Sales Force Oversight Ain't Easy
Selling season is nearly upon us, so with that in mind, here are some thoughts to help plans prepare. In this post, I'll detail some sales oversight and reporting best practices we've seen applied with success in a number of plans.
When creating an effective agent oversight program, keep in mind that agent oversight requires a program, not a process. There is really no single indicator that can identify all outliers. A successful agent oversight program requires a collection of metrics that - when combined - paint a clear and concise picture of an agent or group of agents' performance.
Some of the data we often see included in effective oversight programs includes:
- OEV Calls
- Secret Shopping
- SOA Audits
- Rapid Disenrollment
- Ride-alongs
- Sales Call Monitoring
One of the most challenging aspects of agent oversight is often that the data needed to execute powerful reports can originate from a number of different sources. For larger plans, this task is even more challenging because of divisions between departments. Therefore, don't try to reinvent the wheel when designing these reports; plans can create and track a number of different oversight metrics from data that is readily available from enrollment.
There are quite a few potent reports that can be developed to assess agent/broker risk, (at both the plan level and individual level). These can be created using just a monthly enrollment report (TRR & MMR) combined with various data points from the activities listed above that your sales management should be tracking. Keep in mind - whichever reports are developed — use them in unison: tracking by one data point must become a practice of the past.
Here are some simple best practice reports we suggest:
- Percentage of Direct Oversight activities not met (combined pass/fail from secret shops, OEV calls, SOA audits, etc.)
- Rapid Disenrollment Rate (set benchmarks)
- Complaints vs. Agent Assisted Enrollments (create acceptable thresholds)
Finally, once the oversight program is in place and agents are in the field actively selling, make an effort to run two self-perpetuating oversight processes. The first involves pulling a random selection of active oversight activities from the population to identify potential outliers. Then, once outliers are identified from either the random sampling process, or through adverse behavior, plans can administer more focused activities.
I hope these strategies were helpful. Stay tuned to the GHG blog for more tips for successful selling this season!
RIP Harry Gorman, Conservative Agitator, Patriot
I lost my 98-year-old grandfather last week. Harry Gorman was a hugely influential figure with his 2 sons, his 4 grandchildren, and his 7 great-grandchildren. An immigrant Jew who lost most of his family in the Holocaust, he was a husband, father, printer, diamond-cutter, inventor (he invented the cardboard phonograph record, which my contemporaries will recall on the backs of cereal boxes or in National Geographic magazines in the late '60s and '70s), mayor, philanthropist, gardener extraordinaire, dance instructor, naturalist, a hard-core right-wing conservative agitator, and a patriot. He taught me much about politics (though we didn't agree on much), work ethic, entrepreneurship, and importantly, how to die well.
Until his last breath my grandfather warned obsessively in his daily blog posts about the decline of the American economy, about the "traitorous" conduct of our elected officials on both sides of the aisle who allowed our national debt to spiral out of control, about the dangers of doing business with China, about the hazards of illegal immigration (though a refugee himself, one of his more famous essays was titled "Joe Legal vs. Jose Illegal"). His blog -- "Grandpa's Cleansing Shower" lives on here -- but I accept no responsibility for those offended by its content. You were warned: the guy was brilliant but frozen in 1950s American values and was somewhere to the right of Genghis Khan (e.g., his post "Motherhood -- Still the Most Beautiful Career in the World" -- a great poem imploring women to stay home with the kids. Yeesh).
Like I said, we didn't agree on much. He practically had a stroke when I told him I was going to work for President Clinton back in 1993. But you always knew where Harry came down on an issue, and his passion was based on a primordial love of this country. How many nonagenarians do you know who daily implored his peers to call their elected officials? His many years of successful public service as Mayor of Greenville, NY — he was re-elected but only served two terms as a term-limit advocate, and never left office with a budget out of balance -- showed him how politics can work — or fail. He talked the talk because he had walked the walk.
He was a true conservative, who held conservative values but who also believed in conservation and naturalism, a
Roosevelt-style environmentalist. He was as fascinated by the behavior of lionesses or honeybees as he was about the national debt. He and my late grandmother were fanatical gardeners, born of an abiding fascination with God's wonders. He would see God's hand in a perfect ripe tomato or a fish from his pond. At its height they could have fed half of Greenville with that magnificent garden of theirs. Making things grow -- whether it was flowers, cucumbers or great-grandchildren -- was Harry's greatest joy.
