nº8 - Fal 2021
MMS 2022 SNEAK PEEK
MA MEMBERS TELL ALL
MISLEADING MARKETING TACTICS
Our annual event returns to Vegas. See what’s planned.
What they like, dislike about their plans
CMS memo reminds MA plans about marketing best practices
THE LATEST NEWS
KFF report: 7 in 10 Medicare beneficiaries didn’t shop around for new plans during 2018 open enrollment
RISE accepting nominations for 2022 quality award
The high cost of dental and hearing care: Seniors face big bills whether they are in traditional Medicare or Medicare Advantage
3 findings on how Medicare members use digital health tools"
Medicare Advantage premiums will drop to historic lows in 2022
AHIP warns of potential costs to seniors if Congress adds dental, hearing, and vision benefits to traditional Medicare without adjusting MA benchmark
MA in the news: More plans to offer non-medical supplemental benefits in 2022; Study finds industry provides $32.5B annually in additional benefits, lower out-of-pocket costs; and more
CMS releases 2022 MA and Part D Star ratings
Commonwealth Fund blog post highlights the role of Medicare agents and their impact on beneficiary choice Insurance brokerage study: 3 out of 4 seniors say Medicare is ‘confusing and difficult to understand’ New cloud-based Medicare Advantagein-a-box aims to simplify operations for health plans
GAO report: Large number of dying MA beneficiaries switch to traditional Medicare in last year of life" Report: Most on Medicare forgo dental care due to lack of dental coverage
Connected TV: Why it’s the media platform to watch DMW Medicare beneficiaries want communications from their health plan: Make sure yours are effective Engagys
READ OUR ENTIRE COLLECTION OF INSIGHTS AND ARTICLES 2
MA&E COMMUNITY NEWSLETTER
Letter From the Chair
IN THE THICK OF AEP: CMS ISSUE MARKETING NOTICE DEMANDIN MAOS POLICE DOWNSTREAM LEA GENERATION VENDORS The Annual Election Period (AEP) is upon us once more. The hope for the pandemic to recede have been dashed with the upswing in the Delta variant, so this AEP may look a lot like last AEP, from a marketing and sales perspective. The race towards the world series for baseball is intensifying, there are wild cards playing out in baseball and in AEP, and we are all feeling the craziness of the moment. One of the “wild cards” will again be the “The Joe Namath Commercials”–this “cowboy” style lead generation campaign put a stain on the integrity of Medicare marketing for the whole industry last AEP and during lock-in this year. The Centers for Medicare & Medicaid Services (CMS) has come out recently with a notice to demanding that Medicare Advantage Organizations (MAOs) step up their games on policing and remediation with their downstream lead generation vendors. There is more to say and do on this hot topic. Benchmarking of Key Performance Indicators (KPI): We told you we would put together a benchmarking study and we plan to roll the surveys out in early January 2022, once the smoke from the AEP clears and you come back rested from the holidays. There is a survey ready for marketing KPIs and another for sales KPIs. Keep an eye out for the surveys and show up at our annual Medicare Marketing and Sales Summit in Las Vegas that starts February 16, 2022, at Caesar’s Palace to hear the findings we will report out to you. It’s time to rock and roll the AEP, so check out these important and informative articles to help you along the way. See you in Vegas! Best wishes and kind regards,
Kevin Mowll, Medicare Member Acquisition & Experience Community Chair The RISE Association
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MA Members Open Up About
What They Like, What They Dislike About Their Health Plans
One of the most popular sessions each year at RISE West is a focus panel moderated by Kathleen Ellmore, managing director of Engagys, and made up of Medicare Advantage (MA) members who discuss their policy choices, their overall health plan experiences, access to care, and what plans can do to improve services. 4
