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Topic: Sales & Marketing
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.
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.
For those of us who have worked for years in the marketing and sales arena, the release of the Centers for Medicare & Medicaid Services (CMS) memo, “Request for Input on the 2019 Medicare Communications and Marketing Guidelines,” on April 12, 2018, somehow felt like the end of an era. In this memo, CMS confirms the Medicare Marketing Guidelines (MMG) will be renamed the “Medicare Communication and Marketing Guidelines.”
The Wall Street Journal reported last night (Cigna Nears Deal to Buy Express Scripts) that Cigna is in final talks to acquire Pharmacy Benefit Manager (PBM) Express Scripts (ESRX) for a whopping $67 billion. ESRX was the last truly independent major PBM, and the deal signals the end of an era…and ushers in a new one, further blurring the lines between insurers, providers, and their primary vendor. The combined entity will reach over 250 million people and will have a ripple effect on many of their competitors.
The February 2018 Medicare Advantage (MA) enrollment report is out and includes the tail end of Annual Election Period (AEP) activity.