The policy analysis and guidance you need by the experts you trust, daily.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Cathy Aquino on Benefits are Submitted. What’s Top of Mind for 2019 Marketing & Sales?
- CMS Doubles Down on Member Experience – FAQs | Gorman Health Group Blog on CMS Doubles Down on Member Experience
- Regan Pennypacker on Latest Audit Enforcement Actions Issued by CMS
- Kathleen Chapman on 2019 Medicare Advantage Rate Announcement & Call Letter
- Michelle Juhanson on Latest Audit Enforcement Actions Issued by CMS
Topic: Sales & Marketing
Thank you to all who came to the Gorman Health Group (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.
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.
Friends, some hot intel from the field for Medicare Advantage (MA) in 2019:
- Expect many new entrants to the MA market, especially provider-sponsored plans moving up the food chain.
- We are seeing benefits improve by $20-40 PMPM, dependent on county revenue-to-cost ratios and plans’ Star ratings. Expect to see many more low-cost, narrow network products. Premiums will hold the line or fall, with $0 PCP copays going mainstream.
- We are continuing to see new $0 or low cost plans this year – that is where enrollment is growing. Plans are adding new products to capture the New to Medicare market.
- We are expecting to see many cobranded products this Annual Election Period (AEP) with regional and national players teaming with local health systems and physician groups.
- We are seeing an increase in marketing budgets this year, plus more aggressive sales distribution strategies, since many Plans understand that this year and next are expected to be big growth years. The reinstatement of the new (old) Open Enrollment Period (OEP) fundamentally changes your sales and marketing strategy. For new plans, or those new to MA, who have never been through an OEP, there is even more to consider from a strategic perspective.
- We are seeing dental and over-the-counter drug benefits being added to most products, as well as a widespread increase in travel benefits, which Boomers love.
- Groundbreaking new supplemental benefits under the new CMS policy won’t be the norm in 2019. Most plans simply didn’t have time after the April announcement and the bid deadline. 2020 however will see an explosion, especially in at-home essential care benefits and palliative care, transportation, and telehealth. An OTC benefit will be a game-changer in the new era of expanded supplemental benefits in MA in 2019 and beyond. Not only do OTC products delivered to the member provide tremendous value and loyalty, but when used as an incentive in chronic care management it changes behavior and improves member adherence. Our merger partners at Convey Health Solutions are the best at it. Learn more here.
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: Read more
At Gorman Health Group, we have the privilege of collaborating with organizations across the full spectrum comprising our members’ experience – from health plans and providers to vendors and pharmacy benefit managers (PBMs) – and though almost every person I talk to in every type of organization strives to create excellent member experiences, many struggle to successfully do so. The Centers for Medicare & Medicaid Services (CMS) recent pledge to put patients first in all of their programs has changed the calculus of “the member experience” in Medicare Advantage (MA). We’ve heard these words for years, but this time it’s real.
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.