Topic: Compliance

Most, if Not All, States Will Be on the Federal Exchange by 2020

John Gorman

Correction: June 20, 2014

An earlier version of this article misidentified the state of Washington as preparing to enter into the Federal Exchange. Though the state of Washington is having trouble with its enrollment website, Washington Health Benefit officials have clarified that Washington state has no intention of becoming part of the federal marketplace.

Read more

Leave a comment | Share | |

Tuesday Night’s Primary Elections Were Huge. Here’s What They Mean for Our Industry.

John Gorman

House Majority Leader, Eric Cantor (R-VA) is toast.  Trounced in his Richmond district by a nobody Tea Bagger Tuesday night. Cantor gave up his leadership position yesterday. Depending on where you sit politically, either the unthinkable or the inevitable happened.  In fact, a Majority Leader hasn’t lost incumbency since the office was created in 1899.   “The defeat of the second-ranking Republican in the House by an ill-funded, little-known tea party-backed candidate ranks as the biggest congressional upset in modern memory and will immediately generate a series of political and policy-related shock waves in Washington,” wrote Chris Cilizza of WaPo.

Read more

Leave a comment | Share | |

Lighting the Path in the Golden Age of Government-Sponsored Health Programs: Join Us for the GHG Client Forum

John Gorman

More than 300 guests will convene on May 1-2 at the Red Rock Casino in Las Vegas for the 2014 Gorman Health Group Forum, our annual strategic retreat for leaders in government-sponsored health programs. This year’s gathering promises to be the most actionable, content-packed conference you could attend on how to succeed in this new Golden Age of government business. And when the learning and planning is done for the day, we will celebrate this unique moment in health care history as only GHG can in Vegas.  Here’s what’s happening this year and why you’ve got to join us: Read more

Leave a comment | Share | |

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.

Read more

Leave a comment | Share | |

Navigators and Agents Gone Wild

John Gorman

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.

Read more

Leave a comment | Share | |

Much Progress on Healthcare.gov, But “Back End” Fixes Will Determine Success

John Gorman

Of the many, many things I gave thanks for last week, there was Jeffrey Zients, the White House management guru brought in to sort out the mess that is the launch of ObamaCare, and for his geek squad working feverishly on the fixes.  His long-awaited progress report was released on Sunday, and it’s amazingly sanguine for a government document.  Knowing big IT projects as we do, it’s impressive how far the fix team has gotten in a matter of weeks, much of it in consumer-facing functionality on the “front end” of the website and the enrollment process.  What remains to be seen is what can be done this month on the crucial “back end” functions that connect to insurance companies participating in the exchanges — the functions for which ObamaCare will ultimately be judged when coverage kicks off on January 1, and the true test for Mr. Zients and his geeks.

Read more

Leave a comment | Share | |

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.

Read more

Leave a comment | Share | |