Three Reasons to Invest in the Open Enrollment Period
The Open Enrollment Period (OEP) is back with some new rules. Starting January 1, 2019, Medicare Advantage (MA) enrollees have a one-time opportunity to switch their plan, similar to a grace period. This opportunity ends March 31. Both new MA enrollees and existing enrollees have the opportunity to switch plans. This is a new opportunity for MA plans to both 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 OEP.
Let Your Data Do the Talking
Recognize the power of the data available to you, and utilize that data to develop communications to new and existing enrollees, make organizational and/or operational changes to your operations, and allow this data to eventually feed into your product development process. Utilize leading indicators such as grievances, customer service complaints, rejected claims, and similar data to identify issues. Lagging indicators such as disenrollment surveys, especially if they are “real time,” provide valuable information. Continual analysis of both leading and lagging indicators can fix potential problems, identify members at greatest risk for disenrollment, and provide the basis of building an attrition model to predict members most likely to leave going forward.
Member Services and 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 new members and your existing member communications and interactions with current members to ensure they are best in class. You may want to have member events this year so they understand the 2019 benefits – and if you have great news for them, you want to make sure they hear it. 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. 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. 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 2019 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? Now is the time to reassess how you are communicating with your members and make certain you are maximizing your opportunity.
Marketing 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
- Medicare Supplement
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 free-standing inserts in January or March and/or advertise on TV. Utilize branding during this time since it puts your brand in the market during the OEP. Whatever you have the resources to do, make sure you are strategic in your efforts to make it worthwhile.
It’s 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 me at dhollie@ghgadvisors.com.
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Taking Advantage of Reimbursement Increases & New Benefit Opportunities for MA?
The Centers for Medicare & Medicaid Services (CMS) has provided increases in reimbursement to plans, and Gorman Health Group believes this trend will continue for Medicare Advantage (MA) for the immediate future. So how are you taking advantage of this?
- Are you increasing your service area?
- Are you entering MA for the first time?
- Are you increasing your benefits and lowering premiums in existing plans?
- Are you introducing new products that will be more competitive in the market?
If you answered “yes” to any of these questions, the time to start planning for 2020 is now.
The Notice of Intent is due to CMS on November 12 of this year. You now have less than two months to ensure you have a clear strategy in place if you plan on increasing your service area or are entering MA for the first time. If you answered “yes” to either question #1 or #2, now is the time to do the following:
- Market analysis of proposed new counties you are planning to enter
- Three-year enrollment opportunity analysis
- Development of a scorecard to understand which counties have the best opportunity
- Feasibility study to provide guidance on how long it will take to be profitable
For existing plans that are not expanding their service area, now is the time to do the following:
- Membership analysis by plan including:
o Age
o Geography
o Length of time with plan
o Chronic conditions and how they affect the MLR
o Disenrollment findings
o Plus other data based on the story it tells - Competitive product and benefit analysis utilizing 2019 plans and benefits
- Market analysis
Now is the time to develop your strategy so by 1st quarter 2019 you are ready to start implementing your strategy for new plans and more competitive benefits for 2020. CMS have now given plans enormous leeway in developing benefits—now is the time to take advantage of this opportunity. Today, some benefits will need to have returns on investment, and others will need to be researched to find new vendors to actually provide the benefits. In addition, you need to ensure operational limitations are not hindering you from finding the right set of benefits for your plans.
If you need help, please don’t hesitate to contact me. We at Gorman Health Group are happy to assist in any way.
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Prep for the 2019 Medicare Communications and Marketing Guidelines
I am shocked the 2019 Medicare Marketing Guidelines (MMG) did not come out last Friday since that is when I started vacation. But no… a week later, we are still waiting, and now the wait really starts to impact the development of our marketing strategies and tactics.
In reviewing the April 12, 2018, Centers for Medicare & Medicaid Services (CMS) memo asking for request for input on the 2019 Medicare Communications and Marketing Guidelines, our Marketing team at GHG got together to think about what we would do right now not knowing what the changes are and not being 100% sure if these changes are going into effect. Here are a few suggestions to get your marketing team ready for what we are expecting:
#1 Disclaimers: There is a good chance many of the current disclaimers will be modified and/or deleted. This should not stop you from developing creative materials, although you should have some alternative copy ready to be utilized if the majority of disclaimers go away. Some ideas to consider:
- Laundry list of most important benefits
- Additional “call to action” copy to get prospects to either call you or go to your website
- Copy that clearly states your differential in the market – and it doesn’t matter if this is a repeat of copy. Repeating the most important points you want a prospect to remember is an important strategy!
