In Light of COVID-19, Overcommunication is Necessary

Since COVID-19, otherwise known as coronavirus disease, surfaced in China at the end of last year, consumers have been bombarded with media coverage and corporate communications about the spread of the pandemic, the necessary precautions, the state of the global economy, and changes to operations, most of which has been less than positive.

In particular throughout this news cycle, the various health organizations, such as the Centers of Disease Control and Prevention (CDC) and World Health Organization (WHO), have continued to emphasize that older adults and people with preexisting conditions are at a higher risk for serious COVID-19 illness. Many of those people have Medicare.

Because of this, Medicare beneficiaries are understandably confused and scared. There is an unfortunate amount of false information being distributed, and every news organization has their “spin” on the coronavirus disease. How do they know what is real? Where can they go for reliable and accurate information? This uncertainty is compounded by being stuck in isolation, which can lead to or worsen depression. Medicare beneficiaries are extremely vulnerable right now, and they need a voice of reason, a source of truthful and factual information to calm their fears. As a health plan, you can be that voice.

What should be communicated to members?

Health plans have access to a wealth of knowledge about COVID-19 that can and should be shared with beneficiaries. If you haven’t already, you can be helping members understand:

  • What is coronavirus disease and the seriousness of the virus to the Medicare population 
  • The symptoms of the coronavirus
  • What to do if the beneficiary believes they have the virus
  • What actions to take to prevent the beneficiary from contracting the virus
  • How to stay healthy both physically and mentally
  • Any changes in benefits during this time, such as:
    • Telehealth Benefit: What is it and what can it be used for? Who should the beneficiary call for a telehealth visit? Are there copays when using the telehealth benefit?
    • Prescription Drug Benefits: Are there any changes to copays or refill amounts?
    • Access: What happens if someone is not at home and needs to see a doctor?

How should a health plan communicate to members?  

As important as the content of your message is, the method by which you deliver it is also important. Members need this critical information to exist in a place where they can easily access and understand it. Some suggestions include:

  • Your Website: Dedicate a section of your website/member website and/or build a landing page to address all of the communications topics listed above. Continue to fill those pages with daily content to update members. (For example, an FAQ section or Q&A from your medical director would be very meaningful.) This will help you become the source of truth.
  • Mail: Send a letter to all members explaining the expanded benefits granted by CMS, including any changes to current benefits for members, and then direct them to your website/landing page for the most up-to-date information.
  • Nurse Line: If not already done, consider adding plan-specific scripting for potential member questions. This can include the availability of after-hours support, the potential risks for contracting the virus, what members should do if they have a fever, where members can go for testing or if symptomatic, and prescription drug access.
  • Email: Email helps you communicate quickly and efficiently. Members should receive updates at least weekly during this time to reinforce that you are there for them, reiterate benefit changes, and share other critical updates. Always direct them to your website/landing page for the most up-to-date information.
  • Social Media: Facebook should be updated frequently with helpful lifestyle tips, such as how to get food delivered, senior hours at stores, and other information that might be beneficial. Use your most effective social media platforms to educate your members and nonmembers about the virus, as well as the expanded telehealth benefits available. Direct them to your website/landing page for the most up-to-date information.
  • Health Plan App: Use this as an additional channel for the latest facts and information, and direct members to your website/landing page for the most up-to-date information.
  • SEO: Optimize your website/landing page for search in order to bring members and nonmembers to your site. It’s important for truthful and factual information to be at the top of search results to drown out false claims and “spin.” Plus, you might also pick up a couple new members during the process!
  • Customer Service: Give your representatives the tools they need to be successful. They will be getting many calls and should have strong communication guidance to deal with the multitude of member questions. Consider a special task force of customer service members/clinical providers to be available to answer members’ complicated questions.
  • Public Relations: Seek out interview opportunities on the radio, TV and in print to help disseminate truthful and factual information to members and nonmembers alike.
  • Webinar: For a more creative approach, a webinar on coronavirus disease and how your health plan is working to support members allows you to get as close as possible to a “face-to-face” interaction while members are quarantined and staying in their homes.
  • Care Management: Conduct additional outreach to members who are the most vulnerable due to multiple comorbidities or high-risk illnesses such as heart disease, lung diseases and diabetes.

How often should a health plan communicate?

