6 Tactics for Better Agent/Broker Management During COVID-19

On May 29, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Contract Year 2021 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements. While the compensation rate increases are a welcome update for agents/brokers, it is important to explore these changes in the context of COVID-19 and how the standard Medicare selling practices will not be sufficient for the 2021 Annual Enrollment Period (AEP). 

How can Agents/Brokers Navigate Medicare Sales During COVID-19?

Here are 6 tactics organizations and sales teams should consider to adjust strategies for COVID-19.

  1. Know and follow your state and local government requirements around stay-at-home orders and mask wearing. As healthcare leaders, organizations have the unique opportunity to position themselves as the go-to resource on the latest state and local mandates for the community, beneficiaries, and sales teams (internal and external). Partnerships with key network provider groups can emphasize this position.
  1. Invest in systems that allow for virtual meetings; conduct appropriate training and education well in advance of the start of AEP. Training and education don’t stop with sales teams. Organizations should make sure that beneficiaries understand the intricacies of a virtual sales meeting and provide support throughout the entire process to keep technology frustrations at bay. In addition, organizations must remember to establish compliant expectations for recorded virtual meetings and submission and/or record retention as needed for sales oversight programs to remain effective.
  1. Modify seminar strategies to limit participation and allow for safe social distancing. Does your organization and/or sales team rely on vigorous seminar strategies? GHG recommends evaluating seminar locations now to understand if the space will allow for a minimum 6 feet of distance between attendees. Providing this assurance demonstrates that beneficiary protection is top of mind. Organizations may also want to schedule multiple seminar sessions throughout the day to allow for the potential need to cap attendees per seminar because of limited space.
  1. Be prepared to move seminars to a virtual setting. The threat of a COVID-19 second wave in the fall is real and may lead to another round of economic shutdowns. If your “plan A” includes group seminars, make sure your “plan B” can move these seminars to a virtual setting.
  1. Arm field sales representatives and agents/brokers with face masks and hand sanitizer to distribute at one-on-one meetings and seminars. Bonus if the face masks and hand sanitizers include your branding or logo.
  1. Agents/brokers should be staying in contact with their clients. Organizations should provide tools to their sales force for discussing COVID-19, such as a COVID-19 Quick Reference Guide. Resources like this help to position the agent/broker, and ultimately your organization, as their trusted resource and support system in not only navigating Medicare but also the pandemic as well.

What This Means for Health Plans

The commissions may be higher this year, but the work is anything but “business as usual.” Both organizations and agents/brokers alike need to adjust their strategies to ensure an effective and safe AEP season. If you don’t have a game plan for adjusting to the new normal this AEP, now is the time to develop your Plan A, B, and C.

If you have any questions about the information above, or need assistance transitioning to a digital-first AEP sales strategy, GHG can help. Contact us today to get in touch with an expert.

OMB-Approved 2020 Program Audit Protocols

CMS has published the OMB-approved 2020 Program Audit Protocols, available for download here: https://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/ProgramAudits

CMS also announced a possible reprioritization of the 2020 program audits in an effort to complete them later this year. Sponsors should review the new protocols and prepare for any changes in data reporting, process, etc.

Reach out to Tina Bailey, CCEP with any questions or help navigating the changes.

CY2021 Marketing Models, Standard Documents, and Educational Material

While we await the associated HPMS memo, CMS had uploaded the CY2021 materials to their website. You can preview them here: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMaterial

As the Bid Submission Timeline Approaches, So Does the Release of PY2021 Model Documents

It’s that time again… the frantic whirl of both bid submission and material development in anticipation of the upcoming plan year and sales/enrollment activities.

If you are a health plan with multiple contracts and/or plan benefit packages (PBPs), you know how daunting material development and review can be.

