.”

2. Clarify roles through a responsibility matrix to set clear expectations around who the right people are for different responsibilities and their specific rules of engagement.

A brief roadshow presentation is a great resource to open the lines of communication and share the outline of a compliance program, how you can help others, and steps others can take to help the process in return.

3. Provide purposeful communication on a regular basis. Weekly meetings, frequent performance feedback, and regular phone calls allow the opportunity to stay ahead of a problem rather than wait for something to go wrong. After an in-person meeting or phone call, a follow-up email is a great way to ensure all parties are on the same page.

4. Escalate a problem immediately to the appropriate person defined in the responsibility matrix. The ability to address the issue quickly in a solution-oriented and calm manner will demonstrate an effective compliance program. “The earlier you do this, the better,” said Irvin. “CMS looks for really prompt responses to something going sideways.”