Medicare Program Audits — Four Things Operations Should Be Doing Today
Do you think the Centers for Medicare & Medicaid Services (CMS) program audits are stressful? We often make it worse for ourselves than it already is. Imagine being in the audit webinar pulling up a case and having CMS say that case was to be excluded from the universes. Instead of showing your department, processes, and system capabilities, CMS is getting the impression you don't even know your data well enough to pull a correct universe. What can Operations departments do to get ready? Here are four things you can begin doing today to be ready:
- Set up automated universe pulls, both with internal systems and delegates. Automating these processes will allow you to pull them quickly and use them on a regular and ad hoc basis. Additionally, automating the process will help you identify which fields are not being captured properly or at all in your system. This can be the biggest difficulty in pulling universes and not something you want to find out when you receive your CMS audit notice. Start this process today.
- Learn to use the data in the CMS audit universes. CMS uses these formats for a reason. CMS has fine-tuned this process to allow them to most readily identify outliers and potential issues. This will help you as you monitor your own operational departments and identify hidden trends. It will also help you regularly monitor your delegates.
- Set up time to complete mock audits of the potential outliers. Pick 10 sample outliers on a monthly basis to review to determine if there are issues with your processes or universe pulls. It makes sense to do this within each operational area internally. You should know what is happening within your department before anyone else identifies it; this includes members, Compliance, or CMS. You will be surprised what you will learn through this review.
- See it to the end. Think like CMS when you complete your reviews. Put aside your thoughts on system limitations and department politics and how many times you have tried to address an issue. How does what you find impact members? How does this follow guidelines? If you identify issues, complete the process by running a beneficiary impact and root cause analysis. This will let you know scope and give you the information you need to address the issue. This may be supplying the information to allow a prioritization of a fix you haven't been able to get prioritized before.
When we in Operations see CMS audits as something that is managed by Compliance, we do ourselves a disservice and lose out on one of the most valuable tools we should all have in place. Implementing these processes will change the dynamics of your department, promote ownership, and make a live CMS audit easier.
The Gorman Health Group Operational Performance practice consultants have been in your shoes. We have faced the multiple priorities and pressure to meet production goals and maintain team satisfaction at the same time. If you need assistance in setting up an audit-ready department, we can help.
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At Gorman Health Group, we maintain the country's largest staff of senior operations consultants. Our team assists dozens of health plans every year in scrubbing their member data and can translate your business strategies into practical, efficient and rigorous work processes with the highest degree of compliance and accountability. Click here to learn about GHG's Operational Performance services >>
Gorman Health Group has decades of experience stress-testing hundreds of operational business units and can assist with implementing CAPs post-audit or in proactively addressing operational problems before regulators come knocking. Visit our website to lean more >>
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Health Plans Need to Start Talking About Disparities in Care
On the heels of a recent groundbreaking RAND report on racial disparities in Medicare Advantage (MA), the US Department of Health & Human Services' Office of Civil Rights (OCR) issued a regulation that requires serious attention in health plans participating in MA, Part D, Medicaid, and ObamaCare. It's a game-changer in advancing health equity and reducing disparities.
The new regs, implementing Section 1557 (the nondiscrimination provision) of the Affordable Care Act, prohibit discrimination, marketing practices, or benefit designs that discriminate on the basis of race, color, national origin, sex, age, or disability. This will escalate disparities from simply being a "quality improvement need" to being a huge compliance issue. It goes without saying that an investigation of your plan by the civil rights cops splashed across local news would be devastating. As the Centers for Medicare & Medicaid Services (CMS) has begun more aggressively using their data to identify these disparities, health plans certainly should begin doing the same.
The final rule prohibits sex discrimination in healthcare, including by:
- Individuals cannot be denied healthcare or health coverage based on their sex, including their gender identity and sex stereotyping. These last two items are of particular importance given transgender policy enforcement is relatively new. OCR has prosecuted cases recently where transgender patients were discriminated against in hospital admissions and room assignments, denying mammograms to transgender females, denial of gender reassignment surgery as "cosmetic," and harassment by medical transport drivers.
- Women must be treated equally with men in the healthcare they receive and the insurance they obtain. OCR has prosecuted several cases recently where hospitals assigned male guarantors when a wife obtained services but not the other way around.
- Categorical coverage exclusions or limitations for all healthcare services related to gender transition are discriminatory.
- Individuals must be treated consistent with their gender identity, including in access to facilities.
- Sex-specific health programs or activities are permissible only if the entity can demonstrate an exceedingly persuasive justification.