If not delayed, the Centers for Medicare and Medicaid Services (CMS) will publish the plan year (PY) 2021 model materials by the end of May. Major changes to the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) are not anticipated, since they have been approved by the Office of Management and Budget (OMB) through December 2021. Regardless, ensuring accuracy of materials is critical as errors can lead to enforcement actions by CMS. Things to consider when developing PY2021 materials:

  • CMS model use
  • Following instructions found both in models and separate Health Plan Management System (HPMS) memo(s)
  • Applying the correct benefits to all of the documents
  • Submission and distribution timelines
  • Including fulfillment activities
  • Technology requirements (website changes)

How We Can Help

GHG has been assisting our clients with both development and review of required materials for over a decade. We have a long, successful history of supporting these efforts. Our team undergoes re-training every year prior to deployment of any engagement, and we have a standardized process in place that is adaptable to any of your particular needs. In addition, we have HPMS access and can submit materials on your behalf. Contact us today to discuss how we can best support you.

Medicare Sales in the Age of COVID-19

There’s no doubt about it: COVID-19 will change the way we sell Medicare products.

In previous years, health plans relied on agents for seminars, town halls and “kitchen table” sales. This year, plans cannot depend on face-to-face interactions with Medicare beneficiaries to be successful in the upcoming Annual Enrollment Period (AEP). Medicare beneficiaries are one of the most vulnerable groups for this virus. Meeting with people one-on-one and/or in larger groups is unsafe in this environment.

Plans will need to adjust and get creative in order to make sales goals this year.

Over the last few months, GHG has been working with several health plans on pivoting strategies to navigate the new norms of COVID-19 and a Presidential election year upon us. Here are some tips to consider.


This year, Medicare sales will be defined by those who enable an effective virtual selling environment. Health plans should be in close contact with top brokers, helping to build tools to be utilized during new-to-Medicare/Initial Enrollment Period (IEP), Special Enrollment Period (SEP) and AEP. Most, if not all, one-to-one discussions and seminars will be conducted online; having access to audio and/or video conferencing tools will be critical. This also includes an online enrollment tool for agents/brokers, so if your plan does not currently offer it, now is the time to get one! Agents/brokers will want to walk prospects through the online enrollment process over the phone or via video conference (e.g., Zoom).

In addition, having the right tools is one aspect, but this type of selling is different from the usual one-to-one, in-person discussion. Even if you enable video for both parties, it’s difficult to read and understand body language during a conference call. Agents will need to adapt selling styles to take this into consideration.

Still, the path back to “normal” is unknown. Even when social distancing restrictions and stay-at-home orders are lifted, it’s questionable when “the most vulnerable” for COVID-19 risk will feel comfortable again. Plans will need to hold agents/brokers accountable for the health of prospects when entering homes, as well as how to safely approach a “kitchen table” sales environment—clean hands, disinfecting wipes, masks, etc.

This means that call centers will be very important for the future of sales.

Call Centers

Many plans utilize call centers as a way to answer questions and move prospects to the next step, such as fulfilling information requests or sending to an agent/broker. It may be time to rethink that strategy. Considering the impacts of COVID-19, plus Presidential election season, telesales will play a much bigger role in hitting sales targets for 2021.

GHG recommends using licensed agents who can sell over the phone and have the opportunity to set up an online conference call to take the prospect through the process, if that’s needed to close the sale. Having trained several internal call centers, we’ve found that many don’t know how to sell or close a sales opportunity. We cannot stress enough the importance of having a thoughtful call center strategy this year (and don’t wait until AEP to test new approaches—start with your new-to-Medicare program). Selling approaches and monitoring will be key to success.

Online Sales

Online sales have been increasing over the last several years, and COVID-19 will undoubtedly precipitate moving this to the next level. New-to-Medicare beneficiaries especially are gravitating towards digital platforms, and online/social media channels are now a viable and profitable form of advertising for most Medicare plans.

Plans today need a solid online presence that serves as a “real” sales channel, not just a website with CMS information and an online enrollment process. When a prospect visits your website, can they easily travel through a well-organized sales process? Is your market differential front and center? The sales experience should be easy and user-friendly for prospective members, with access to customer service via phone or chat to get answers to their questions quickly.

What's Next?

