March 25, 2021 - Star Ratings Updates: A Focus on Member Experience

March 25, 2021


A Focus on Member Experience Webinar

Recent updates from CMS have led health plans to revisit their Star Ratings strategies and recalculate their path forward. Specifically, the increased weighting of member experience measures means that MA plans will need to consider Star Ratings and member experience in nearly every aspect of their organizations.

Join GHG Advisors and SPH Analytics in this exclusive webinar as we take a member-centric CAHPS approach to the upcoming changes and the recent Final Rule, and share implementation strategies for plans to attain that elusive 5th star.

Date: Thursday, March 25th
Time: 1:00 – 2:00 PM ET

Topics for this webinar will include:

  • Overview of the upcoming changes to Star Ratings
  • Impacts of the recent Final Rule on member experience
  • Analytic-driven insights on current market trends and challenges
  • Member-centric implementation strategies for 2022 and beyond


Register Now

Strategies to Ensure Accurate Coding and Submission of Upstream Encounter Data

On Demand Webinar: Strategies to Ensure Accurate Coding and Submission of Upstream Encounter Data

October 22, 2020

On October 8th, GHG’s SVP of Healthcare Analytics and Risk Adjustment Solutions, Jeff De Los Reyes, moderated a webinar with Austin Bostock of Pareto Intelligence and Meleah Bridgeford of Episource to discuss the future of the regulatory environment, as well as steps you can take to ensure that your data is ready in advance of the submission deadline.

Our speakers shared their unique perspectives on the best strategies to deploy to ensure that your upstream encounter data is accurate, complete, compliant, and ready for submission.

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

In this webinar…..

Some of the key questions answered in this discussion include:

  • What are the major impacts from CMS’ 2022 Advance Notice on the current regulatory environment? CMS is projecting the risk score impact of transitioning to the 2020 HCC risk adjustment model to be 0.25%. While the impact on MA risk scores being calculated using 100% encounter data is projected to have a neutral impact at 0.00%, the shift to EDS is very much driven by the complexities of the process, and our experience shows the impact could be between a 1-3% difference between EDS versus RAPS. – Jeff De Los Reyes, GHG
  • What are the potential risks for either revenue exposure or compliance exposure as plans move from RAPS to EDS? To avoid the risk of compliance exposure, it’s important to not only look for incremental revenue, but to also take a bi-directional look at both adds and deletes to ensure the data is complete and accurate. When it comes to revenue exposure, we’ve found that data leakage can lead to suppressed risk scores and result in an average of $35-$50 PMPY impact for both the MA and ACA markets. – Austin Bostock, Pareto Intelligence
  • How can plans proactively prepare to mitigate the undue burden that EDS can cause? One way to manage this process is by tracking encounters through the entire submission process (i.e., tracking the recipient of the claim from CMS all the way back to your EDW). Another major factor is timing. Many plans currently submit RAPS on a near-monthly basis, but it’s going to be critical to submit EDS just as frequently, if not more frequently than RAPS. – Austin Bostock, Pareto Intelligence
  • With front-end submissions being so complex, how can plans evaluate their readiness for remediating back-end EDS errors? The key to being successful with EDS is knowing your data. Plans must be able to identify where data leakage is most likely to occur, whether it be from receiving incomplete data from providers or potential errors with internal system processes. Conducting a RAPS/EDS revenue audit or an EDS gap analysis can identify these top errors and help plans prioritize remediation efforts. – Meleah Bridgeford, Episource

The answers to these questions and many more are discussed at length in our October 8th webinar titled, “Strategies to Ensure Accurate Coding and Submission of Upstream Encounter Data.” Click below to receive access to a recording of the webinar and explore the various insights from the panelists.

For additional questions and inquiries about how GHG can support your needs, please contact us.

AEP Sales Strategies for a Pandemic & Presidential Election

JULY 14, 2020

On Demand Webinar: AEP Sales Strategies for a Pandemic & Presidential Election

On June 30th, GHG hosted a panel discussion with Bill Stapleton of HPOne, Dwane McFerrin of Senior Market Sales, and Tom Richert of Blue Cross and Blue Shield of Louisiana to discuss the challenges of selling during an election year with the possibility of no “kitchen table” sales.

Our speakers shared their unique perspectives on the best strategies to deploy for a fruitful 2021 AEP and beyond.

