Topic: Performance Optimization

Build a Better Medicare Advantage Enrollment Experience

Convey Health Solutions

Large Medicare Advantage carriers invested a median of $11.25 per member per month in marketing in 2015, and spent a median of $17.44 on account and membership administration, according to a Sherlock Company analysis. With that kind of spending, the last thing a carrier needs is for seniors to become confused and frustrated by the enrollment process, but that is exactly what happens when carriers rely on technology that is not up to the task.

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Insights into Common Operations Projects and Findings

Julie Billman

One of the best things about being a consultant is that we get to meet a lot of really great people who are passionate about what they do and the members they serve. At Gorman Health Group, our projects span a wide range of activities – from implementing new programs to mitigating production, quality, and compliance concerns. Working with our clients, we see some of the common issues that plague the industry and a variety of best practices. In you attended the Gorman Health Group 2018 Forum in April of this year, you heard a variety of our most common projects and critical findings. If you weren’t able to attend, below are a few of the highlights from that event. As these are common projects and findings, you may want to take a look within your organization to determine if these might be potential issues for your plan. Read more

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Takeaways from the Gorman Health Group 2018 Client Forum

John Gorman

The Gorman Health Group 2018 Client Forum concluded last week in Las Vegas with over 300 of our closest clients and partners. As we enter our 22nd (!) year, we returned to the Red Rock Resort where a great time and shared learnings were had by all.

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Lack of Staff: Biggest Hurdle to Success

Regan Pennypacker

Staffing continues to be a major hurdle in the healthcare industry. A recent poll conducted by Gorman Health Group showed that 38% of respondents believed the biggest hurdle to success in their organization was lack of knowledgeable staff or lack of staff.

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Four Common Operational Pitfalls in Medicare Advantage

Julie Billman

I live in the Northeast, and we are once again in the midst of a nor’easter. It is this time of year when I consider moving south. The only way to keep on top of this volume of snow removal is to regularly clear driveways and sidewalks. Some snow is a very heavy lift, and some is very light and easy to shovel—and so it is with working through some of our common Medicare Advantage (MA) operational issues. Our experiences with clients cover a wide range of projects: we complete operational assessments, financial reviews, operational trainings, and policy and procedure (P&P) reviews. Throughout our projects, we see some common themes that cause health plans to trip. Some take more effort to resolve, but some are light lifts.

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Understanding Your QMB Dual Eligibles

Julie Billman

The Centers for Medicare & Medicaid Services (CMS) Advance Notice and Call Letter included additional reminders to plans about managing Qualified Medicare Beneficiaries (QMBs). A QMB is a dual-eligible beneficiary who does not have full Medicaid. Instead, that individual has Medicare cost-sharing subsidies by the state Medicaid program for Part A and B covered deductibles and coinsurances. When a QMB member is part of a Medicare Advantage (MA) plan, it becomes the MA plan’s responsibility to ensure providers do not balance bill the member for the plan deductibles and cost sharing for Medicare-covered services provided by the MA plan.

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CMS Releases Part II of the Medicare Advantage Advance Notice & Draft Call Letter

Olga Walther

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.

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