Harry firmly believed you don't stop laughing because you grow old, you grow old because you stop laughing. You don't make it to 98 without a few laughs — especially about the serious stuff he trafficked in. His last joke to me, about a month ago : "Johnny...a liberal, a conservative, and a moderate walk into a bar. Bartender says, ‘Hello, Mitt.'"
He was a tortured man, screaming his warnings of America's decline to anyone who would listen, driving himself slightly mad by his inability to do anything about it except make noise. He failed 2 suicide attempts in his last year. If he was serene about anything, it was his readiness to die, and he welcomed his final peace. He made his wishes clear, and he passed comfortably in his sleep, with the dignity he deserved and insisted on. His passing reconfirmed my passion for end of life issues -- we should all die so well, and so well prepared.
Andy Rooney once said "The best classroom in the world is at the feet of an elderly person." He was right on. Harry Gorman, patriot and patriarch, is missed, but his lessons that stand the test of time will live on.
Right-Wing Senators Offer Competing Medicare Reform Plan
Things are getting more and more curious on the Hill as various factions line up to offer their Medicare reform proposals to kick off budget season. Four far-right Senators -- Rand Paul of Kentucky, Mike Lee of Utah and South Carolina's Lindsey Graham and Jim DeMint -- will unveil a plan Thursday that would transition Medicare beneficiaries into the same health care program offered to federal employees, while gradually increasing the eligibility age and means testing. The proposal arrives less than a week before House Budget Chairman Paul Ryan, R-WI, is expected to release his own Medicare overhaul plan in a fiscal 2013 budget proposal.
The plan would allow seniors to enroll in the Federal Employees Health Benefits Program (FEHBP) beginning in 2014. Everyone in FEHBP pays the same premium, and plans must accept all comers. The proposal would literally phase out the existing Medicare program over an unspecified time period. Instead, seniors would be able to choose from the same options that federal employees (and Members of Congress) have. The proposal "provides Medicare patients with the best health care in America and will forever protect seniors' interests by aligning them with self-interested politicians," a fact sheet said.
Under the senators' bill, the federal government would subsidize three-quarters of the cost of the average plan for enrollees. To prevent health care plans from selecting only the healthiest patients, the government would pay plans 90 percent of the total costs for treating the top 5 percent of their most expensive enrollees. The plan would gradually shift the eligibility age for seniors by three months annually until it reaches 70 in 2034. Wealthier seniors would pay a greater percentage of the costs, and Medicaid would provide assistance to low-income seniors. Republican staffers estimated that the plan would reduce the deficit by $1 trillion over 10 years and reduce Medicare's gap between the cost of promised benefits and its revenue from taxes and premiums by almost $16 trillion over a 75-year window. They also said the bill would save individual enrollees $1,500 per year in out-of-pocket costs.
While from a policy standpoint this isn't a bad concept, in reality this thing doesn't seem to stand a chance in hell. Just giving credence to Democrats' "MediScare" talking points that the GOP wants to "kill Medicare as we know it" -- as it does -- seems a kiss of death, especially in an election year with most 65+ voters more nervous than a long-tailed cat in a roomful of rocking chairs. But it's the timetable of their proposal that also provides a stiff headwind: it would go into effect in 2014, when most other proposals have delayed changes into the next decade so seniors currently enrolled in the program would not be affected.
In his fiscal 2012 budget proposal, Ryan proposed transforming Medicare into a system under which seniors receive government payments to purchase private health insurance plans beginning in 2022. Supporters compared the system to the federal employees' health plan, but Democrats derided it for ending traditional Medicare, saying it would endanger guaranteed health care coverage for seniors.
Ryan will introduce his plan next week with new wingman Sen. Ron Wyden, D-OR, which would create a new competitive insurance marketplace in 2022. Ryan/Wyden would allow seniors to choose between approved private plans in the marketplace and the traditional fee-for-service Medicare model. It would control costs by giving seniors an annual federal subsidy to help pay for the approved private plans or traditional Medicare.