#2 Font Size: If CMS no longer mandates that all marketing materials have at least a Times New Roman 12-point font type, it will be much easier for the Marketing teams to fit in additional copy points. You may want to develop materials in 11-point and 12-point font to see what extra space you may gain. You may be able to utilize some of the ideas above to help increase marketing points, especially on postcards. Although remember – those whose eyes are over age 65 are not able to read very small type, and if you reverse out the type, it may become illegible, so we would not recommend anything smaller than 11 point font.
#3 Referrals: If CMS allows you to announce that you can offer a gift for a referral and you can request email addresses when asking for referrals in addition to the mailing address – start planning for a mailing now! What free gift could you provide for a referral? Think about allowing members to send referrals to the plan by email, phone, as well as mail so you can utilize these leads quickly for the Annual Election Period (AEP).
#4 Business Reply Cards (BRCs): BRCs that do not mention plan-specific benefits do not need to be submitted into the Health Plan Management System (HPMS). Make sure now that your BRCs do not mention benefits. This is an easy fix—make it now.
#5 Provider Communications: CMS is expected to clarify it is not a violation of CMS marketing requirements if contracted providers notify their patients that the contract status between the provider and the plan/Part D sponsor is changing. We have seen many plans this year developing benefits and products with their providers. Utilizing providers to communicate this relationship during AEP is important. You don’t have to wait for the guidelines to be released on this one – it is already allowed!
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Benefits are Submitted. What’s Top of Mind for 2019 Marketing and Sales? Learn more
Whether you need help establishing an effective member experience or member communication strategy, cataloging and evaluating existing member communications, or identifying opportunities to streamline and strengthen your member engagement tactics or interventions, we can help. Read more here
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Benefits are Submitted. What’s Top of Mind for 2019 Marketing & Sales?
Now that benefits have been submitted, the emphasis is turning to Sales and Marketing. When speaking with different Medicare Advantage plans across the country, you start to hear different things about what is going to be important for Marketing and Sales this Annual Election Period (AEP) and Open Enrollment Period (OEP). Here is some of the top “buzz” we have been hearing from plans:
- Bigger marketing budgets for 2019! Many MA plans are happy with their 2019 MA products and want to take advantage of this opportunity to grab market share. We see increased spending in New-to-Medicare programs, AEP direct mail, and social media especially.
- More diverse sales distribution strategies are coming into play this year. We have seen many MA plans really diversify their sales strategies and do the following:
- Increase Field Marketing Organization (FMO) arrangements and number of contracted agents.
- Pay attention to the metrics of the telesales team and either decide to outsource this function or develop much stronger training internally, plus build a more solid process to get leads to the proper sales channel quickly instead of just sending out sales packages and delaying the sales opportunity by several weeks.
- Build web strategies to increase online sales, especially to the New-to-Medicare segment.
- OEP is back! We have spoken to several MA plans about this new/old enrollment period, and here is what we are hearing from the marketplace:
- Make sure onboarding is perfect since you no longer have nine months to change a bad first impression. Make sure prospects understand what to expect when they enroll, and meet that expectation.
- Show the love to both your new members and those you have determined are most likely to leave in the first quarter. Member meetings with food help drive attendance as well as welcome calls.
- Although MA marketing is not allowed during the OEP, there are a few different ways to ensure your name is reinforced during the OEP:
- New-to-Medicare programs – running a few free-standing inserts might be helpful
- Brand marketing TV in the first quarter
- Medicare Supplement marketing, especially in January if you have Medicare Supplement
- Ensure your agents (both internal and external) understand the OEP rules and make the most of bringing you sales during this time
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Blending Network Strategy and Product Strategy
As more and more health systems and provider organizations successfully manage the shift from patient care to population health management, long-term health plan strategic planning should be blending network strategy with product strategy as a key indicator of the ability to achieve clinical and financial goals. The majority of providers are savvy at managing pay for performance and upside risk arrangements, and as providers have seen the margins narrow and plateau, plans have had to adapt and move beyond simple incentivizing for behavior change. We heard from the Centers for Medicare & Medicaid Services (CMS) the Accountable Care Organizations (ACOs) with upside-only risk have not performed as well or increased savings in comparison to those ACOs with downside risk and skin in the game. Systems that have ventured into managing downside risk and percent of premium arrangements and that have been successful have an appetite for more. Certainly moving up the food chain from a provider to a payer has been a topic of conversation among CEO’s of large integrated delivery systems. They have worked hard to align physician trust and referral networks, build a strong name brand in their local communities, and negotiated contracts with health plans that have met and exceeded care and cost containment goals, and the question of where do we go from here is top of mind.