The next few months are certainly going to be interesting. Given the unpredictability of the current environment, be sure to cover your bases now to be prepared for this AEP—including establishing a backup plan if needed. With COVID-19 and the Presidential election, AEP will be a difficult endeavor, but plans can utilize the OEP, agents/brokers and new-to-Medicare advertising to drive sales during AEP.

GHG is available to answer any questions you have and help evolve sales strategies for this unprecedented environment. Contact us to start the conversation.

New Benefits & Special Enrollment Period (SEP) During a National Emergency

Since President Trump declared COVID-19 a national emergency in all 50 states and the District of Columbia, a Special Enrollment Period (SEP) for Medicare beneficiaries is allowed. The SEP runs from March 1st to June 30th.

What is a Special Enrollment Period?

The SEP exists for Medicare beneficiaries who were unable to make an election during the Open Enrollment Period (OEP), including both enrollment and disenrollment decisions. If an enrollee did make an election decision during OEP, they are not eligible for the SEP.

SEPs present a unique opportunity for Medicare Advantage (MA) plans to capture new enrollees. However, this effort may be best left to the sales team. The number of Medicare beneficiaries taking part in this new SEP is most likely lower than the OEP, so it would be difficult to achieve a high return on any new marketing investment.

New Benefits During a National Emergency

In addition to the SEP, MA plans may offer additional benefits during a federal or public health emergency. There are a variety of benefits that can be offered, but they must be offered uniformly to all plan members. Here are a few examples:

  • Introduce an OTC benefit or increase an existing OTC benefit allowance. (Must be health related, unless part of Supplemental Benefits for Chronically Ill Enrollees [SSBCI].)
  • Waive the plan premium
  • Offer new mandatory supplemental benefits, such as meals or transportation
  • Provide a cell phone and/or tablet. (Again, this must be for health-related services only, unless part of SSBCI and there is a reasonable expectation of improving or managing the health or overall function of the chronically ill member.)
  • Decrease and/or eliminate copays/coinsurance of any benefits

What Should Medicare Advantage Plans Do?

With the current COVID-19 environment, the upcoming deadline for bid submissions, constant communications with members, and navigating the new normal for AEP, it may be difficult for MA plans to consider a change at this time. However, introducing new benefits during this unprecedented time demonstrates your plan is committed to going above and beyond for its members. Just remember—if you decide to make changes and believe they are worthwhile, advertise them! You’re in an SEP, after all.

If you need help navigating this SEP or anything related to marketing through COVID-19 and a Presidential election year, contact us to start the conversation.

Health Service Delivery Tables Deadline is Fast Approaching

CMS requires MA plans to maintain a compliant network at all times. We understand that your plan may have deployed your network analytic teams to support other functional areas due to the pandemic; however, the mid-June deadline to submit Health Service Delivery (HSD) tables for CMS review is fast approaching. Based upon the data in your provider and facility files, GHG can typically run a network analysis to review your plan’s adequacy in 2-3 business days, as well as support your HSD submissions.

Contact us today to perform this critical final check before the deadline.

AEP Marketing During COVID-19 ...AND a Presidential Election

Developing a marketing strategy during a Presidential election year is difficult enough. But adding in the current, and eventually, post-COVID-19 environment, which is unprecedented, makes it even more challenging.

As we mentioned in a recent webinar, Medicare Advantage (MA) plans will need to “think outside of the box” when developing and executing a go-to-market strategy for the 2021 Annual Enrollment Period (AEP). Making slight modifications to last year’s plan will not cut it in this “new” environment.

The Medicare Advantage 2021 AEP Will Be Here Before We Know It

Now is the time to dissect your marketing and sales channels; waiting any longer will put you at a disadvantage. Below are a few ideas to consider when rethinking a 2021 go-to-market strategy.

Branding and Creative

Hopefully, you have already been communicating to members and the community about COVID-19 and how to stay safe. Those visuals and brand components, as well as the tone, should extend into AEP communications, especially for localized plans. The messaging should focus on ensuring both prospects and members know you were there for them during COVID-19 and will continue to be there every step into the future. Fear of change is difficult for this population, and particularly for the switcher market, plans must alleviate that feeling of fear through messaging.