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This year’s panel of 10 MA members didn’t disappoint and were candid about their likes and dislikes, including the reasons for switching plans, whether they pay attention to Star ratings, and why they would or wouldn’t opt for a telehealth visit in the future. Reasons why they switch or would consider switching plans: Primary care physician no longer included in the provider network; increase in premiums and copays; and difficulty obtaining referrals to specialists. The most important factors when considering a new health plan: Easy access to high-quality primary care physician and referred specialists; coverage of procedures and medications; cost (premiums and copayments); and supplemental benefits (such as gym memberships and vision coverage for contact lenses and prescription eyeglasses). How they find out about different health plans: Most said they receive paper flyers in the mail and then look at the individual health plans on their web sites to compare coverage and costs. Whether Star ratings factored into their decision of enrolling in a plan: Only two panelists were familiar with Stars. Of the two, one senior said he did consider Star ratings as well as word of mouth when he chose his plan. The other said the rating was not a determining factor when she enrolled in her plan. However, when Ellmore explained the Star rating system, most of the panelists said they would look for 1-5 quality rating the next time they considered switching plans. Their thoughts on the level of communication from their health plans: Responses were mixed. Five felt their plan offered just the right level of communication, three said they didn’t get enough, and two thought they received too much information. One senior said he got too many explanation-of-benefits forms that came months after his doctor visits, so it was difficult to reconcile whether he actually received the service. But another said he wished he got the explanation of benefits more
“Ways that health plans could personalize communications is to reach out about preventive care services available to them and send information about how to follow a healthier lifestyle.”
frequently. Two members said they prefer getting statements via mail so they can write notes on them for future reference; others preferred digital and say they can print statements if they need a hard copy. Whether they feel as if their plans know them as individuals: Only two felt their plans really knew them. One senior said the health plan follows up with him to see if he made it to his scheduled appointments, including visits to his urologist and podiatrist. The plan also sends him a printout of his conditions and what he needs to address with the physicians. “It makes me feel good and gives me a sense they know me,” he said. Among those who didn’t feel as if their plan knew them: Ways that health plans could personalize communications is to reach out about preventive care services available to them and send information about how to follow a healthier lifestyle.
missed the hands-on aspect of in-person visits; the other scheduled three separate appointments and each time was kept in a waiting room for hours and the doctor failed to show up. Other panelists had more positive experiences. They liked the option because they lived far away from their providers. One woman said she made an appointment after hours and the doctor was very responsive, even checking in on her in the waiting room to let her know how long it would be until he could meet with her. How plans could improve the overall member experience: Provide information (even in an email) about how close they are to reaching the donut hole and suggest inexpensive alternatives to purchasing medication once they reach it; offer online chat capabilities on their websites so they can get an immediate response to their questions or concerns rather than waiting for a return phone call days later; cut the cost of premiums; allow seniors to use their entire discretionary account amount for overthe-counter products at once, rather than divvying up the amount quarterly (“I could buy a better blood pressure monitor with $160 at the beginning of the year, rather than a cheaper version with the $40 quarterly allowance”); offer members a specific name and contact information of a benefit specialist who they could reach out to with questions; and provide extra incentives to encourage preventive care, such as gym memberships.