The regs also include important protections for individuals with disabilities and those with limited English proficiency by:
- Requiring covered entities to take appropriate steps to ensure communications with individuals with disabilities are as effective as communication with others.
- Covered entities must post a notice of individuals' rights, providing information about communication assistance, among other information.
- Covered entities are required to make all programs and activities provided through electronic and information technology accessible to individuals with disabilities, unless doing so would impose undue financial or administrative burdens.
- Covered entities cannot use marketing practices or benefit designs that discriminate on the basis of disability.
- Covered entities must make reasonable changes to policies, practices, and procedures, where necessary, to provide equal access for individuals with disabilities.
- Requiring covered entities to make electronic information and newly constructed or altered facilities accessible to individuals with disabilities and to provide appropriate auxiliary aids and services for individuals with disabilities.
- Requiring covered entities to take reasonable steps to provide meaningful access to individuals with limited English proficiency. Covered entities are also encouraged to develop language access plans.
Resources
CMS recently announced the release of the 2017 Medicare Marketing Guidelines for Medicare Advantage Organizations and Part D Sponsors, which include added language, clarifications, and new requirements. Join Regan Pennypacker, GHG's Senior Vice President of Compliance Solutions, and Carrie Barker-Settles, Director of Sales and Marketing Services, on Tuesday, June 28, from 1-2 pm ET, to discuss what provisions in the final guidelines will have the greatest impact on your organization and how plan sponsors can prepare for the upcoming changes. Register now >>
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The Evolution of Healthcare.gov — It's Time to Play Ball!
Now that the Federally-Facilitated Marketplace (FFM) is paying Issuers directly from the FFM system versus the Issuer's system, we are participating in a different type of ball game. Issuers now need to shift gears and begin thinking about how they can impact a timely and accurate payment of Advanced Premium Tax Credit (APTC), Cost Sharing Reduction (CSR), and User Fee (UF) charges. Two key areas are at play here: the reduction in tracked discrepancies and ensuring action is taken to resolve and apply consumer data corrections to the FFM system to be in sync. As Issuers react to the May payment cycle and prepare for June payment, they are beginning to think about their overall payment strategy from this point on.
When considering the Issuer's role, the days of not establishing the necessary resources to research and resolve all discrepancies simply because the volume is too high will not suffice during an audit or bring revenue in the door either. So when we talk about an overall payment strategy, it is important for Issuers to recognize they are playing on the team responsible for tracking, fixing, and overseeing their reconciliation program, which includes building an expected payment and outstanding payment based on data cleanup that is pending.
Bringing transparency to the FFM model is the first step towards alignment of data between the Issuer and the FFM and true reconciliation. Imagine being able to discuss with your government partners the substantial payment impact your organization is experiencing simply because the FFM has not applied all outstanding data corrections. That phenomenon is actually occurring today. Since January 2016, the FFM suspended the application of field-level corrections to the FFM system until this month. Issuers should finally see six months of updates reflected in their July payment and are working towards quantifying what that impact will be.
As the FFM model continues to evolve, Issuers are still working towards solving their own challenges:
- Lack of strategy for timely and accurate payment of APTC, CSR, and UF charges
- Unmanageable volume of discrepancies and inability to prioritize
- Backlog of submitted disputes and delays with the Marketplace updating system corrections
- Struggling with measuring and managing the chaos
- Missed revenue opportunities
- Not audit ready
Based on the importance of being in sync with the Marketplace — both FFM and State-Based Marketplaces (SBMs) — Gorman Health Group (GHG) has launched a new reconciliation service with a focus on reducing the volume of enrollment and payment discrepancies while building best practices within Issuers' Finance and Enrollment departments. Now that discrepancies represent real dollars, the stakes are high.
Through GHG's Marketplace reconciliation services, Issuers will be able to track and resolve enrollment and payment discrepancies and quantify the financial impact of those reconciliation efforts. GHG's reconciliation experts will equip Issuers with the knowledge to predict their payment (prospective and retrospective) each payment cycle and build a process to react when the actual payment is not what your organization expected, either through a submitted dispute or internal update.
Our proprietary tool, Valencia™, which currently reconciles 42 percent of the 12.7 million Marketplace enrollees, supports clients' reconciliation processes with a comprehensive approach. Aside from managing enrollment and payment reconciliation, Valencia™ provides compliant and transparent workflow to ensure your operational processes — and the resulting payment — are as accurate as possible. Our goal is to help Issuers manage the chaos and be audit ready.