Marketing Channels

Advertising during an election year is challenging. The tried-and-true tactics aren’t viable; everything else is more expensive than normal; and it’s even more difficult to capture beneficiary attention. What can MA plans do?

  • TV: Purchasing TV spots is typically a nightmare. When developing your media plan, take into account other ways you may want to utilize TV commercials. Incorporating them into social media, landing pages or websites warrants consideration.
  • Social Media: For the last several years, we have seen plans implement strong, cost effective social media campaigns. This AEP is the perfect opportunity allocate more marketing spend to social media. Recent survey results from Deft Research indicate a continued increase in the effectiveness of online media and websites for growing enrollment. Test different social media and digital channels to find the best strategies to capture Medicare beneficiaries shopping online.
  • Direct Mail: Medicare beneficiaries receive a lot of mail during election season. Postcards may get lost in the clutter. Instead, try direct mail “kits” that are designed and written to stand out. Timing and targeted are also critical. Front-loading your marketing with a strong finish will help you during the heat of the election. Also, developing strong direct mail response models is important for this AEP. This is the perfect opportunity to send more direct mail, but only mail to those who are most likely to respond and cut out the least responsive segments.

Backup Plan

We are in uncharted territory with this pandemic, and no one has a crystal ball to understand how, or if, the market will respond this year. That’s why we recommend having a backup plan. If TV is a non-starter, what will take its place? If results are not what you need them to be, is there an opportunity to send one more direct mail campaign? Is it worthwhile to invest more in social media? Are newspaper ads, Free Standing Inserts (FSIs) or radio ads ways to help increase overall marketing results? Having alternate or additional materials ready, if needed, could be the difference between exceeding lead and sales goals, and falling short.


This AEP, it will be critical for enrolled beneficiaries to feel comfortable about their decision—both during the sales process and long after. Plans must have a strong onboarding process to prevent buyer’s remorse, including materials that clearly explain what to expect during the enrollment process, as well as multiple communications touch points (e.g., delivery of their ID card). Capturing communication preferences early and honoring those decisions sets the tone for the entire member experience. Also, set up multiple ways to communicate benefits, such as virtual town halls and phone calls, to ensure members get acclimated to your plan.


Marketing/advertising strategy is one focus area that plans need to assess and rethink in the context of the COVID-19 pandemic and an election year. There are also sales channels. How will your sales strategies and goals need to change for the upcoming AEP? Stay tuned for additional recommendations on the GHG blog over the next few months!

If you have any questions or need assistance with your AEP marketing strategy, contact Diane Hollie.

Strategies to Support Value-Based Reimbursement During Uncertain Times

As we are all experiencing a new normal in our personal and professional lives during the COVID-19 pandemic, the ability to keep up with the ever-changing clinical and regulatory environment in healthcare has made even the most seasoned healthcare executive feel as if they were swimming against the current.

Providers and Accountable Care Organizations (ACOs) engaged in risk-bearing contracts with CMS and other private payers have rightly expressed significant concern over the ability to accurately predict and have an impact on potential shared savings and losses. A recent National Association of ACOs (NAACOS) survey indicated over 56% of ACOs would consider exiting the program if CMS did not offer amenable solutions to protect against downside losses.

What Can Risk-Bearing Providers and ACOs Do?

As we saw last week, CMS is adjusting the financial methodology, in order to support keeping ACOs in the program. The ability to pivot and deploy resources to manage membership, as well as be proactive and adaptable in your overall strategic plan, is critical for any ACO or provider group taking risk. A key to supporting value-based financial goals is quickly activating strategies to engage members and continue to drive and deliver on clinical goals.