As we have met and strategized with provider systems from baby steps to pay for performance to negotiating their first risk deal, there has been and still is, in some cases, a strong reliance on health plans to set clinical pathways and benchmarks. From the provider perspective, the reporting and transparency with the plan partners has been a key consideration in whom to collaborate with and how they have set internal benchmarks. However, systems are starting to realize and explore the administrative support organizations available and stepping out on their own to become a Provider-Sponsored Organization (PSO), which doesn’t seem as scary as it may have five years ago. Still, in meeting with providers, the biggest misconceptions have been what does it mean to be and how do the requirements differ from a PSO versus a Provider-Specific Plan (PSP-Narrow Network), do we meet the requirements, and what is the best option for us?
The answers to those questions spark the first steps when we begin to traverse the local healthcare landscape and blend the network and product offerings. Diane Hollie, our Senior Director of Sales, Marketing and Strategy states “Brand is very important when blending two organizations. Will members be buying the Plan for its reputation and benefits or will the Hospital System attract a member base the Plan is currently not attracting and why?”
When plans and providers consider entering into a co-branding PSP (aka Narrow Network) options, a few key considerations are:
- The majority of Narrow Network PSPs are Health Maintenance Organization (HMO) products and have risk-sharing contracts.
- Increase in volume – Can the health system handle the influx of new patients? If the primary care system is at capacity, what is the strategy to ensure new Medicare members are seen timely?
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Pressure Test your 2019 Expansion Strategy in 3 Steps
Do it now! Get your benefit strawman, enrollment projections, and financial goals developed before benefit season begins!
Step 1: Market Analysis – Hopefully you have already performed this step before you submitted the Notice of Intent to Apply (NOIA), but if not, it’s not too late. A market analysis typically includes the following:
- Penetration analysis
- Enrollment trends and market share
- Product trends and growth patterns
- Competitive analysis
- Premium and benefit trends
- Demographic analysis
Now that the 2018 benefits have been released, it is time to relook at the product, benefit, and premium trends through a market analysis to see what has changed so you are fully prepared for the beginning of benefit season in February 2018. The Gorman Health Group (GHG) Marketing team was just evaluating a new product for a client and discovered their competitors added three new plans for 2018. This changes how you look at the market. It is important to understand how your clients changed their product and plan portfolio for 2018 and then look at the 2018 Annual Election Period (AEP) results in February to solidify your market analysis, but you will want to start building your strawman of benefits and premiums now.
Step 2: Market and Enrollment Opportunity – Understanding your market opportunity is critical, and too many times a Medicare Advantage (MA) plan develops enrollment projections on the back of an envelope or in a board meeting instead of looking at the market and understanding the “real” market opportunity. Understanding the market potential and then looking at how much of the market you will be able to gain is a much better way to estimate your enrollment projections.
Our Product team recently worked with a client who was trying to determine why there was such a variance between their current sales results and enrollment projections. During GHG’s review of the client’s enrollment projection methodology, GHG identified certain demographic and market considerations were not included despite being taken into consideration when developing their marketing and sales strategies.
“These exclusions [demographic and market] are common,” says Nilsa Rudisill, Vice President, Sales, Marketing & Strategy, “and even more so is disconnect between company enrollment projections and sales and marketing strategies.”
Step 3: Financial Feasibility Study – The next step is to pressure test your hypothesis with a financial feasibility study. Although a feasibility study is not an actuarial study, it does test whether a hypothetical benefit design could work in a target market based on revenue and cost characteristics of that market. It also takes into account assumptions about the Centers for Medicare & Medicaid Services (CMS) payment trends, enrollment, premium and costs, and projected enrollment over a period of five years.