To learn more about the GHG's reconciliation services, and how they support enrollment and payment reconciliation for Issuers, please contact ghg@ghgadvisors.com.
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Gorman Health Group has launched a new reconciliation service with a focus on reducing the volume of enrollment and payment discrepancies while building best practices within Issuers' Finance and Enrollment departments. Now that discrepancies represent real dollars, the stakes are much higher. Visit our website to learn more >>
With Gorman Health Group's Valencia™, you'll always know where your membership and premium-related data is out of sync, thus eliminating missed revenue and inappropriate claims payments. You'll also have complete control of rigorous, compliant and transparent workflow controls that complement your enterprise system. Set up a demo today >>
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Medicare Marketing Guidelines Summary of Changes — Have They Left You Scratching Your Head?
On June 10, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the release of the 2017 Medicare Marketing Guidelines (MMG) for Medicare Advantage Organizations (MAOs) and Part D Sponsors.
Added language, clarification, and new requirements seem to be the theme with the recent updates. So how do these changes affect business as we prepare for the 2017 Annual Election Period (AEP)?
At Gorman Health Group (GHG), our team of subject matter experts comes together to provide you with clarification around a few key changes from the final MMG Summary of Changes and recommendations for your organization.
Marketing — Diane Hollie, Senior Director of Sales & Marketing Services, says, "Although CMS has stipulated provider and pharmacy directories are considered non-marketing material, it doesn't mean the provider directories don't get submitted to CMS. In fact, all plans must submit their hard copy provider directories to CMS on an annual basis."
CMS is now referring Sponsors to the Medicare Managed Care Manual, Chapter 4, for provider directory guidance and the Prescription Drug Benefit Manual, Chapter 5, for pharmacy directory guidance — making it a more complicated process. The following are just a couple of provider directory rules found in Chapter 4, which were announced earlier this year in a 4/28/16 Health Plan Management System (HPMS) memo.
- All hard copy directories must be uploaded into HPMS as a non-marketing material under the XXX submission code.
- All hard copy directories must be uploaded prior to making the directory available by September 30.
- Because provider directories are considered non-marketing, MAOs should not include a status after the material ID.
- To distinguish the provider directories as non-marketing, the following material ID should be used: plan's contract number, followed by an underscore, followed by a series of alpha numeric characters chosen at the discretion of the plan, followed by an underscore, followed by the letters "NM." Example: HXXXX_ABC124_NM
While it is noted the MMG has referred readers to the PDBM, Chapter 5, for pharmacy directory guidance, there is no cross-referenced information. This could be an indicator a revised Part D Chapter 5 will soon be released. Without it, Sponsors will be left scratching their heads.
Sales — Carrie Barker-Settles, Director of Sales and Marketing Services, understands the importance of agent/broker oversight and Sponsor sales activities. "Helping plans/Part D Sponsors and agent distribution channels navigate the dos and don'ts of the rules and regulations can be very overwhelming, but at GHG, we can make that challenging task less daunting for both."
Below are just some of the changes relating to sales oversight:
- Telephonic Contact — Plans/Part D Sponsors may call their current MA and non-MA enrollees or use third parties to contact their current MA and non-MA enrollees about MA/Part D plans. Examples of allowed contacts include calls to enrollees aging into Medicare from commercial products offered by the same organization and calls to an organization's existing Medicaid/Medicare-Medicaid Plan (MMP) enrollees to talk about Medicare products. The updated guidance clarifies, when discussing Medicaid products, Sponsors must follow all applicable Medicaid marketing rules. Plans/Part D Sponsors, sellers, and telemarketers may conduct these telephonic activities, but we recommend you fully understand all the regulations for both unsolicited and solicited contact before reaching out to Medicare beneficiaries.
- Compensation Payment Requirements — Whether you use employed, captive, and/or independent agents, you must inform CMS yearly by the end of July which channels you will be using as well as the compensation payment rates or ranges. The compensation structure must include:
- How the Plan/Part D Sponsor intends to disseminate compensation, specifying payment amounts for initial and renewal compensation.
- CMS has clarified in the revised guidance the compensation structure must stay the same for the compensation year that was put in place by October 1.
- How the Plan/Part D Sponsor intends to disseminate compensation, specifying payment amounts for initial and renewal compensation.
Some Plan Sponsors may have already been following this process, but if not, yearly requirements outlined in the MMG suggests all Plan Sponsors check policies and procedures to ensure they adhere to their clarification.