During this time, overcommunicating is actually a great idea. Adding web content daily is not too much. Sending weekly emails or emails as soon as you have significant information to share is not too much. Adding daily updates to Facebook is not too much, especially when Facebook content can be fun and informative (and many need a little fun right now). People want to know that their health plan is there to support them, and being in constant communication with helpful, truthful, and factual information is one way you can show that.

Who else should health plans be sending communications?

Members should be your highest priority, as they are the most vulnerable right now. But keep in mind the other audiences impacted by COVID-19 who also need to be hearing from you:

  • Providers: Providers need your full support in standing up a telehealth benefit and understanding how to properly bill it. Multiple methods and communications should be utilized to partner with providers on telehealth.
  • Brokers: In many situations, your brokers are your voice, and you want them to be educated on what is happening. Broker emails, portal communications, and webinars are all strong methods of communication to keep them informed and up to date on the latest developments. Plus, they should be made aware of how and when you are communicating to members.
  • Outreach Partners: Ensure State Health Insurance Assistance Programs (SHIP) and other organizations are aware of benefit changes and the lines of communications available to your members.
  • Caregivers: Many people are caring for their parents who have complex needs and are very vulnerable during this unprecedented time. Providing guidance on what they should do and how to monitor those in their care will help eliminate uncertainty and ensure both themselves and their loved ones remain safe and healthy.

Above All Else, Choose the Right Tone

Over the last several weeks, health plans have been wondering who, what, how, and how often in relation to their marketing and communications activities. Above all else, keep in mind the sensitivity of this conversation. Be clear, simple, and genuine. Do not condescend or demand. The right tone should be empathetic, understanding, and helpful, so that members feel less uncertain, confused, and scared.

If you still have questions on how to communicate with members and providers, consider attending our upcoming virtual open forum on Thursday, March 26th, where the healthcare experts at GHG and analytics leaders at Pareto Intelligence will answer all of your specific questions across a variety of topics, including Marketing, Star Ratings, Risk Adjustment, Compliance, Network Adequacy and Development, Telehealth and Analytics.

5 Key Takeaways for Product Leaders from the Advance Notice

The news is out and one thing is clear: CMS is proposing significant changes across all focus areas for Medicare Advantage (MA) plans in the 2021 Advance Notice and 2021/2022 Proposed Rule. On top of that, CMS has announced that there will be no draft or final call letter this year. Instead, items typically released in the call letter will be provided through a combination of rulemaking (in the case of policy) and HPMS memos providing process instructions and other guidance.

With bid submissions on the horizon, these announcements must be
top of mind for MA plans. Below are the key takeaways for product strategy
leaders to prepare for 2021:

  1. In 2021, Medicare beneficiaries with ESRD will be able to enroll in MA plans. Also, organ acquisition costs for kidney transplants will be excluded from MA benchmarks, except for PACE organizations. Plans will need to account for this in the development of 2021 bids. In addition, plans will need to change enrollment forms, enrollment scripts and other materials that reference ESRD eligibility for 2021.
  2. In 2021, MA Part D (MAPD) and Prescription Drug Plans (PDPs) will be able to offer a second tier for specialty drugs with lower beneficiary cost sharing. This change allows plans to negotiate better deals with manufacturers in exchange for placing their drugs on the preferred tier. Plans will need to work closely with their Pharmacy Benefit Managers (PBMs) to understand if this will be offered and the types of drugs that will be on the list. Plans who extend this to their members have the opportunity to utilize it as a retention opportunity for current membership, as well as a sales opportunity.
  3. Plans will have more flexibility to include telehealth providers in certain specialty areas (e.g., psychiatry, neurology, and cardiology) and will be allowed a 10% reduction in the number of beneficiaries required to meet time and distance standards. This is especially important for rural areas. Plans that were not able to enter counties because of network issues in the past may want to revisit this for 2021.
  4. CMS is clarifying and codifying its previous guidance on supplemental benefits. For Special Supplemental Benefits for the Chronically Ill (SSBCI), there is a minor clarification to expand the chronic conditions for which SSBCI may be offered. Hopefully, CMS will release this guidance soon.
  5. CMS is not a fan of D-SNP look alike for many reasons. For plans where either the bid or actual enrollment exceeds 80% of members entitled to medical assistance, CMS proposes to not enter or non-renew the plan’s contract. (Where threshold exceeds 80%, members could be transitioned to a D-SNP offered by the organization.) If you don’t currently have a D-SNP, this could be a loss of membership. Plans who compete against these D-SNP look alike plans may see an increase in membership this year.