Providers and ACOs should consider:

  • Developing member registries or lists to assist in prioritizing outreach to members according to need. Work with health plan partners to tag team on those members falling into a coronavirus high-risk category, engage members with chronic care needs to ensure monitoring for potential crisis indicators, or in areas that are not as hard hit by the virus, target members for proactive preventative health screenings that can be done via remote patient monitoring.
  • Utilize non-traditional personnel to support outreach strategies. We understand it has been difficult to keep staffing levels at full capacity. Engage underutilized staff to support outreach efforts by developing simple decision trees they can follow with an escalation plan should they come upon a member needing urgent clinical support.
  • CMS has offered latitude in its guidance around telehealth. If your office has not yet offered telehealth services to members, this might prove to be the perfect opportunity to explore how telehealth solutions and remote patient monitoring could enhance your practice in the transition from volume to value. More people are looking beyond the standard urgent care visit to have greater flexibility in receiving care, especially follow up visits, remotely.
  • As you and your team work through the member registries, it affords the perfect opportunity to look at patients through a social determinants of health (SDOH) lens and develop strategies for areas such as medication access and food security, which are putting them at risk for failing to execute on a care plan. When you are at risk for the total cost of care of your patient panel, enabling the member to be as successful as possible by including community services in their plan of care can be a critical element of improving health.
  • The pandemic has opened conversations on mental health issues to a broader audience. Identifying and addressing potential mental health issues as part of the outreach process is an important proactive measure for the overall health of your patients.


GHG has the depth of experience from working with numerous health plans and providers to assist you in focusing on and developing strategies, such as those discussed above, that will keep your practice or ACO ahead of the fast-paced regulatory landscape. It is critical to be adaptable to challenges with patient care, as well as on the lookout for potential financial opportunities, such as risk adjustment and payor contract analysis, to assist in mitigating losses.

Please reach out to Ellie Martin to further discuss how our team can support your ACO or practice during this complex and challenging time.

On Demand Webinar: Four Lessons Learned from the 2020 AEP Results

On April 14th, Diane Hollie of Gorman Health Group was joined by George Dippel from Deft Research for a thoughtful, data-driven discussion about the enrollment outcomes of the 2020 Medicare Advantage (MA) Annual Enrollment Period (AEP).

With support from a recent analysis on the AEP data by Pareto Intelligence, the webinar presentation explored the many variables affecting product and benefit design in MA, as well as how MA organization (MAO) decisions about those variables impacted 2020 enrollment.

If you did not get a chance to attend the webinar, click here to view the recording.

Some of the key takeaways from this discussion an analysis include:

  • Lesson #1 – Explosive Growth in MA Continues: With a projected 80 million Medicare-eligible Americans by 2035 and 41% of age-ins enrolling in MA each month, the MA market is ripe with opportunity. Where are we seeing the most growth by geography? By MA plan? In which products?
  • Lesson #2 – $0 PPOs Are Changing the Game: When looking at 2020 enrollment data, the movement to $0 PPOs is still in the early stages, but these plans are growing rapidly. Data from Deft Research's 2020 Medicare Shopping and Switching Study gives us critical insights to consider while building your own MA products.
  • Lesson #3 – Market Movements Introduce New Options for Consumers: New market entrants and exits change the competitive landscape for MA every year. In 2020, Medicare beneficiaries had more plans to choose from, more types of plans (such as Special Needs Plans) to evaluate, and more benefits to consider (especially when taking supplemental benefits into account). What does this mean for MA plans going into 2021?
  • Lesson #4 – Changing Consumer Behavior is Creating New Trends: Additional research from Deft on shopping and switching behaviors for seniors provide insight on how to market your MA plan during an election year. What strategies and tactics can you deploy to break through the clutter?
  • BONUS – Taking COVID-19 into Account: At the end of the webinar, our Medicare experts discuss how to communicate with and market to MA beneficiaries in the aftermath of COVID-19, while also navigating an election year.

Watch the Webinar On Demand!

These lessons are discussed at length in GHG’s April 14th webinar titled, “Lessons Learned from the 2020 AEP Results.” Use the form below to receive access to a recording of the webinar and explore the various insights from Gorman Health Group, Pareto Intelligence and Deft Research.

Where Do We Go from Here?

Now more than ever, MA plans must be prepared to adjust and pivot sales and marketing strategies to address a post-COVID-19 world and this busy election year.

For help building a data-driven strategy, get in touch with GHG's Sales and Marketing experts.