"I come from a trust but verify world," says Regan Pennypacker, Senior Vice President of Compliance Solutions," and when the updated MMG is released, it's important Compliance teams disseminate the document to ensure affected business units can determine impact." "It's also important," she states, "to reconcile and ensure supplemental memos and clarification emails sent between revisions have also been rolled into the new guidance." For example, the Part C aspects of the August 13, 2015, "Clarification of CY2016 Medicare Marketing Guidelines" has indeed been rolled into the MMCM, Chapter 4, but as noted above, the Part D aspects pertaining to pharmacy directories has not. "This means plans will need to continue to reference that memo to ensure they are following the guidance as it pertains to pharmacy directories."
"Overall," states Regan, "it will be important for Compliance to partner with Sales and Marketing staff to ensure adherence to all changes and clarifications."
We have highlighted just a few of the key changes, but to learn more, register to join our upcoming webinar on June 28, 2016, from 1 - 2 pm ET.
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Once you have your PBPs in place (we can help with that, too), our teams can develop or review your sales collateral and creative by product type to help ensure your high-impact messaging is both targeted and compliant. Visit our website to learn more >>
Gorman Health Group's Sales Sentinel™ is a flexible, module-based software solution with the ability to onboard agents, provide training, manage ongoing oversight activities and pay commissions. Created by GHG, Sales Sentinel™ was designed to address the specific needs of government managed care organizations. Request a demo today >>
The MSSP Final Rule
On June 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Shared Savings Program (MSSP) Rule, making some significant improvements to the MSSP program. The two notable changes are the use of regional factors when resetting Accountable Care Organizations' (ACOs') benchmarks and a new incentive to transition to the two-sided risk model. These new changes will no doubt help retain existing participants as well as help move some participants into tracks with risk-sharing arrangements.
A significant change, which the industry has been pushing for, is the use of regional Fee-for-Service (FFS) spending rather than national spending data to adjust cost benchmarks in the second or subsequent contract year period. Participants have long argued that success is not properly assessed because participants are currently measured against their own past performance rather than other providers in the same region. Thus, successful ACOs are potentially penalized in future years, while poor performing ACOs realize greater rewards.
CMS will use a phased-in approach to transition to the regional adjustment, with a weight of 35% applied the first year, moving to 70% the second year. CMS also addressed comments on ACOs who may currently have higher spending than their region by allowing for a slower phased-in approach. Initially, the weight placed on the regional adjustment will be 25% in the first agreement period and will increase to 50% in the second agreement period and 70% in the third agreement period.
An ACO's regional service area will be determined by the counties of residence of the ACO's assigned beneficiary population. The regional service area will include any county where one or more assigned beneficiaries reside.
CMS will continue to establish the first year historical benchmark based on Parts A and B FFS expenditures for beneficiaries who would have been assigned to the ACO in each of the three years prior to the start of the ACO's agreement period. However, CMS will now only use assignable FFS beneficiaries for the calculation rather than all FFS beneficiaries.
CMS is also trying to give more incentive to move into Track Two, with downside risk, by allowing for a phased-in transition. CMS will now allow participants to move into Track Two but provides for an additional fourth year of one-sided risk.
CMS did decline to provide an accelerated path into a two-sided track for contracts currently under Track One, which will prevent them from meeting the criteria for advanced alternative payment models (APMs). Because the performance period begins in 2017, these APMs that will be in the second or third year of their agreement period will miss out on bonus payments for 2019.
As of January 2016, there were over 400 ACOs participating in the shared-savings program, serving more than 7.7 million beneficiaries. Most of these are still under Track One, which does not include downside risk. Coupled with the new incentives under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Systems, for which the performance year begins January 2017, organizations should take a good look at the opportunity of taking the plunge into ACOs.
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We understand Medicare ACOs: We have helped launch seven or eight over the past two years. But we also understand that this is just a first step toward taking greater control over the Medicare revenue stream by "moving up the food chain." Our team of veteran executives can help your ACO evaluate the options, manage the workflow to achieve either a Medicare Advantage contract with CMS or a risk contract with an existing MA plan, and continue to achieve improved outcomes Visit our website to learn more >>
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Avoid the Sharp Edges and Prepare for Your Next CMS Audit
How can a health plan steer clear of the sharp edges for which the Centers for Medicare & Medicaid Services (CMS) will be looking? I'd like to focus on the clinical side of both Organization Determinations, Appeals, and Grievances (ODAG) and Special Needs Plan Model of Care (SNP MOC) and being prepared for your next CMS audit of these areas.