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

Some of the key questions answered in this discussion include:

  • How has the current climate impacted your brokers? Organizations that are able to utilize distributors are being impacted far less than organizations that are dependent on face-to-face agents. These face-to-face agents are discovering that they must they find ways to adopt new technologies to stay competitive in today’s selling landscape. – Dwane McFerrin, Vice President of Medicare Solutions, Senior Market Sales
  • How is this push to adopt technology impacting your senior population? Some are fairly quick to adopt, while others are more resistant. Many carriers have had to introduce alternative enrollment methods that don’t require high levels of computer literacy, and “agent-aided self-enrollment” may very well be a crucial part of AEP this year. – Dwane McFerrin, Vice President of Medicare Solutions, Senior Market Sales
  • What kind of support have health plans been asking for since things started changing in March? In short, plans are asking for support in three critical ways: 1) flexibility on staffing and scripting, 2) more robust technology, and 3) marketing assistance. – Bill Stapleton, CEO, HPOne
  • When developing a marketing strategy, how can plans ensure that their ads are reaching their target audience? Now more than ever, plans need to stay flexible and be willing to move media dollars around to accommodate the current and evolving political climate. – Tom Richert, Vice President of Marketing, Blue Cross and Blue Shield of Louisiana

The answers to these questions and many more are discussed at length in GHG’s June 30th webinar titled, “AEP Sales Strategies for a Pandemic & a Presidential Election.” Click below to receive access to a recording of the webinar and explore the various insights from the panelists.

Where Do We Go from Here?

Now more than ever, MA plans must be prepared to adjust and pivot sales and marketing strategies to address a post-COVID-19 world and this busy election year. For help building a strategy for 2021 AEP, get in touch with GHG’s Sales and Marketing experts.

Special thanks to Dwane McFerrin of Senior Market Sales and Bill Stapleton of HPOne for joining GHG and contributing to such engaging conversation!

As a full-service insurance marketing organization (IMO), Senior Market Sales is dedicated to helping independent insurance agents leverage time, make more money and put their business in a position of distinction. Contact SMS to learn more about their services.

HPOne has quickly become one of the highest performing marketing, member acquisition and retention companies in the health insurance industry. Contact HPOne for more information on their custom sales, marketing, and contact center solutions.

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

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

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

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

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

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

Watch the Webinar On Demand!

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

Where Do We Go from Here?

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

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

On Demand Webinar: Four Trends in Supplemental Benefits for 2021 Success

Supplemental benefits have been a valuable differentiator for Medicare Advantage (MA) plans since the Centers for Medicare and Medicaid Services (CMS) expanded the scope of coverage to certain non-medical supplemental benefits in 2018. Since then, we have seen continued expansion in supplemental benefit adoption and prevalence, which has required MA organizations (MAOs) to become even more creative in plan design to stay competitive.

So, how can you capture and maintain a competitive position in your market? Insights found by a Pareto Intelligence analysis after the MA Annual Enrollment Period (AEP) tell an important story that can influence product pricing and benefit design strategies for 2021. In a recent webinar, Gorman Health Group (GHG) Vice President of Sales and Marketing, Diane Hollie, shared the critical trends in supplemental benefits from the AEP results data that health plans need to know going into 2021 bids. Below is a summary of the key takeaways.

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

Trend #1: Supplemental Benefits are Becoming Table Stakes

With the number of $0 HMOs, PPOs, and even HMO-POS plans available in the market—and with many supplemental benefits becoming homogenous across plans—consumers have new expectations about the “standard” offering when sitting at the kitchen table with a Broker.

This is apparent when comparing overall supplemental benefit prevalence between 2019 and 2020. In 2020, only 17% of MA Plans (in the Individual market, including SNP plans) did not offer any supplemental benefits versus 27% in 2019.

Trend #2: The Nationals are Offering Supplemental Benefits at a Higher Rate than Other Plan Types

When reviewing the enrollment data by type of MA plan (e.g., National Plans, Blues Plans, Provider-Sponsored Plans, Regional Plans), it was apparent, in most cases, that the Nationals offered major supplemental benefits, such as the over-the-counter (OTC) and meal benefits, more than other plan types.

One interesting benefit to note is “Transportation Services.” Regional plans, start-ups, and smaller MA plans in the “other” category were on par with the Nationals as far as providing the benefit. This could be attributed to D-SNP plans in this category, but it is certainly a trend to watch going forward.

Trend #3: Supplemental Benefits Can Impact your Member Experience

Given the increase in supplemental benefits offered, health plans should focus even more on member experience. As an example, in the recent Medicare Shopping and Switching Study from Deft Research, inadequate dental coverage was the most prevalent coverage issue mentioned by MA members, followed distantly by poor vision coverage. Therefore, if a plan doesn’t have sufficient dental coverage, member satisfaction may suffer as a result.

But simply offering the benefit is generally not enough to satisfy consumers. When a plan offers supplemental benefits, especially comprehensive dental benefits, communication is critical to managing members’ expectations. This includes:

  • Properly explaining the details of the benefit to ensure that the Medicare consumer doesn’t select the plan with a different understanding of the offering and end up disappointed the first time they attempt to use the benefit.
  • Outlining how to access the benefit once becoming a member or receive the benefit once it becomes available. Typically, supplemental benefits are implemented by outside vendors, which may require members to understand how to use up 6, 7, 8+ different companies to access benefits. This may cause confusion and poor member experience if member education and infrastructure are not properly aligned.

Trend #4 The Availability of Supplemental Benefits Correlates to Higher Enrollment Growth Rates

With data now available from multiple years of plans offering expanded supplemental benefits, we wondered: Does the availability of supplemental benefits impact enrollment? Preliminary results say yes.