GHG’s Finance, Marketing, Sales and Product teams work very closely together to customize the assumptions that impact this study for our clients based on level of comfort, capabilities, and growth opportunity, even if it means the overall opportunity does not look promising in the end. For example, this study was performed for a client who was interested in offering a Special Needs Plan statewide. Although the financials appeared sound, we looked beyond the numbers to tell the client “what it really” takes to launch a successful product in their particular market by providing multiple financial scenarios, including a scenario that appeared less profitable in the short term but actually more manageable as a company new to MA.
This process allows you to make smart, informed decisions about your current or potential market without all the investment upfront. This type of process is not a one and done! It tends to be a very iterative process to understand how to dial the levers in the market to see if and when you can expect profitable growth. So take the time now to get it done right, or spend the money later by guessing incorrectly.
Resources:
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
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Now Is The Time To Start Planning For 2019 Medicare Advantage Growth
Here are three planning questions you need to ask yourself right now:
- Are you losing market share because you are not offering the right products or product mix?
- How could the profitability of your Medicare Advantage (MA) enrollment change if you expanded your service area?
- Is now the time to begin offering an MA plan?
There is a proven process to go about answering these questions.
The first step begins with a market analysis to assess both current and/or proposed markets. Looking at market enrollment trends and understanding the market demographics with product and premium analyses help you understand what levers are driving the market. Plus, a benefit analysis starts to show which benefits at which premium price points are most favorable.
You then want to take the results from the market assessment and build an enrollment projection to understand what the five-year trend might be with a new product at a certain benefit level and price point or how your current product might perform in a new service area.
The next step is to pressure-test your hypothesis with a financial feasibility study. Although a feasibility study is not an actuarial study, it tests whether a hypothetical benefit design could work in a target market based on the revenue and cost characteristics of that market. It also takes into account assumptions about the Centers for Medicare & Medicaid Services (CMS) payment trends, enrollment, premium, and costs.
This process allows you to make smart, informed decisions about your current or potential market without all the investment upfront. Now is the time to start planning since the Notice of Intent to Apply (NOIA) is right around the corner in November. This type of process is not a one and done! It tends to be a very iterative process to understand how to dial the levers in the market to see if you can develop additional, profitable growth. So take the time now to get it done right, or spend the money later by guessing incorrectly.
Resources:
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>
Addressing Key Questions on the 2018 Medicare Marketing Guidelines
We had a fantastic turnout for our webinar last week on the 2018 Medicare Marketing Guidelines (MMG). Something I’ll reiterate is that the MMG are for everyone. Nilsa Rudisill and I had plenty of spirited discussions when working to narrow down the content to fit in a single hour. We know your time is valuable, and we appreciate everyone’s attendance.
Some great questions were received that Nilsa and I thought would be beneficial to share in case others in the industry are contemplating similar themes. Some of our clients even shared their responses from the Centers for Medicare & Medicaid Services (CMS). While we cannot share those specific responses, it does confirm to us there are ambiguities in certain sections, and the agency is responding in a timely manner. Therefore, if you are in doubt, reach out!
- Let’s address the sample Summary of Benefits (SB), a key document for beneficiaries. By no means is the sample a “model” document in the same vein as CMS releases model Evidence of Coverage documents. Most readers already have their SBs under development, which is great.
- A few questions came in pertinent to the submission of events to CMS in the Health Plan Management System (HPMS). When does the change take place? The guidance applies to 2018 activities. Unless CMS says otherwise, continue to submit events pertinent to the 2017 plan year.
- Does the change in HPMS submission of events signal a change in surveillance activities? From the outside looking in, the answer is yes. CMS used the information submitted by sponsors to select events for surveillance. A change in the agency’s direct monitoring activities should not change your own internal monitoring and auditing, unless, that is, you already know you need to step it up.
- How should Scopes of Appointment (SOAs) now be tracked? Nothing much has changed. The documentation may be in writing in the form of a signed agreement by the beneficiary or a recorded oral agreement. Any technology (e.g., conference calls, fax machines, designated recording line, pre-paid envelopes, and email) can be used to document the SOA. Remember, you must document the scope of the appointment prior to the appointment. Be prepared to demonstrate this in your documentation.
As we’ve stated before, you’ve got to wonder if each revised chapter CMS issues is a collection of lessons learned from the previous period of time. Regardless, the agency seems to be streamlining and refining guidance not only to ease burden on sponsors but to also provide necessary clarification as needed. What changes are impacting your organization and to what extent? Contact us on ways we can help your operations be successful in implementing the MMG.