With the February enrollment data officially released, look out for another article next week on the results of the Annual Enrollment Period (AEP). And, join us on March 4th for an exclusive webinar on the Supplemental Benefits Trends to Address in 2021. In that webinar, Diane Hollie will highlight what we are seeing in the market that may influence your benefit and product decisions for 2021. Click here to register.

If you need help navigating the product and benefit design
implications of CMS’ recently released policies, contact Diane Hollie at

The OEP Is Almost Upon US! Are YOU Ready?

January 1, 2020,
Medicare Advantage (MA) enrollees have a one-time opportunity to switch their
plan, similar to a grace period, and the opportunity ends March 31. Both new MA
enrollees and existing enrollees have the ability to switch plans. This is a
chance for MA plans to win and lose enrollment! To make sure you are not on the
losing enrollment side, here are a few ideas in which to invest resources and
budget before the upcoming Open Enrollment Period (OEP). Per the Deft research
2019 OEP study, “Almost 75% of the OEP
switchers had also switched during AEP!”
GHG expects to see more movement during OEP this year as Medicare
beneficiaries are more aware of the opportunity.

Services and Member Communications Need to Be the Stars of OEP!

Member communication
interactions (either verbal, written, or in person) could either break or win
you the OEP. You still have time to review your welcome interactions with both
new and existing members to ensure they are best in class. You may want to have
member events this year so new and existing members understand the 2020
benefits – and if you have great news for them, you want to make sure they hear

The goal is to ensure
every new member knows what to do January 1 and to have multiple touches that
educate, welcome, and engage members about their new MA plan. The earlier you
start this process, the better. You do not want buyer’s remorse occurring at
any point from the sale through the end of OEP. Existing members need to be
educated about any changes in benefits, and if your data is talking to you, you
will have a list of members who need “real” hands-on member service touch points.

Basic awareness of
online portals and any mobile apps offered by the plan also correlate strongly
to plan loyalty. Loyal members are more likely to participate in plan wellness
programs, which can help with cost containment and utilization.

In addition, when was the last time you really looked at
the communications going to your members?

  • Are
    you communicating too much or not enough?
  • Do
    the communications have the same tone and messaging throughout? Or are they
    just recycled from year to year?
  • Has
    the Member Services team received training lately to make sure they are
    reinforcing the tone and messaging you want your members to hear and feel?
  • Do
    they know the 2020 benefits and what benefits to make sure members know about?
  • Do
    you listen to Member Services calls to ensure you are providing the member
    experience you portray in your advertising and communications?
  • Do
    you take member feedback into account in designing member materials?

Usefulness of member
materials in regards to understanding coverage and benefits is strongly
associated with loyalty. Now is the time to reassess how you are communicating
with your members and make certain you are maximizing your opportunity.

Cannot Be Forgotten

Health plans are unable to market the OEP opportunity but
do have the ability to market the following:

  • Branding
  • New
    to Medicare
  • Education

Although you may not
have much of a budget for marketing during the first quarter, you can utilize
it effectively. Make sure you are advertising in January and the last few weeks
of March. If you have educational events, advertising them digitally or though
radio will help bring additional awareness to what your organization does for
its members. Most plans have a very robust “New to Medicare” budget already, but
you may want to invest in some freestanding inserts in January or March, amp up
your digital advertising, and/or advertise on TV. Utilize branding during this
time since it puts your name in the market during the OEP. Whatever you have
the resources to do, make sure you are strategic in your efforts to make it

It Is
Not All About Winning Enrollment

At Gorman Health Group, we are hearing many clients talk about gaining enrollment during the OEP but not so much about the possibility of losing membership. Your goal should be to ensure you have everything in place for this OEP to make certain you are on the winning side of OEP and are not giving up your membership to another MA plan that made sure they strategically invested in this opportunity!