For ODAG, what should be straightforward still causes plans to have challenges. CMS monitors that plans:
- Process initial requests in a timely manner
- Use correct clinical criteria
- Ensure a matched specialty when indicated and
- Include external review when indicated
While plans strive to meet these criteria, some still struggle. In addition, as we all learned in our clinical training, if it is not documented, it is assumed to not have been done. Be sure you have the support of a system designed to manage initial determinations and reconsiderations and document well in the system. Remember, CMS will look for a live file review, and you will want to practice so this segment flows well, showing your team to be well-trained and knowledgeable.
Next, let's look at the components of the SNP MOC reviews. Sections 2, 3, and 4 all require clinical attention. CMS will be looking for documentation that you did what you have committed to in the MOC and your policies. Are initial and annual Health Risk Assessments (HRAs) completed, and how is the information incorporated into the Individualized Care Plan (ICP) and the Interdisciplinary Care Team (ICT)? CMS will also expect to see your quality measures as defined in Element 4 of the MOC.
In my presentation on case management at the 2016 GHG Forum, I stipulated that all SNP MOC members must be in case management. Members who opt out still need to be followed by the Case Management team without direct member input. Successful case management requires a supportive culture, well-trained staff, and system documentation using evidence-based tools. Not only is strong case management a CMS expectation ― it is essential to effectively manage a SNP MOC population.
I hope these thoughts are useful as you manage your Medicare line of business. Please reach out to me if you have questions, comments, or would like to discuss health plan support from the GHG Clinical Solutions team at mdashiell@ghgadvisors.com.
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We are now in the Golden Age of government-sponsored health programs, and the opportunities and challenges that come with this shift have never been greater. Learn key takeaways from our recent client Forum on how to survive in government programs. Read now >>
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AEP Marketing and Sales Readiness — Do You Pass the Quiz?
The following are questions Gorman Health Group would ask when conducting an assessment on marketing and sales strategies and execution plans for our Medicare Advantage clients. Take the quiz today and see if you are on track for a successful Annual Election Period (AEP).
If you have answered "no" to any of these questions and you feel you are behind the eight ball — contact us, and we can get you on the right track. AEP is just around the corner!
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Understanding what's working and what's not within your sales and marketing plan is a must in the ever changing competitive Medicare market.Our seasoned veterans will work with your team to redefine sales and marketing strategies that will pay big dividends short and long-term at your plan. Visit our website to learn more >>
Gorman Health Group's Sales Sentinel™ is a flexible, module-based software solution with the ability to onboard agents, provide training, manage ongoing oversight activities and pay commissions. Created by GHG, Sales Sentinel™ was designed to address the specific needs of government managed care organizations. Contact us today to set up a demo >>
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The Formulary Season
It's the formulary season, and you should be in the home stretch for your Health Plan Management System (HPMS) submission. What's on the formulary and what changes were made to the formulary are among the top reasons why members either enroll in or disenroll from a health plan. Manufacturer price increases over the past two years and the number of high-cost specialty drugs released to market make formulary decisions and utilization increasingly difficult and significant to the health plan's bottom line. With an average generic medication utilization rate of 80-85%, there is limited movement to improve. Some thoughts to consider:
Custom vs. Template
Offering a custom formulary targeted to treat a subset of enrollees with a chronic condition seems to be the wave of the future through value-based insurance design. Counterarguments center around a probable increased cost for the Pharmacy Benefit Manager (PBM) administering a custom formulary as well as increased compliance risks for the maintenance and updating of a custom formulary.
Cost-Sharing
Monthly member out-of-pocket cost-sharing for commonly used formulary brand and generic drugs varies widely across Part D plans; for five of the ten top brands, monthly costs can vary as much as $100. Medications (including the specialty tier) with the highest cost share are generally non-formulary brand medications. Non-formulary specialty medications are sometimes ten times higher if they are non-formulary.
Utilization Management
The number of prior authorization (PA) edits approved through the coverage determination request process should be assessed by the plan. If over 90% of the requests are approved, is it really cost effective for the plan (especially if coverage determinations are delegated to the PBM) to continue to utilize the edit? That expense may be better utilized in performing retrospective reviews to ensure medications are being used for approved indications.
Coverage Gap
For 2017, members are responsible for 40% of the cost of brand name drugs and 51% of the cost of generic drugs in the coverage gap. Plans should determine the potential medical costs (emergency room, physician visits, hospitalizations) of members not taking their chronic medications or only taking a subset that they can afford in this coverage gap period. Providing additional gap coverage for medications makes sense in some benefit/risk scenarios.