Resources:
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>
Digital Marketing in the Medicare Advantage World
“Internet shopping rates have surpassed the rates of all other shopping activities.” As marketers, we have heard for years now that omnichannel is the way to go and that baby boomers are online. But we still see a lack of focus on digital in many Medicare Advantage marketing strategies. Deft Research’s “2016 Age-in Study” shows for the first time that internet shopping is the highest utilized channel for researching products (the shopping part) among age-ins in 2016. Clearly, digital can no longer be considered an additional channel—it is the channel. And the best thing about digital marketing, it is data-driven. In nearly real time, you have the opportunity to understand what is working and what isn’t.
So, now that you are underway with pre-Annual Election Period (AEP) marketing and implementing your sales and marketing strategies, how does your digital marketing stack up? Consider the following…
- Be the local authority on Medicare Advantage: Not only ensure that you are the result in local website searches on Medicare Advantage but that your Medicare Advantage website includes educational information. Think easy-to-read visuals and 10-minute educational videos intended to provide common answers to Medicare Advantage questions and explain Medicare Advantage to those aging in. Consider making these videos searchable on video sharing sites like YouTube, then post your videos on social media sites like Facebook, Instagram, and Twitter. You want beneficiaries in your service area to go to you with their questions, not your competition.
- Internet shopping tool is a must! Internet shopping is the most widely used shopping channel by the Medicare Advantage age-in population. As more baby boomers age in to Medicare, this trend is expected to continue. If you don’t have an online shopping tool, make this a priority now. The shopping tool should support a potential member in clearly comparing plan options all the way through to completing an enrollment form.
- Current member email and cell phone communication programs (MA or other lines of business)Traditionally, email and cell phone communication programs have been rare in the Medicare Advantage world, but for the younger population, this method of communication is expected. It is what they are used to pre-Medicare Advantage. As we see more tech-savvy and internet-savvy beneficiaries, there is a huge opportunity to stay connected with your members, drive Star Ratings, and keep your members happy and healthy. You may want to consider care management text messages, reminding members of upcoming doctor appointments, seasonal at-home care tips (e.g., allergy season, flu season, etc.), and targeted medical tips and information for members with certain clinical conditions. And finally, when developing your mobile strategy, Gorman Health Group recommends considering a mobile application that allows members to access their personal, password-protected member portal. We recommend enhancing your member portal to include not only newsletters, member education videos (see #2) and plan information but also premium payment abilities, claims status checks, and doctor appointment tracking.
Interested in giving your marketing strategy a digital boost? We are here to help! Contact GHG today to see how we can partner with your Marketing team to develop a robust digital marketing strategy.
Resources:
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>
Three Reasons Why Pre-AEP Marketing Is Critical
One of the reasons healthcare marketing is so interesting is that it’s never static for long. Once you think you have it figured out, something changes in the mix. Pre-Annual Election Period (AEP) marketing is one of those phenomena that changes the mix in AEP marketing. If a pre-AEP marketing strategy is not in your marketing plan this year, here are three reasons why you may want to reconsider:
- In working with plans across the country, many are finding the pre-AEP mailing to be the most cost-effective mailing in the AEP mix and also generates the most leads. Typically, these are inexpensive mailings or postcards that arrive in the mailbox the latter part of September – right before AEP.
- Since the Centers for Medicare & Medicaid Services (CMS) states plans/Part D sponsors cannot market for an upcoming plan year prior to October 1, you must develop advertising that is very generic in your messaging, can be informational and educational, and utilizes direct response-oriented language with a very strong call to action to generate a response. This strategy seems to be paying off.
- When a plan is new to the market or introducing a new product to the market, multi-channel, pre-AEP marketing has been found to be very productive. Advertising the brand and/or hinting of something new helps build recognition, chatter, and leads before the full barrage of marketing begins in October, especially for new plans. Although this type of marketing may not have a strong return on investment by itself, it can be measured in the overall AEP marketing analytics.
Whatever your situation, we have seen pre-AEP marketing take many different approaches – with a few that appear to have crossed the line – so make sure you “stay within the lines” of CMS’ regulations with your pre-AEP marketing. We would be happy to assist you with developing a pre-AEP strategy to help you meet your goals.
Resources:
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>