Topic: Part D

Member Engagement and Experience are the New Risk Adjustment

John Gorman

In this new era of Star Ratings in Medicare Advantage and Part D, where a 4+ score is now do-or-die, health plan survival comes down to two things: member engagement and the member experience.  They’re the new risk adjustment when rates in 2014-2015 will be at their lowest levels in more than a decade, and a low-quality rating is a kiss of death in government programs.  Plans that can’t evolve into kinder, gentler, more coordinated and Member-Centric service providers are already beginning to disappear.

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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

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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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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.

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Pay me now or pay me later: Things to keep in mind when you set your 2014 budget

William MacBain

Back in the ’80’s Fram Oil Filters had an advertising campaign that featured an actor dressed as a mechanic, admonishing viewers to get their oil changed and get a new oil filter, to prevent costly engine damage.  “Pay me now or pay me later,” he said. 

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Reading the Stars in Medicare in 2014-2015

John Gorman

Whatever you may think of healthcare.gov, CMS is killing it on the Medicare Star Ratings Quality Demonstration.

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The Shutdown Will Become the Siege of the ObamaCare Teahadists

John Gorman

If you’re paying any attention to the worsening drama here in DC, dig in because the calendar is not our friend.  With the stalemate over the government shutdown ossifying, the Congress just backed into the debt ceiling, which we’ll hit in less than two weeks.  Now we’re going to need a big deal both reopening the government and raising the debt ceiling to get out of this mess, at the very moment postions are hardening.  A few days ago, I thought a shutdown would go on for about a week…now I’m thinking it might be a month, or even longer.  And that could have big implications for ObamaCare, Medicare and Medicaid.

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