What they think about telehealth visits: Half of the panel said they participated in a telehealth visit during the pandemic. Two didn’t like the experience; one said it was superficial and he CLICK TO SEE OTHER ARTICLES
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REAL- LIFE IN S PIR ATIO N BEHIN D T HE HIT MOV I E
“ RUDY ”
TO PRESE N T KE Y N OTE Daniel “Rudy” Ruettiger will share his message on how to “dream big” and the importance of building relationships at the RISE Medicare Marketing & Sales Summit, February 16-18, 2022, at Caesars Palace. Daniel “Rudy” Ruettiger, the most inspiring graduate to walk the halls of the University of Notre Dame, will kick off the first day of the 2022 RISE Medicare Marketing & Sales Summit with a message on how to overcome obstacles and achieve your dreams. Twenty-seven seconds—and years of perseverance—was all it took to cement Ruettiger into college football history as one of the greatest sports underdog stories ever told. The third of 14 children and the son of a steel mill worker, Ruettiger struggled in school due to undiagnosed dyslexia. Despite his academic challenges and being undersized at 5’6’’ and 165 pounds, his lifelong dream was to attend the University of Notre Dame and play football for the Fighting Irish, his father’s favorite team. He was rejected from Notre Dame three times before finally receiving his acceptance letter. Eventually he won a spot on the Notre Dame scout team, which helps the varsity team practice. In the last home game of his senior year, and in its final moments, Ruettiger 6
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tackled the Georgia Tech quarterback, the only play in the only game of his college career. He is the first player in the school’s history to be carried off the field on the shoulders of his teammates. Although it was his first and last time he stepped onto the field during an official game, he earned his place in football history and became a University of Notre Dame legend. The 1993 movie “Rudy” that is based on his life is considered one of the all-time great sports films ever made. Ruettiger’s keynote will take place at 9:10 a.m. Thursday, Feb. 17, 2022, the first day of the main conference. His presentation will explore the idea of having
and building a dream, ways to stay on course and overcome obstacles, and the importance of developing relationships throughout your life. The Medicare Marketing & Sales Summit will be held Feb. 16-18, 2022, at Caesars Palace, Las Vegas. Preconference workshops and an opening reception will take place on Wednesday, Feb. 16 followed by the main conference. Click here to download a brochure, see the agenda, and view a complete list of speakers.
Everything we’ve planned so far
les a S & g n rketi turn to a M e r Medica m it to re Su
RISE will return to Caesars Palace, Las Vegas, Feb. 16 to 18, 2022 for the 15th annual Medicare Marketing & Sales Summit. Here’s what you need to know about planned preconference workshops, networking opportunities, keynote presentations, general sessions, track sessions, roundtables, and our health and safety protocols. It’s been a long two years, but RISE is excited to head back to Vegas to bring Medicare Advantage health plan executives together to learn insights that will take their sales and marketing strategies to the next level. The 15th annual Medicare Marketing & Sales Summit (MMS) will feature three days of in-person learning on topics related to Medicare advantage marketing, sales, product development, and member engagements. We’ve already lined up 40 industry experts to speak on more than 20 sessions and have eight planned networking opportunities.
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Here’s a look at the preliminary agenda:
Wednesday, Feb. 16 The event will begin with two afternoon preconference workshops from 1 to 4 p.m.: Shannon Decker, M.Ed., vice president, clinical performance, Brown & Toland Physicians, pictured right, and Kathleen Elmore, managing director, Engagys, will lead a behavioral science workshop on how to attract customers. They’ll provide a deep dive into customer theories, real-life scenarios, incentives that lead to changes in behavior, how to capture consumer interactions, and how to develop an effective outreach strategy. The second workshop will focus on SSBCI Benefits and how participants can determine which ones will bring members the most value and have the highest return on investment. Leaders will share case studies about successful disease specific SSBCI programs and tips for implementation and explain how to evaluate which benefits are worth the investment to increase retention. We’ll end the day with champagne roundtables and a cocktail networking reception from 4 to 5:30 p.m. The interactive roundtables will feature 20-minute speed-networking type presentations featuring the latest technologies and solutions.