For example, plans that offered comprehensive dental, transportation services, and/or meal benefits grew an average of 5% from 2019 to 2020, versus only 2-3% growth for plans that did not offer these benefits. The same goes for the OTC benefit… Plans that offered an OTC benefit grew 7% on average and plans that did not offer OTC actually decreased enrollment by 2%.

In diving further into OTC, Pareto’s analysis shows that the annualized benefit amount correlates to the amount of enrollment growth for a plan. MA plans with over $300 in annual OTC benefit grew 11%, whereas plans with an annual OTC benefit of up to $200 grew only 3% on average. This demonstrates that certain benefits are more influential for plan choice than others, which can help determine where to place the supplemental benefit dollars.

Watch the Webinar On Demand!

All of these trends are discussed in much deeper detail in GHG’s March 4th webinar titled, “Supplemental Benefits Trends to Address in 2021.” Use the form below to receive access to a recording of the webinar and explore the various data points discussed in this article.

Where Do We Go from Here?

In five years, MA plans will look very different than they do now. The new mindset of the baby boomer who is aging into Medicare will force change; they expect more from a plan and will demand it. Plans will need to improve member experience and address the social determinants of health (SDOH) specific to their population with various supplemental benefits.

This is also the time to reimagine the benefit/plan development process. Waiting to see what other plans are offering and following the leader is no longer sufficient in the long term. Plans must understand what members want/need and how to offer it effectively. There is also an opportunity to introduce benefits into the market that will help lower costs, increase Star ratings, and retain members over time, but this means effective change using strong data analysis with a clinical and quality lens in product and benefit strategy today.

For help with plan development, product strategy and benefit design, and more, get in touch with GHG’s Sales & Marketing team.

Webinar Recap: 2019 MCMG Highlights

Thank you to all who came to the GHG webinar regarding the 2019 Centers for Medicare & Medicaid Services (CMS) Medicare Communications and Marketing Guidelines (MCMG). We had a great attendance and are working to answer all of your questions and get a Q&A to all who attended plus the presentation! We wanted to take a minute to discuss a few items where GHG received a large number of questions: mailing statement disclaimers, Open Enrollment Period (OEP) beneficiary plan changes, and website review.

Mailing Statements

There are now only two mailing statements in Appendix 2 of the Disclaimers. The first is for Plan Information, and this is causing the most confusion. The disclaimer states the required text is “Important [Insert Plan Name] Information”. GHG interprets this to mean this disclaimer only needs to be on your member’s important plan information such as enrollment, benefit, operations, and other important plan information. GHG does not believe CMS intends advertising mailings to use this disclaimer as it would be confusing and misleading to prospects.

In addition, GHG contacted CMS about the requirement to insert the plan name since there was confusion about whether the plan needed to utilize the plan benefit package (PBP) plan name vs. the Medicare Advantage Organization (MAO) name and whether this was even necessary since the name of the plan is already on the envelope. GHG’s interpretation of CMS’ response is that as long as the name of the MAO is on the envelope and is recognizable to the member as their health plan, then inserting the plan name is not needed.


There was some confusion regarding the plan types a beneficiary can select during the OEP. A beneficiary is allowed a one-time change. The following chart describes the allowed changes:

  • Medicare Advantage Prescription Drug plan (MA-PD) to MA-PD
  • MA-PD to MA-only plan
  • MA-only to MA-PD plan
  • MA-only plan to MA-only plan
  • MA-PD to Original Medicare (with or without Part D)
  • MA-only plan to Original Medicare (with or without Part D)

Website = New Guidance From CMS That Will Make You Smile!

Those in Original Medicare or Original Medicare with Part D are not able to enroll in an MA-only or MA-PD plan. In addition, the OEP is not available for those enrolled in Medicare Savings Accounts, Cost plans, or Program of All-Inclusive Care for the Elderly (PACE) plans.

On Friday, May 10, CMS released an email blast, “Updates to the Website Requirements in the Medicare Communications and Marketing Guidelines.” CMS is no longer requiring website marketing content to be submitted into the Health Plan Management System (HPMS) for a 45-day review. Plans can now submit their websites via HPMS as a Word document that contains a URL (sound familiar?). Screenshots, test sites, etc., are not needed. Plans are permitted to submit the website as File & Use – both their own and/or third party websites. This means all websites must be submitted five days before going live, so mark your calendar! In addition, CMS added guidance about the Material ID and websites. All website pages must have a Marketing ID, but the ID does not need to include “M” or “C.”

When making website updates, the plan must include the website’s URL in a Word document and include a summary of the changes. The updates may go live five days after HPMS submission. Plans do not need to take down their website while making updates, but make sure the changes do not go live until five days after the HPMS submission.

CMS has stated another version of the 2019 MCMG will be released before the end of the summer. I am hoping for more clarifications to occur. Let us know how we can help you!




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