Wyden said this week that he was encouraged by North Dakota Democrat Kent Conrad's enthusiasm for the proposal during a recent hearing of the Senate Budget Committee, which Conrad chairs. Wyden said he would spend the rest of the year trying to build bipartisan consensus for addressing Medicare. With the Senate's most conservative members laying down their own marker, the elusiveness of election-year consensus may be compounded.
Romney Declines Medicare Coverage, Confirming "1%er" Label
Gov. Mitt Romney turned 65 this week and, strangely, announced that he won't be signing up for Medicare to stay on private insurance. In doing so he served up another softball for Obama and his opponents for the nomination.
The decision puts Romney in a tiny minority: the vast majority of seniors choose to participate in Medicare. Nearly all seniors are automatically enrolled in Medicare Part A, which covers hospital care -- but they can choose not to use it. But 95 percent of seniors choose to enroll in Medicare Part B, which covers physician services, once they're eligible, according to the Kaiser Family Foundation.
Medicare is likely to be a significant issue in the presidential race, and Democrats will use Romney's decision to demonstrate that he is out of touch with the average American senior. They're already preparing to hammer him over his promises to transform Medicare with a plan similar to the one proposed by House Budget Committee Chairman Paul Ryan.
You'd think a candidate with relatability issues like Romney has would be looking for any opportunity to have a prop like a Medicare card to wave and say "I'm one of you." Instead, he's only confirming his status as a "1%er" who's dangerously out of touch with average Americans. This strikes me as the healthcare equivalent of his recent gaffe that his wife drives "a couple of Cadillacs" -- "we have Cadillac insurance, too -- you folks take the bus." Man, this guy has a tin ear for how his wealth plays among the public.
As GOP's Kamikaze Culture War Continues, the Senate Slips from Its Grasp
The Wall Street Journal reported on what we've been speculating on: that the GOP's renewed culture war is calling into question the party's ability to recapture the United States Senate this year. "The GOP is facing a tougher fight on a landscape that hasn't stopped changing. In states such as Maine, Nebraska and North Dakota, Senate races that had once looked like slam-dunks for the GOP have become far more competitive. Democrats may not win all those states, and they are still at serious risk of losing their majority. But they are forcing Republicans to fight on a much broader and more expensive battlefield. The result is that the campaign for the Senate, which was already promising to be one of the fiercest fights of the year, is beginning to resemble the topsy-turvy GOP presidential primary, characterized by sudden shifts in fortune among candidates."
Since the 2010 midterms, Democrats have worried about their grip on the Senate, an institution that is crucial for both parties given the current political alignment in Washington. Democrats hold a 53-47 majority. Of the 33 Senate seats up for re-election, 21 are Democratic and two are independents who caucus with the party—and many are in conservative states. The party's standing was further eroded by a string of retirement decisions. Incumbents in swing states including Wisconsin, New Mexico and Virginia said they wouldn't seek new terms, turning what would have been safe Democratic seats into competitive races.
The Journal examines 4 prominent races that have recently taken turns in the Democrats' favor, especially last week's shocker that centrist Republican Senator Olympia Snowe wouldn't seek reelection after all. In Maine, that virtually clinches the seat for popular former governor Angus King, a left-leaning independent.
The biggest question to my mind is how the eventual Republican nominee effects the down-ticket races like Senate seats. It's now obvious that the race will now stretch well into May -- and possibly the convention itself in August in Tampa -- before a nominee becomes clear. In the interim we're likely to hear more culture war fodder as Santorum tries to force Gingrich from the race and further differentiate himself from Romney. If the nominee is Santorum, I'll say it here: not only will the GOP lose the Presidential race, they'll snatch defeat from the jaws of victory in the Senate too. And if it's Romney, the enthusiasm gap will strongly favor the President and incumbent Democrats defending those 21 seats.
Garry Trudeau, the genius behind the comic strip Doonesbury, cited the biggest reason for the Republican's loosening grip on the Senate best: "For some reason, the GOP has chosen 2012 to re-litigate reproductive freedom, an issue that was resolved decades ago. Why Santorum, Limbaugh et al. thought this would be a good time to declare war on half the electorate, I cannot say...I thought reproductive rights was a settled issue. Who knew we had turned into a nation of sluts?"
The End of Health Insurance?