Thursday, Feb. 17 We’ll start the day early with registration and a networking breakfast at 7:30 a.m., followed by a special session at 8 a.m. with Kathleen Ellmore, managing director, Engagys, who will unveil the findings from the sixth annual RISEEngagys Survey of Healthcare Consumer Engagement Practices. The survey focuses on the successful mix of channels of consumer outreach, the investment organizations are making to improve consumer engagement, common challenges, and initiatives to overcome those challenges. Keynote Daniel “Rudy” Ruettiger, the real-life inspiration behind the hit movie 8
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“Rudy” and one of the greatest sports underdog stories ever told, will then take the podium for a presentation on how to overcome obstacles and achieve your dreams. Despite his small frame and academic challenges, Ruettiger eventually achieved his lifelong dream to attend the University of Notre Dame and play football for the Fighting Irish. In the last home game of his senior year, and in its final moments, he tackled the Georgia tech quarterback, the only play in the only game of his college career. MMS favorite, George Dipple, executive vice president, client services, Deft Research, will follow with a session on trends in Medicare consumerism. Dipple will discuss recent findings from Deft Research’s annual study on Medicare shopping and switching and how to use the results to adjust your AEP strategy. Next, we’ll hear from a panel on key drivers to master the member experience and ensure Star ratings. Moderator Steven Selinsky, vice president of product strategy, marketing, and community outreach, will ask the panel about opportunities for marketing and sales beyond onboarding, the communication strategies used that were most effective to retain members during AEP, and best practices in governance structure. Panelists to include Archie Dey, director of consumer experience and insights, SCAN Health Plan, and Kristy Croom Tucker, director of member experience & acquisition, BayCare Health Plans. Before we break for lunch, join the Milliman team for a Tools & Technology Spotlight in the exhibit hall. Milliman representatives will showcase their latest tech tools during this session from 11:45 a.m. to 12:05 p.m. After lunch, we’ll break into track sessions. The marketing track will include: • A panel discussion on how to maximize your digital marketing strategy • A session on aggregators, online brokers & more: Effectively navigate the frenemy relationship to prepare for 2022 AEP The sales track will include:
• A panel discussion on master broker relationships to win business • A panel discussion on the keys to successful sales channel management and distribution • A session on how to prepare your internal sales staff and call center agents for AEP All attendees will then come together for a leadership panel, who will discuss the shift in Medicare marketing and sales to capture business and paper for unknown COVID variables. Moderator Shannon Decker, M.Ed., vice president, clinical performance, Brown & Toland Physicians, will ask panelist about current trends, innovative strategies, and partnership opportunities. The panel will include Dustin VanDuine, director of new business sales, Health Alliance Plan, and Barbara Sandoval, manager, Medicare field sales, Providence Health Plans. The day will conclude with interactive champagne roundtables and a networking cocktail reception. The interactive roundtables will feature 20-minute speed-networking type presentations featuring the latest technologies and solutions.
Friday, Feb. 18 Rise early for breakfast in the exhibit hall at 8 a.m. and join Kevin Mowll, pictured above, chair of RISE’s Medicare Member Acquisition & Experience Community, Naomi Irvin, chief of staff-government markets, Blue Cross NC, and Steven Selinsky, vice president of product strategy, marketing and community outreach, HAP, for a special session on “The Joe Namath industry disrupter: The impact on Medicare marketing compliance.” Irvin will then join Deborah Marine, JD., compliance officer, SummaCare, for a CMS regulatory roundup: Pro tips to avoid pitfalls. They’ll review the current political environment and regulator changes that impact sales and marketing, including the abandonment of the Medicare Communication and Marketing Guidelines, and explain how to partner with compliance and legal teams to develop your own oversight structure ad
policies to ensure consistency and mitigate risk. Following the Tools & Technology Spotlights in the Exhibit Hall and networking lunch, participants will then break into the following tracks: The supplemental benefits track will include: • A panel discussion on how to enhance your product design to attract and differentiate • A panel discussion to build a successful supplemental benefits strategy • The innovative approaches to sales and marketing track will include: • A panel discussion on innovative sales approaches to thrive in the hybrid sales landscape • A panel discussion on how to optimize omni-channel marketing strategies to engage • A panel discussion on how to strengthen your local presence to differentiate and gain market share Attendees will then return for a concluding general discussion on how to craft your diversity and inclusion messaging with confidence. Naomi Irvin, chief of staff – government markets Blue Cross NC, will discuss best practices to develop a compliant diversity and inclusion marketing strategy, guidance to ensure inclusive messaging to avoid stereotypes, and challenges and lessons learned to launch and incorporate a consistent approach to diversity and inclusion messaging. RISE is excited to welcome you back to Vegas and in-person events. To ensure the health and safety of attendees, speakers, exhibitors, and staff, proof of full COVID19 vaccination status is required to attend The 15th annual Medicare Marketing & Sales Summit. Click here for the complete list of health and safety protocols and what you need to know before you make your travel arrangements.
