The Voice of Regan Pennypacker

Regan Pennypacker

About Regan Pennypacker

Regan brings to Gorman Health Group clients more than a decade of operational and compliance expertise in Medicare Advantage and Part D. In her role at GHG, she assists health plans with audits, gap analyses, and plan implementation by creating policies, workflows and marketing materials. Her expertise also extends to providing detailed training for compliance and operations, specifically in grievances, appeals, and compliance auditing. Read more

2016 CMS Applications: Highlights and Basics

Regan Pennypacker

This week’s CMS industry training on applications was quite informative, and contained many audience questions that you will want to hear.   The recording is already available to registrants for those who missed it.  There was way too much information for me to summarize, so I have included here a few highlights from the call and some basics that are easily overlooked.

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2016 CMS Application Season Begins

Regan Pennypacker

Yesterday CMS released the 2016 Part D application, and this afternoon the 2016 Medicare Advantage (MA) application was released.  Despite the applications’ release dates, potential and current Plan Sponsors should be well under way in the preparation of the upload that is due on February 18th.  Aspects of the application that require significant lead time to accomplish include the establishment of an adequate network and the acquisition of the required state licensure.

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4 Points to Ponder from CMS’ Oversight and Enforcement Conference

Regan Pennypacker

On June 26, CMS hosted their MA-PD Oversight and Enforcement conference. Not one of the topics was less relevant to the audience than another – they prepared ahead of time to present current, critical information related to their data-driven approach to oversight, best practices and common findings, preparing for an audit and enforcement actions. I was glad to see CMS invite plan sponsor staff to share their experiences. They included Todd Meek of SilverScript Insurance Company; Margaret Drakeley of Kelsey Care Advantage; Shannon Trembley of Martin’s Point Health Care; Marcella Jordan of Kaiser Permanente, and Jenny O’Brien of UnitedHealthCare. Their first-hand accounts are worth your full attention.

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Integration of MMP Requirements

Regan Pennypacker

MA-PD plans have plenty to worry about with CMS requirements, regulator’s issue of the day, or Central Office determining what issue to hang their hat on today, seemingly changing with the shift of the wind. It is a challenge to keep track of it all, but it’s a necessity we promote and support.

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Innovating in 2014

Regan Pennypacker

CMS has developed an Innovation Center to address health care payment and service delivery models. It is a great site to find information about current Innovation Model Partners, and a place to share your ideas on how care can be delivered and paid for in ways that will lower care cost and improve quality of care. As always, the service to beneficiaries is at the heart of these initiatives, and for the program to continue, partners must be innovative.

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Consultant Assessment in the Headlines

Regan Pennypacker

Consultants were in the news this week; that doesn’t happen often. In this scenario which I will not deeply dive into, a private consulting team was brought on to independently assess the status of a certain federal health insurance enrollment system. Their assessment, after reviewing hundreds of documents and conducting scores of interviews, includes a number of risks with some detailed root cause drivers.

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Innovation and Quality must go hand-in-hand

Regan Pennypacker

Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said “Quality is Job 1″. No truer words apply when it comes to maintaining high quality plan options for our nation’s Medicare beneficiaries.

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