For more information about the OEP opportunity and ways you can set up your team for success, contact us at or

Three Ways to Retain Your Members for 2020

It’s the Annual Election Period (AEP) and now
is a really difficult time to turn your thoughts away from what’s right in
front of you, but a strong retention program can be the difference between
achieving your enrollment goals or missing them.  Member retention is key to long-term
success.  Net growth does not happen with
new sales alone, but with a careful balance between new sales and the retention
of members once they have enrolled.  The
following are three recommendations to help you think through opportunities for
your retention plan.

  • Onboarding new members and developing a year-long engagement strategy is crucial today. Per the Deft research 2019 (Open Enrollment Period) OEP study “Almost 75% of the OEP switchers had also switched during AEP!”  And GHG expects to see more movement during OEP this year as Medicare beneficiaries are more aware of the opportunity.  Developing a structured onboarding strategy that begins with the agent (whether it is a sales agent or telephone representative) is important.  In addition, developing a Welcome package and Welcome calls that occur well before the new member is accessing benefits is important.  During these communications, you need to capture how each member wants to be communicated with going forward to find the best way to interact on a one-to-one basis. 

Today there are multiple benefits (all with different rules and access points) that are offered by vendors and not the health plan which can cause confusion. This doesn’t include the plan rules, provider issues, and the complexity of some of the pharmacy benefits offered today.  Developing a year-long multi-channel education strategy for new members is key to engagement.  This strategy should be more heavily weighted to the first three months during the OEP.


  • Many times GHG asks the question “How do you educate members about new benefits, especially new additions to the Plan or decreases in premium and copays?”  In most cases the response is the Annual Notice of Change (ANOC).  GHG considers this a government document not a member communication.  While there is advertising to increase membership, many times the effort is not made to let members know what you are doing for them.  Communicating to your members about what you do right and the improvements you are making to benefits, premiums, providers, and even better operational improvements can help the member to ignore the AEP or be persuaded by agents or the advertising in the marketplace.  Many times this can be done by a variety of touch points such as outbound phone calls, newsletters, emails, your website, member meetings, or digitally to make sure the member has reinforcement in a variety of different communication channels.
  • Developing a specific retention strategy to target those most likely to leave.  Typically, we know those who are in a Medicare Advantage (MA) plan less than three years and members with the little to no utilization or engagement are most likely to leave, but does that hold up for your MA plan?  Profiling members most likely to leave and investing in a retention strategy to engage these members will more than pay for itself.  Also, it is important to measure this and understand what the potential return on investment is for these efforts.  As budgets are constantly under scrutiny, you need to understand what these investments in retention save you in the long run.

These are just three tips to get you started on your way to increasing membership, just by keeping the members you have!  If you have questions or want more information about how you can develop a member retention or engagement strategy reach out to me at or call me at 215-499-1417.  Call today – it is not too late to get this done before 2020!

The Medicare Plan Finder (MPF) Tool AND its Much Needed Make-over

Starting this AEP Medicare beneficiaries will have a new experience when researching Medicare Plans on  The site is much more user friendly and provides a much cleaner user experience.  The picture below displays the new home page you will see when you enter the site.

It’s hard to
believe that the original MPF, one of the most widely visited tools for
Medicare Beneficiaries, is ten years old. 
In that time, the functionality, look and user experience has pretty
much remained unchanged. 

GAO Findings

The Government
Accountability Office (GAO) completed a study in July 2019 and found that the MPF
was difficult for beneficiaries to navigate and it provided incomplete
information. It also stated that beneficiaries struggle with using the MPF
because it can be difficult to find information on the website and the
information can be hard to understand. For example, MPF:

  • Requires
    navigation through multiple pages before displaying plan details,
  • Lacks
    prominent instructions to help find information, and
  • Contains
    complex terms that make it difficult to understand information.

In response to
a GAO’s survey, 73 percent of SHIP directors reported that beneficiaries
experience difficulty finding information in MPF, while 18 percent reported
that SHIP counselors experience difficulty.

New and Improved MPF

CMS has
redesigned the MPF site to tackle the problems raised above and from first
glance (the CMS training and the new MPF view online) it appears that CMS has
greatly improved the navigation and ability to find information.  CMS conducted intensive rounds of consumer
testing, took information from multiple reports and recommendations from web
design experts to develop the new look, feel and navigation.

still have the option to go on the site as a blind user or to sign into the
site.  For Medicare beneficiaries who
sign into the site and create an account there are a couple of very
personalized experiences that are only available if you create an account.