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Misleading Marketing Tactics? CMS third-party marketing memo calls out advertising tactics that mislead, confuse MA beneficiaries 10
MA&E COMMUNITY NEWSLETTER
The Centers for Medicare & Medicaid Services (CMS) issued a long-awaited memo outlining best practices for Medicare marketing campaigns conducted by third parties. But does it go far enough? RISE weighs in.
As a result, RISE created a workgroup to address Medicare marketing compliance.
CMS Response The CMS memo reminded MA organizations that they are responsible for first-tier, downstream or related (FDR) entities adherence to CMS guidelines, including compliance with applicable Medicare laws and regulations when acting on the plan’s behalf. This includes the requirements that all marketing materials be submitted to CMS in advance and that MA plans may not mislead, confuse, or provide materially inaccurate information to current or potential enrollments.
In an Oct. 8 memo to Medicare Advantage (MA) organizations, the agency expressed concerns with misleading national advertisements that promote MA plan benefits and cost savings. In some cases, the plans are only available in limited-service areas or for limited groups, and the advertisement may use words and imagery that may cause beneficiaries to think the message is coming directly from the government.
Background Kathryn Coleman, director, Medicare Drug and Health Plan Contract Administration Group, said in the memo that CMS has received complaints from beneficiaries and caregivers that highlight sales tactics designed to rush or push beneficiaries into enrolling in a plan. Coleman didn’t name the advertising offenders but, in recent months, RISE members have expressed concern with the controversial Joe Namath commercials that tell viewers they are entitled to eliminate premiums and copays and get dental care, dentures, eyeglasses, in-home health services prescriptions, unlimited transportation, and home delivered meals at no additional cost. It also touts a give-back benefit for those who live in certain ZIP codes that adds money back to their monthly Social Security check. In some instances, the commercials aired in markets where the benefits were not available, and this caused lead generation companies to aggressively promote their lead sales to e-brokers who were not always vetting vendors on how they obtained the leads. RISE members said the ads drove rapid disenrollment at some MA plans because members didn’t understand the implications of plan switching.
“MA organizations are accountable and responsible for their marketing materials and activities, including marketing completed on a MA plan’s behalf by an FDR...”
Advertisements that address plan premiums, cost sharing, or benefit information—even those that don’t specifically mention a plan by name or are made on behalf of multiple MA organizations— are defined as marketing under 42 CFR §422.2260. This means that they must be submitted to CMS prior to their use. “MA organizations are accountable and responsible for their marketing materials and activities, including marketing completed on a MA plan’s behalf by an FDR. Where such marketing materials and activities fail to meet our requirements, the MA plan may be subject to compliance or enforcement actions,” Coleman said in the memo. The agency urged MA organizations to take the following actions: • Make outbound phone calls to beneficiaries, as opposed to letters, to establish and maintain a system for confirming that enrolled beneficiaries have, in fact, enrolled in the MA plan and understand the rules applicable under the plan. • Review rapid disenrollment to identify trends associated with “bad players.” In addition to recouping agent/broker compensation for rapid disenrollment, organizations must recoup any administrative payments made to an FDR where rapid disenrollment occurs. • Review actual marketing and enrollment calls bet ween
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beneficiaries and call centers/ agents to ensure compliance with the communications and marketing requirements. • Require FDRs to identify the origin of the enrollment lead (e.g., call in based on TV ad, response to mailing). • Record the entire sales call as well as all telephonic enrollments. • Require FDRs to disclose all contracted third-party relationships. CMS said it is monitoring the “chain of enrollment,” which includes the marketing materials, lead generating activities,
“...it will hold them accountable for any misdeeds involved in the daisy chain of lead generation and marketing...”
