Navigators and Agents Gone Wild

Since the October 1 launch of the ObamaCare health insurance exchanges/marketplaces, there’s been a growing din over the field conduct of navigators and insurance agents, in the process of enrolling eligibles on behalf of the exchanges or the health plans participating in them.  Meanwhile, the associations backing brokers are putting pressure on the Obama administration, insisting that brokers should be more involved in the enrollment process.  Add a regulatory infrastructure that is lax — at best — when it comes to training and enforcement … does anyone else have a sense of déjà vu?  It’s the market conduct growing pains of the Part D inception all over again.  There is no doubt that some of the “navigators and agents gone wild” stories out there are simply anecdotal rumor mill reports coming from enterprising local reporters, or are “stings” by conservative bloggers and activists scoring cheap anti-reform points.

But it’s also true that navigator and broker involvement has been controversial since the inception of ObamaCare.  You likely remember that in the early versions of the ObamaCare laws, that brokers were not even in the picture and Republicans have made great political hay so far of the navigators as the healthcare equivalent of ACORN.  Over 100 community organizations in 34 states won $64 million in Federal grants to field thousands of outreach workers to find and help enroll the uninsured, and they’ve been hounded mercilessly by Congressional oversight committees, local reporters and ObamaCare dead-enders.  Even the most well-intentioned brokers and navigators have had a rough go of it during these first two months.  Here’s the harsh reality: Brokers face a backlog of enrollees who, for one reason or another, have not been able to submit their application.  And the current flood of beneficiaries out there stuck in the application process are overrunning the system — there isn’t enough time left to process them all, ESPECIALLY when you take into account the difficulty brokers have helping consumers who are already halfway through the process before they ask for help.

To add insult to injury: Because of insufficient training, many brokers weren’t prepared for how this would play out.  It wasn’t until they encountered real problems, sitting next to their real clients, that the lack of training and preparation made itself painfully clear.  The deck is stacked against the broker community here, and the media spotlight will continue to get hotter.

For health plans using brokers to distribute their products in the exchanges, there is very little chance that it can or will be done effectively.  Every plan’s goal is to understand and have some degree of control over how the brokers are representing the brand and the products in the field.  But the huge influx of brokers into the process, very little training beyond the bare minimum required by the feds, no guidance from CMS on broker conduct, and the enrollment portal problems — can oversight of these agents even be on the radar?

It’s all so reminiscent of the perfect storm of sales misconduct during the launch of Medicare Advantage and Part D.  In 2007 and 2008 Congress held several hearings where witnesses testified that sales agents had marketed without licenses, portrayed themselves as Medicare employees, and misled Medicare beneficiaries about plan benefits.  Some of these events were a simple matter of insufficient training or understanding of the implications of their behavior, which we are ripe to experience in the exchanges.  Others were blatant fraud. Congress’s response to these incidents was the enactment of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which prohibited or limited certain marketing activities by sales agents and plan sponsors, required that all sales agents be trained and tested annually, and be State licensed, among other things. Plans responded by adopting leading-edge solutions like GHG’s Sales Sentinel (now covering over 55,000 agents in Medicare and the exchanges) to help them onboard, manage and oversee their brokers and agents in the field.  In the exchange world, the biggest risk of all of the mayhem is a health plan’s reputation — which we’ve seen shattered by agent misconduct in the past. And the biggest counter balance initiative is for plans to blaze the trails when it comes to providing field agents sufficient guidance and training on conduct and repercussions, until CMS and the states catch up.

Resources

GHG’s Sales Sentinel is the only sales oversight tool designed specifically for health care organizations operating in regulated government markets. To learn how Sales Sentinel can help your organizations agent onboarding and ongoing oversight process, visit our website >>

During the 2013 GHG Forum, Executive Chairman & Founder John Gorman, discusses how important it is to successfully train, on-board and conduct ongoing agent oversight for your Plan’s success. Click here to access the recording>>

Listen as Senior Director of Product Operations at Gorman Health Group, Alex Keltner discusses GHG’s Sales Sentinel, the solution to train, credential and onboard your sales force. Access the podcast here >>

Join us December 11 from 2:00 — 3:30 pm ET for a lively session with Gorman Health Group strategy and data analysis experts who will discuss actual case studies that show how plans can mine data for precious insight that can help improve performance. Register now >>