  1. When
    it brings up drugs, the site will populate the drugs that are on file that
    beneficiary is known to have taken.  The
    beneficiary will have the opportunity to accept all of the drugs or to add or
    delete drugs to the list.  This will help
    personalize their estimated drug costs.
  2. You
    have the opportunity to utilize a live chat feature that will take you real
    time to a representative from 1-800-Medicare who can help the beneficiary with
    their questions.

Even if you
don’t sign in there are still really great new features: 

  • You
    can now select three pharmacies instead of two when you are asked to select
  • Before
    you could only compare two Plans for MA and PDP plans, now you can compare
    three plans
  • There
    are new filters for selection such as star rating, company,  different supplemental benefits (wellness,
    vision, dental, hearing, transportation and fitness benefits), covers all the
    drugs on the beneficiary’s drug list
  • The
    plan details is much more inclusive with many of the supplemental benefits
    including those that apply only to beneficiaries with chronic conditions

beneficiaries and agents who utilize this for their clients will definitely see
a great improvement but there is still room for a better experience for
beneficiaries.  Some of the immediate
ones we noticed were:

  • The
    ability to see if the beneficiary’s doctor is in the network – this is one CMS
    is looking to tackle soon
  • Medicare
    Supplement premiums – there is still a range of premium but CMS is hoping to
    get better data to fix this issue.
  • With
    many of the new supplemental benefits it only states whether they are covered
    or not but does not show the benefit detail, such as cost-sharing and
    limitations. This still does not provide beneficiaries with all the
    information they need to make the best decision. 

Overall it is a
great next step.  Go on the site now to
get a look.  Up until AEP, you see the
old site but can access the new site. 
Once AEP arrives you will only be able to see the new and improved MPF.

Why Member Experience? And Why Now?

Recently, I was having a drink with a friend in the industry, and I started talking about our member experience roadmap. My friend made the mistake of asking me why I was bringing this up now – weren’t there more important things to be worrying about, such as developing the right product or Star Ratings? This upcoming Annual Election Period (AEP) is projected to be a strong one – why is member experience top of mind? Unfortunately for my friend, she had to hear a very long-winded version of why member experience is important, especially since this is a passion of mine! I'll spare you the same diatribe, and instead provide the highlights of my conversation.

Member Experience Starts with the Sales Process – Strong member onboarding during the sale kicks off the member experience process. With strong onboarding, an understanding of what to expect from the plan, and when to expect communications, the new member is likely to start off feeling confident in his or her purchasing decision. In addition, giving the member certain tasks of what he or she should do as a new member, such as making a doctor or eye doctor appointment, helps to engage them as a member.

Member Experience Affects OEP and Retention – In a recent webinar with Deft Research (Deft) and I, Deft stated the majority of all Open Enrollment Period (OEP) switchers were AEP switchers. This is a powerful reason to ensure plans have a strong member experience process in place for new members. Switching Medicare Advantage plans is a big deal. Not treating your members like it is a big deal or not providing the proper information timely and properly sets off buyer’s remorse. Before this past OEP, a plan had nearly 9 months to make a good first impression – this is no longer the case. Look at the cost of each new sale – when you lose these members during OEP, it is a real lost financial opportunity.

Member Experience Is Critical to Star Ratings – Recently, a Gorman Health Group client who went from 4 stars to a 3.5 stars asked us to figure out how much the lost half star cost them. It was over $30 million – that’s A LOT of benefit dollars! Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores help drive Star Ratings, and plans have been doing this for years. Why are plans still struggling? Because they don’t understand what is driving member frustration and fixing the root cause(s) of member dissatisfaction, and creating a positive membership experience. Developing “journey maps” and really understanding how/when to best engage your members will help areas beyond just your CAHPS®.

Member Experience Is Becoming an Important Part of Product Development – Member experience in the product development process has recently started to become a real issue – but, it is a good problem to have to solve. With the addition of multiple new mandatory supplemental benefits such as over the counter (OTC), transportation, meals, and other benefits, we are seeing growing frustration related to access to benefits. Plans today are now contracting with multiple vendors to offer these great new benefits, and the number and types of benefits are going to continue to grow. How does the member access these benefits, and what is the engagement process? Does the plan have multiple vendors sending materials to members? Are there five different phone numbers to call or websites to access? Developing the rules of member experience and a process to make it both easy and efficient for members to access benefits is really important. Plus, setting customer expectations for vendors is important in making your member experience seamless.