Writing in the January 30 New York Times, Zeke Emanuel and Jeffrey Lieberman predict that accountable care organizations will totally replace health insurance within the next eight years.
They credit the health care reform act with establishing this revolutionary new form of care, in which claim processing is unnecessary, and ACOs will perform the risk-pooling function of insurance. This is uninformed twaddle raised to breathtaking heights.
First of all, the affordable care act did not create accountable care organizations. They have been around, under different names such as capitated physician groups and independent practice associations, since the San Joaquin Foundation for Medical Care pioneered the concept in the 1950s. If the notion of capitated groups of physicians hasn't supplanted health insurance over the past sixty years, it's hard to understand how the affordable care act will suddenly cause that effect now.
What the ACA did do was authorize a variant of ACO as an adjunct to the fee-for-service Medicare program (and set up a largely ignored demonstration program for pediatric ACOs under Medicaid). Unlike the imaginary ACO that Emanuel and Lieberman conjure up, the Affordable Care Act version is based on fee for service payments, not capitation. While the Pioneer demo program will experiment with capitation, the vanilla ACO version authorized under health care reform requires that all healthcare providers continue to submit claims and receive fee payments from Medicare. How does this threaten health insurance? It doesn't touch the non-Medicare world at all, and it consciously avoids changing benefits or payment mechanisms in the nation's largest health insurance scheme, Medicare itself.
Emanuel and Lieberman assume that ACOs will be paid on a per capita basis, and that the capitation will somehow flow from the ACO to individual practitioners. In practice, this process requires the enrollment and claim processing functions of an insurance company. From whom, if not insurance companies, will payment be received? They rightly note that about 60% of people who receive coverage from employers are actually insured by the employer, who contracts with an insurance company to perform the tasks of determining eligibility, paying claims, maintaining networks of health care providers (including ACOs of various descriptions), and providing insurance to protect the employer from unusually large claims. How would a Medicare program designed to reward efficiency have any impact on these employer programs?
They envision ACOs pooling risk for populations of 15,000 or more beneficiaries, as insurance companies do now. Any that do so will come under state insurance statues, and will either have to become insurance companies themselves, or contract with insurance companies as risk-bearing provider organizations. Someone, either the ACO or an upstream carrier, will have to carry the reserves and comply with state mandates.
With the advent of health insurance exchanges, it is probably that local provider organizations will be able to develop and market their own insurance plans in competition with the national giants. The exchanges will create a retail marketplace in which the advantages enjoyed by the large carriers in marketing wholesale to employers will be diluted. But make no mistake, these new entrants will still be insurance companies, and will still need to operate in compliance with both the statutory requirements and economic realities that govern the business of health insurance.
WSJ asks, "Can ACOs Improve Health Care While reducing Costs?"
Specifically the question that the WSJ posed in its article on January 23 to three health industry experts, (Don Berwick, former CMS Administrator, Jeff Goldsmith, President of Health Futures and Tom Scully, CMS Administrator from 2001-2004) was whether ACOs are the answer to what ails the health care system. As expected, the response from each of the three respondents differed in outlook, driven by their political, professional and personal perspective.
Don Berwick as the "architect" of a series of innovate healthcare delivery demonstration programs, including Medicare ACO's, obviously is pro ACO - citing the goals inherent in ACO formation as improved quality of services, access and consumer choice, provided at a reasonable cost and accomplished by changing the relationship between provider, consumer and payer.
Mr Goldsmith questions the value of ACO's, citing that ACO's are self serving, not provider friendly, expensive to implement, (an ACO implemented in a midsized market will cost about 30 million) and most importantly don't save patients any money while dictating to the patient the timing, type and quality of treatment available.
Mr. Scully takes a more middle of the road approach, indicating that he likes what Mr Berwick is trying to do but argues that programs like ACO are not significant change agents with respect to timing and incentives. In his opinion ACO are just one minor part of a much larger solution, as yet undefined, that must be achieved to effect significant change in how the US provides healthcare. He does go on to offer a number of recommendations as to how to pay providers, believing as so many do that financial incentives are a more effective tool for changing provider and consumer behavior than any other.
My response is that their opinions about what is good and not so good about ACO's and what is needed to get us out of the healthcare mess we are in is reflective of the debate as a whole. Namely that there is no one size fits all solution to what ails healthcare as it is provided and priced.