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The rapid changes to Part D regulations make the tracking and implementation of these CMS requirements exceptionally difficult — to say nothing of actually managing to them. Gorman Health Group's broad array of services can assist you in post-audit remediation, implementation of best practices, PBM contracting and implementation, interim staffing, clinical process re-engineering, Star Ratings improvement, and claims and PDE assessment and adjustments. Visit our website to learn more >>
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How do health plans increase brand recognition and improve brand loyalty?
It is believed brands who engage on social media channels enjoy higher loyalty from their consumers. So why should health plans and health professionals engage in social media?
Social media provides a key opportunity for health plans and health professionals to build relationships with Medicare beneficiaries through social media, develop trust, and collaborate to design future programs to support the needs of the ever-changing Medicare population.
Social media creates an environment where consumers feel comfortable sharing honest feedback and feel a sense of community. Health plans can use this environment to communicate health and wellness tips, upcoming community events, and, as we enter into the Annual Election Period (AEP), these channels can help promote new products and services, help position products for growth, and provide a place to tell a story about your organization and the services you provide.
Are you still asking yourself if social media make sense for your particular audience, or is it a big waste of marketing dollars? Here are a few additional reasons why social media can help drive engagement, satisfaction, and promotion:
Health Plan
- Social media is not just a marketing tool — it is now a business and communication strategy
- Provides innovative ways to communicate with both prospects and members and deliver key messages about your products and services in real time
- Ability to use current members as advocates to share their positive experiences with your health plan
- Influence consumers not easily reached though traditional or direct communication channels
Consumer
- Consumers now play an active role in their healthcare, obtaining real-time data from their doctor and their health plan through their smartphone or tablet
- Allows consumers additional outlets to receive information in the way they feel most comfortable
- Capture the young adults helping their aging parents gain information and help navigate the complexity of our healthcare system
Is your 2017 social media plan in place? Don't miss out on the opportunity to engage consumers with a communication tool to proactively engage, educate, and identify negativity outcomes with current and future members.
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Gorman Health Group an unparalleled track record working with clients in government programs to develop cost-effective strategies and tactics to help plans achieve maximum potential for their products. Visit our website to learn more >>
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Why Do We Make Simple Things So Difficult?
Time and time again, we encounter "the coolest workarounds" ever invented within the government programs space. Said a different way, we encounter staff who are stuck inventing ways to accomplish the regulatory burden upon their shoulders when they don't have the right processes and tools to efficiently do their job. The manual effort and workarounds almost get the job done but ultimately leave the plan short of their end goal. This phenomenon is not just seen in one operational area but is commonly experienced across multiple disciplines within the health plan.
In some cases, we are stuck with the workarounds forever. There is no good system, and there will never be one that eliminates some of these workarounds. The regulatory web is too tangled for good processes and tools to solve for it.
However, in other areas, we have solutions that will eliminate these workarounds and hundreds of hours of wasted manual effort to do some of the simplest things. One example of this is seen with some of the Part C & D Reporting requirements. We have heard horror stories of multiple team members working multiple weeks on nothing but agent/broker reporting requirements. Why? It's not because they want to but because they don't have the right solutions to eliminate the wasted effort. Without the right solution, the process of assembling these requirements in Quarter 1 of each year involves multiple files from multiple systems, which is never an easy task regardless of the department and data.
The Annual Election Period (AEP) is coming, and plans are making their decisions now in preparing agents for AEP. Have you considered the following questions?
• Is your Part C & D reporting for agents/brokers automated?
• Do you have a system that tells you when your agents are ready to sell?
• Are you using automated processes and tools to onboard your agents, or are you using spreadsheets and man-hours?
• How do you verify whether your Marketplace agents have met training and license requirements?
If you answered "no" or currently can not provide an answer to the above questions, Sentinel is the right solution for your organization.
Our clients who utilize the Onboarding and Oversight modules within Sentinel tend to take a vacation while other plans are doing their annual workarounds. Sentinel combines the ready-to-sell program steps, agent oversight allegation tracking, and enrollment information to produce Part C & D reporting requirements that are ready with a few simple clicks.
Workarounds versus vacation—you choose.
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Sales Sentinel™ is a flexible, module-based software solution with the ability to onboard agents, provide training, manage ongoing oversight activities and pay commissions. Read more >>
Join us on Thursday, May 26, from 1-2 pm ET, for an in-depth webinar analysis of the key changes finalized in the new Medicaid regulation, how these changes will affect states and managed care plans, as well as how to adapt. Register Now >>
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