Strong Member Experience Programs Generate Revenue – Do the math and you will see the revenue. When you look at the lost opportunity of revenue for members switching to other plans – and the cost to enroll another member to make up the revenue – the cost of member experience programs is, in reality, a strong investment.

Enough of my rant! Back to work! But we would really appreciate the opportunity to share our passion for member experience with you. Contact us today to find out how we can help!


Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe

Learn how a single platform designed specifically for Medicare can streamline enrollment and offer a better way to deliver a return on your plan’s investment. Click here

Gorman Health Group is part of the Convey family of companies, which includes Convey Health Solutions, HealthScape Advisors and Pareto Intelligence. Together, we collectively support healthcare organizations with elite consulting services and industry leading technology solutions. Learn more

3 Steps for Success: 2020 Material Creation and Review Season

It’s late
Friday afternoon before Memorial Day weekend and the Centers for Medicare &
Medicaid Services (CMS) has gifted us with the Contract Year 2020 model
materials memo! Although most
organizations wait until the bids are in, we are seeing some plans get a head start
on their materials this week.

Last year there were multiple iterations of the model documents posted by CMS.  Hopefully, the changes to documents by CMS will be minimal this year - although CMS is considering adding instructions for Medicare Advantage (MA) plans to disclose a complete list of Part B drugs that are subject to step therapy requirements in the Annual Notice of Change (ANOC) and/or Explanation of Coverage (EOC) documents.  CMS is seeking feedback on this issue as well as indication-based information and mid-year changes by June 20, 2019.   So we expect to see at least one round of changes to the impacted models.

Here are 3 tips
to help you get ready for 2020:

  1. Evaluate what worked and what didn’t work well in the material review process last year. Did you conduct a lessons learned session at the end of the season? If you did not have a chance to do a lessons learned session, take some time to reflect before you start your material creation with your team.  This way, you can set expectations with your team and colleagues.
  2. Develop tools and checklists. If these are not in place already at your organization, these resources are integral to helping in development of materials and should be developed. Having strong benefit grids, change documents of benefits from 2019 to 2020, and the listing of all current telephone numbers, websites, addresses is really important to make sure your materials are accurate. 
  3. Taking the time to review materials is critical.  These documents are painfully tedious with a high probability for error in creation.  Without proper checks and balances in your review process, your probability of errors increases substantially.  At GHG, we believe a two tier review process across all materials is needed for success. 

Does this quick hit list warrant additional discussion within your team? If you are doing the above already, fantastic! That said, are you inundated with the day-to-day of CMS and/or Annual Election Period (AEP) planning and requests with six+ hours of meetings a day and little time to catch up and actually get your work completed?  Plans today are stretched thin for the development and review of these extremely time consuming, yet critical, materials and CMS has a zero tolerance for errors.

If you need help with either material development, review or both, contact me directly at for more information on how we can help.  But please, call quickly so we can get you scheduled.


Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe

Learn how a single platform designed specifically for Medicare can streamline enrollment and offer a better way to deliver a return on your plan’s investment. Click here

Gorman Health Group is part of the Convey family of companies, which includes Convey Health Solutions, HealthScape Advisors and Pareto Intelligence. Together, we collectively support healthcare organizations with elite consulting services and industry leading technology solutions. Learn more

You Can NO LONGER Be on Autopilot! Live or Let Die to the Nationals!

past Annual Election Period (AEP) was more active than in past years, and the
results show it. There were more than 600,000 net new Medicare Advantage (MA) enrollees
this AEP. The following chart shows the AEP growth of the 10 largest parent
organizations. The top three – UnitedHealthcare, Humana, and Aetna – had
significant gains in enrollment – more than the total growth nationwide. Humana
and Aetna killed it this AEP with a combination of super competitive plans and
expansions into new counties.