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sales talks, and enrollment process, to ensure that organizations follow the requirements. Coleman also said that CMS is working with other federal agencies regarding the appropriateness of the content of certain advertisements.
“The memo treads lightly in referring to the messages as possibly confusing,” she said, adding, “there is a fine line between confusing and deceptive.”
RISE Reaction
MA plans must become more diligent and scrupulous about where leads are coming from, who generated them, and whether they were generated in a compliant manner.
Kevin Mowll, chair of RISE’s Medicare Member Acquisition & Experience Community, said he was pleased that CMS is calling out the activities and tactics that third-party lead generators have used, which have caused confusion and mislead beneficiaries about MA plans and benefits available to them. CMS won’t go after these offenders directly and instead will rely on the long-established requirement that MA organizations are responsible for the activities and actions of the downstream actors in their member acquisition chain. CMS calls the tools that it expects MA plans to use as “best practices,” but they are the standard methods for conducting business in a compliant manner, according to Mowll. “In short, CMS is reminding MA organizations that it will hold them accountable for any misdeeds involved in the daisy chain of lead generation and marketing. The reason for this is that CMS has no contractual relationship to enforce federal regulations with these third-party actors, only with the MA plans themselves,” he explained. Compliance expert Naomi Irvin, who will present a session on Medicare marketing compliance with Mowll at the upcoming RISE Medicare Marketing and Sales Summit, said the memo should remind MA organizations of three points: • The importance of vendor/ downstream entity oversight • Well documented oversight activities are an essential element of doing business–if it isn’t documented, it is as if it never happened • CMS will always look for health plans to act in the interest of beneficiaries
The Takeaway
“CMS reminds plans that they are monitoring rapid disenrollments and complaints from each MA plan, and CMS will hold the outlier plans accountable for their failures to police their lead generation ecosystem,” Mowll said. To stay in compliance, he said organizations must have a thorough process to identify all downstream actors, a rigorous training and education process, tracking and monitoring all the way downstream, and a proactive communication response system. CMS will expect plans to show this system is in place and it works. Furthermore, he said, plans will need to conduct a root cause analysis if there is a problem and follow up with appropriate corrective actions and remediation. “CMS is going to demand proof that these steps are taken,” he said. “The signals are clear: CMS is not going to step in and rescue MA plans from these bad actors. The onus is and always was on the MA organizations to ensure that these regulations are applied systematically and completely.” One word of caution: “Many of us who were around during the wild days of the private Fee for Service MA plans in 2006 through 2008 remember the intense and micro-managed compliance reactions of CMS to the bad actor insurance brokers and agents,” Mowll said. “Those extreme oversight activities were onerous, painful, and expensive, lasting for many years. We do not want to experience a rerun of that movie.”
UPCOMING EVENTS The 6th Annual CMS Bid Boot Camp January 13-14, 2022 Fort Myers, FL
Women in Health Care Leadership Summit December 14-15, 2021 San Diego, CA
Medicare Marketing & Sales Summit February 16 - 18, 2022 Caesars Palace, Las Vegas
RISE National March 7-9, 2022 Gaylord Opryland, Nashville
Part D Master Class Save the Date for August 2022
Transform your AEP Materials Preparation Processes to Scale Your Medicare Advantage Plans
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Melissa Smith & Liz Haynes on 2022 Medicare Star ratings and what plans must do to maintain those scores
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QUESTIONS? REACH OUT TO OUR TEAM
Ilene MacDonald Editorial Director imacdonald@risehealth.org
Tricia Rosetti Content Marketer trosetti@risehealth.org
Tracy Anderson Marketing Coordinator tanderson@risehealth.org
Deborah Antoszyk Graphic Designer dantoszyk@risehealth.org
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