ACO's are not a panacea solution for what ails health care. It is not a model that can be replicated in all parts of the US via a rubber stamp process. The financial drivers underpinning the ACO enterprise is not a win/win proposition for everyone that makes a living from the healthcare industry.
Accountable Care Organizations are one tool out of an as yet ill defined tool box designed to help "fix" a healthcare system that is crashing around our ears. ACO's offer a pathway for better coordination of services, better communication between provider and patients, a hopefully more realistic approach to patient diagnosis and treatment planning and ultimately a framework within which patients are more engaged in deciding what is best for them when it comes to healthcare,.
Oh and about that 30 million dollar pricetag for implementing an ACO. Think about what an ACO is to do, i.e. organize care, offfer access to that care and provide better patient" thru put" in the inpatient and outpatient setting. Does that really cost 30 million to accomplish per enterprise?
We spend a lot of time, energy and resources talking about and reacting to the shortcomings of our approach to health services provision and pricing. Those critical of initiatives like the ACO enterprise argue that it is not new, hasn't worked , is doomed to fail, etc.. What strikes me is that we spend a lot of time looking backwards to chart the future. Doing so makes it difficult to see what might be ahead when focused on what was and is.
I believe that every problem has a solution and sometimes those solutions are not grounded in the past but are new, innovative and to coin a phrase, (just kidding) must reflect out of the box thinking. Anyone up to the challenge?
Obama and Boehner Have Forever Changed the Medicare Debate
President Obama and House Speaker Boehner may have failed to strike a "grand bargain" on the nation's deficit, but they have accomplished one thing in our world: they have forever changed the terms of the Medicare debate. There is an air of inevitability about some of the proposals they have put forth brewing here in DC.
Obama says he could accept "means testing" the program, which would require affluent seniors to pay more for services. Obama used himself as an example of someone who would pay a higher rate. Obama has also been open to other proposals, including charging co-pays for home health services and for lab work.
Obama also floated on several occasions a provision that would raise Medicare's eligibility age from 65 to 67 -- one that Boehner agrees with him on. In doing so, they gave a controversial idea legitimacy and high political cover. The concept is now likely going to be a fixture in the Medicare debate.
The idea has drawn some support from the GOP in the past. Senators Tom Coburn (R-OK) and Joe Lieberman (I-CT) introduced a bill last month moving the eligibility age up by two years, and Democrats ran from it like scalded dogs. Senate GOP Leader Mitch McConnell didn't endorse the proposal but applauded the effort. Grover Norquist -- the guy behind the GOP's stalwart refusal to move one inch on taxes in this debate -- backed it too.
Under the ACA, in 2014 insurers are banned from turning down any patient — and that could make increasing the eligibility age an easier pill to swallow because 65-66 year-olds would ostensibly have access to coverage in the exchanges. It also means that any increase in eligibility age is unlikely to pass until the exchanges and subsidies are in place in 2014.
The "agreement" between Obama and Boehner -- before talks collapsed last week -- bumped up the eligibility age from 65 to 67 over about two decades. One approach called for increasing the age by one month per year beginning in 2017 until it reached 66 in 2029. In 2030, it would increase two months each year until it hit 67.
The Congressional Budget Office said raising the eligibility age to 67 would save $125 billion over 10 years, adding that the savings would be somewhat reduced by new spending on Medicaid and insurance subsidies to cover the uninsured 65- and 66-year-olds. It's still too big a number to ignore when the bills come due next month.
Expect to see a lot more discussion about these ideas in the coming weeks as we hopefully find our way out of this looming mess. I'm turning 43 next week -- and my retirement plan assumes no Medicare or Social Security for me or my wife by the time we're ready for it. Our generation should be prepared for a very different look to Medicare now that the once unthinkable has become a fixture of the debate.
Obama is the Best Conservative President since Bill Clinton
An interesting article by noted wild-eyed liberal* Bruce Bartlett.
*Bartlett served on the staffs of Congressmen Ron Paul and Jack Kemp and Senator Roger Jepsen; as staff director of the Joint Economic Committee of Congress; senior policy analyst in the Reagan White House; and deputy assistant secretary for economic policy at the Treasury Department during the George H.W. Bush administration.