What is really concerning is the “All Others” line that had a combination of more than 150,000 members and a 3% loss! Are you one of those “All Other” plans? Last year was the perfect year to “go big” with your benefits, marketing, and aggressive sales distribution strategy to compete against the nationals. We saw and helped a few “All Other” plans do it well and win in the market.

don’t worry – if you missed out last year, this year will be another
opportunity to grow your market for 2020. You need to take a long hard look at
what you’re doing and why you’re doing it. And it takes a strong mix of the following:

  • Product
  • Marketing
  • Sales


you can’t do it by changing a couple of benefits or adding another direct
mailing or field marketing organization (FMO) to the mix. You’ll want to do a
thorough assessment of your product, marketing, and sales strategy to ensure
you are keeping abreast of both local and national trends in the market and
really take a good hard look at what you need to change for 2020.  Don’t wait to see what the market will do next
year – lead the market this year!

a benefit and product perspective, the Centers for Medicare & Medicaid
Services (CMS) has given plans the ability to be really creative and create
some benefit differentials. In addition, the new benefit opportunities are
screaming at plans to truly understand their members and put benefits in place
to make an impact on their members’ health and your medical loss ratio.

you done a deep Medicare Plan Finder (MPF) dive to understand where and why you
are on Page 1 – or Page 10? Did you ever wonder why one of your competitors
whose benefits are not as strong as yours has a better position on MPF? There
is a science to MPF, and you need to understand how to arrange your benefits to
be best represented in the market.


a marketing standpoint, how do you stand out from the crowd – is it in a good
way? The nationals have bigger budgets, so you need to maximize your spend
wisely. There are three things to consider:

  1. Creative: Pretty creative doesn’t always
    sell – make sure your ad agency is not setting themselves up to win awards. Are
    you getting out there with marketing that generates leads? It’s the marketer’s
    responsibility to make sure the benefits that prospects want in the market are
    being highlighted multiple times throughout the creative.
  2. Models and Targets: GHG has seen MA plans
    utilize models that are really worthwhile, while others utilize the same model
    to death and forgetting that when you make changes to your products and
    benefits, you can change the dynamics of your targeted segments.
  3. Have you really micro-managed your
    marketing channel analytics to understand what channels need to be further enhanced
    or have decreased spending? In this day of omni-channel marketing, it’s getting
    harder to really understand the dynamics of your marketing dollar, and that’s
    why it’s more important to understand how each channel is operating on its own
    and in concert with other channels. Are you testing new opportunities? Are you
    testing at all?

Sales Distribution

you really need to take a fresh look at your sales distribution strategy:

  1. Are
    your FMOs providing the value you need? Should you be utilizing FMOs? In
    competing against the national carriers, who rely heavily on FMOs, how do you
    stand out in the crowd?
  2. Are
    your employed representatives trained properly? We have seen many sales teams
    that have received little to no sales training. Having a strong sales team,
    whether they are on the phone or out in the field, is critical in today’s
  3. Understand
    that your vendors can be the difference between making goals or not making
    goals. In today’s environment, many MA plans outsource critical functions,
    especially when it comes to the call center. How are you overseeing reporting
    and quality? What is the turnover rate, and how involved are you in training?

we need to step back and really take a fresh look at how and why we are running
our products, marketing, and sales? We need to take a look at how others in the
industry are conducting business, especially those that are gaining membership.
This doesn’t mean we need to copy them – but what should we be doing better
and/or differently to get an edge in the market? This is an exercise that
should be done every year to stay in the game.

If you need help with assessing what you could do differently in your product, marketing, and sales distribution strategies, give me a call – I would be happy to talk with you.


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Top 10 Changes - Draft Medicare Communications and Marketing Guidelines

for Medicare & Medicaid Services (CMS) has released the draft Medicare
Communications and Marketing Guidelines (MCMG) for 2020. Of the CMS draft MCMG
changes, here’s our top 10:

  1. Plans must include a toll-free TTY number when a telesales number is listed in the same font size as the other phone numbers. This requirement no longer applies to the customer service number only. Plans must ensure that all materials include this update moving forward.
  2. Plans/Part D sponsors are now required to submit via the Health Plan Management System (HPMS) hold time messages that include benefit information or promote the plan.
  3. The Centers for Medicare & Medicaid Services (CMS) clarifies that plans must submit their website annually, must include a material ID for the current year on all web pages, and subsequent website submissions with updated marketing content must include a note on where to find those changes on the website along with the summary of changes.
  4. Administrative payments to field marketing organizations (FMOs) can continue to be based on enrollment, provided payments are at or below fair market value (FMV). When impracticable, administrative payments made to agents/brokers, such as mileage and materials, may also be based on enrollment. However, CMS expects organizations to pay actual expenses when possible. Payment structures must be determined prior to a plan year and remain in effect throughout that plan year. Plans must make payment structures available to CMS upon request.
  5. Document changes:
    • Annual Notice of Change (ANOC), Evidence of Coverage (EOC), and formulary erratas may be provided electronically if the enrollee has opted in to receiving electronic versions.
    • If an enrollee has requested a hard copy directory, the plan may attach an addendum of recent updates instead of printing an entirely new document if the request is made prior to the annual update. CMS does not expect a hard copy directory or addendum to be sent whenever there is a change to the directory.
    • Plans must not indicate effective or term dates in the provider directory if a provider is listed prior to the effective date or is confirmed to leave the network.
  6. CMS clarifies that sales lines at organizations are not required to follow the customer service call center hours of operations requirements.
  7. The “health and wellness information” mailing statement has been removed from guidance.
  8. The plan Online Enrollment Center Disclaimer “Medicare beneficiaries may also enroll in <plan name> through the CMS Medicare Online Enrollment Center located at” has been removed for 2020.
  9. The disclaimer “This information is not a complete description of benefits. Call [insert customer service phone number/TTY] for more information” has been removed for 2020.
  10. The federal contracting statement is no longer required on communications that are not marketing. The federal contracting statement is only required on marketing materials.

There are several other changes being suggested – this is just our top ten list.  Plus, all draft changes continue to be subject to further change until the final MCMG are released.


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Tips for 2020 Product Development

It’s the middle of January, and the Medicare Advantage (MA) world now knows whether you were a winner, loser, or maintaining status quo from the 2019 Annual Election Period (AEP). This last year was a great one to test the waters with strong benefit strategies and aggressive sales and marketing techniques. We saw several of our clients really dig deep into their benefits and products to get aggressive and push their actuaries to really get the best products possible, and the results were definitely positive.

Going into benefit planning for 2020, there are a few ideas you should be considering:

  • Chances are, this will be another year where reimbursements are higher, and it is critical to ensure you are as competitive as possible. If you cannot work within your current products, look to build a new one! From a national perspective, the Medicare population is moving to lower premium products – but they still expect all the bells and whistles. When taking at a quick look at the AEP results, there were many plans that did not grow or their growth was minimal. The following shows the top 10 plans with member growth and then all others.

Although the top three plans have amassed the most membership, there is still real opportunity for growth if you go about it with the proper planning.

  • Do you have a growth strategy? Plans today should not just be looking at product and benefit development from a short-term perspective. You should have a continuous growth strategy in place for your products and plans. Product development should not just be a January to June exercise. It should be part of a continuous process that allows you to understand your market, what your members and prospects need, and how to maximize their health and your profitability. Gorman Health Group (GHG) recommends a continuous three-year strategy be in place.
  • Are you taking advantage of the new benefit opportunities for 2019? GHG will be developing a more comprehensive look at benefit and AEP results, but in looking at the opportunity for new and innovative ideas to either affect savings from the benefits (for members with chronic conditions) or use them to attract new membership or just to keep your members at home instead of in the hospital, now is the time to be researching these types of benefits for your products. Are you looking at the right data to understand what your market needs? Here are a couple of benefits being offered by HMOs across the country:
    • Additional meal delivery
    • Bundling of benefit with a dollar cap to allow members more flexibility to personalize benefits
    • In-home support
    • Palliative care
    • Support for caregivers
    • Assistive devices for home safety
    • Adult day care
    • Housekeeping
    • These are just a few of the many benefits now being offered by MA plans.


  • Last But Not Least: Medicare is not the “Field of Dreams” – just building the best product doesn’t mean they will come. MA plans today must ensure their sales and marketing strategies are just as strong and buttoned up as their product and benefits to be successful. Product, Marketing, and Sales should be planning together on building products that will resonate with the market and planning how to best promote and sell in the marketplace.



Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe

Learn how a single platform designed specifically for Medicare can streamline enrollment and offer a better way to deliver a return on your plan’s investment. Click here