Patient Care: A Healthy Debate

A lot has been made of the recent U.S. Preventative Services Task Force (USPSTF) report (http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#needs) on the role, expectations and outcomes of mammography screening in the determination of the presence of breast cancer. Here are the actual excerpts from the report that the media reacted to:

“In 2002, USPSTF concluded that there was fair evidence that mammography screening every 12 to 33 months could significantly reduce breast cancer mortality. The evidence was strongest for women aged 50 to 69 years, with weaker evidence supporting mammography screening for women aged 40 to 49 years.”

“Current knowledge about the development of breast cancer is limited. The effectiveness of screening mammography seen in trials presumably results from the early detection of smaller, earlier-stage tumors, which are more responsive to available treatments. Although the most common breast cancer occurs in the epithelial cells that line the duct system of the gland (ductal carcinoma), the sequence of development of invasive cancer is not entirely known.”

“The USPSTF noted with moderate certainty that the net benefits of screening mammography in women aged 50 to 74 years were at least moderate, and that the greatest benefits were seen in women aged 60 to 69 years. For women aged 40 to 49 years, the USPSTF had moderate certainty that the net benefits were small. Because of the uncertainties related to harms of screening, particularly over diagnosis, and the near total lack of trial data for older women, the USPSTF had low certainty about the net benefits of screening mammography for women 75 years or older.”

Patient care should never be compromised. Given the attention that Health Care reform has generated, any news is viewed good and bad based on the reader and interpretation.

The bottom line is that advancements in technology, research and education, not specific to any issue, or disease, has allowed for greater practicality in administering invasive tests. All progress is positive and debate is healthy.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

AHIP Fall Forum

While Health Care remains top of mind for everyone in the US, the AHIP Fall Forum provided opportunity to learn and review what policies will make a difference in reducing costs and improving service in the system.

Over the next few weeks we'll be discussing the most relevant of those opportunities. Including how private plans can benefit from what the public option is proposing.

For now, we want to reinforce the importance of knowing the demographics of your plan members, and treating them uniquely based on the profile that provides.

Data continues to be the best friend a Health Care provider has in managing and reducing the overall costs in the system.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Wellness: Measurement Shows Improved Health

In a recent article from Anne Zieger in Fierce Healthcare, she highlighted that private insurance plans have begun the debate over how effective employee wellness programs really are. And on the flip side, that large insurance plans haven't invested in the area heavily enough to have an impact, or measured to see any results.

While the debate rolls on with the insurers, Zieger goes on to point out that Emory University has been at work to see if the results are there.

According to the study conducted by Woodruff Health Sciences at Emory, measurable results were found in employee absenteeism (down 3.9 days in 2006 to 3.4 days in 2007 - 1.5 days lower than at standard sites).

This netted a savings of about $414.90 per employee per year, according to the study.

Our Take:

Results are found only when measured. Moving from discussion to action is critical for private insurance plans and measurement needs to be implemented by insurers across all types of coverage.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Medicare & Medicaid: Reduce Costs Through Quality of Information Part 1 of 4

CMS does a good job in many things, and keeping an eye on quality of information disseminated is one.

Their guidelines layout four buckets of review:

1. Utility
2. Objectivity
3. Integrity
4. Transparency and Reproducibility

There are key points to each guideline. Here's a glance at Part I.

Utility

Information is consistently tested with focus groups and should be developed in a collaborative process involving providers, consumers, academicians, and policy analysts

CMS stays active by developing special reports and topical studies that address emerging information needs (email, mobile, social, PDF documentation) that comes from proposed legislative changes and policy debates.

Having these guidelines helps Insurance providers in developing their communications. Moreover, having partners and suppliers throughout the communications chain that respect and understand their intent delivers results for the Medicare and Medicaid system. 

A knowledgeable communications chain from creation to production and dissemination, will ensure that information can be utilized across media and that costs can come out of the system at every step in the process.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Measuring Health Care

At-a-glance:

From The Common Wealth Fund, an interactive map/scorecard on quality of Health care across the US (click here).

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Making Sense of 2010 Enrollment and Disenrollment Guidance from CMS

CMS recently released their updated 2010 guidance for Enrollment and Disenrollment.  A surprise awaited with a new model enrollment forms (exhibit 1 and 1a) along with new notices.

There are also NEW MA exhibits 34, 35, 36 and NEW PDP exhibits 33, 34, 35.  

Exhibit 33	NEW! PDP Model Notice to Research Potential Out of Area Status
Exhibit 34	NEW! PDP Model Notice for Disenrollment Due Out of Area Status (No Response to Request for Address Verification)
Exhibit 35	NEW! PDP Notice of Disenrollment Due to Out of Area Status (Upon New Address Verification from Member)

As with any guidance from CMS, the first step is identifying what’s new, then moving forward with an analysis of how it will change your business; what it could add, change or remove for your processes.

We’ll be providing more on these guidelines as enrollment deadlines approach.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Care: Forward thinking to reduce costs

Do you know the multi-cultural dynamics of your employees, or your insured base membership? 

As an industry looking for all ways to reduce health care costs, an innovative forward thinking approach to is to better understand the multi-cultural dynamics of your members. 

Diving deeper into the demographics – categories such as ethnicity, coupled with age, sex, religious affiliation and other characteristics – can guide and aid you in understanding their needs, develop better treatment plans, and implement more effective out reach programs with the ultimate goal of producing better outcomes related to their specific health issues.  

Better outcomes with improved quality of care for each cultural sector combined with understanding a groups specific disease issues, behavioral dynamics, and family relations will provide better methods of treating our population in general, thus reducing overall health care costs. 

The Multi-cultural dynamics of employees and insured base of membership is an untapped source of analysis that can be applied in reducing overall health care costs. 

This is definitely something to think about, ponder and explore. 

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Audits Aim For “Real Time” Reviews

In years past, the norm for CMS has always been to conduct retrospective audits – essentially a review of data from prior months’ (EX. CMS would arrive at the plan in October to review data from January through June).

Audits were primarily focused their efforts on universe pulls and standard operating procedures along with any known escalated events that came through their jurisdiction such as CTMs.

Moving forward CMS will be conducting audits of plans on a more "real time" basis. They are conducting more "focused" audits and they are keeping a tight view of all plan CTMs and their occurrences.

Also, MA plans are now directed to report more in-depth information to CMS beginning with HEDIS and other metrics. With this increased scrutiny of plans and Medicare Improvements for Patients and Providers Act's arrival in 2008, the theme of tighter monitoring continues to resonate throughout regulation for 2010.

As such, better procedures and business processes are no longer discussion points, but key elements in maintaining quality and compliance (see: The 2010 Call Letter, Marketing Guidelines, and Enrollment and Dis-enrollment Guidance).

As with any guidance and changes from CMS, the first step is indentifying what’s new, then moving forward with an analysis of how it will change your business; what it could add, change or remove for your processes.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Are You Ready? Updates From AHIP Conference

With Annual Enrollment (AEP) soon to be here are you ready?

As with prior years, CMS has issued an extensive readiness check list for plans to follow and guide them in preparation of the upcoming 2010 plan year. 

This year, with the multiple changes in regulation and continued scrutiny of marketing activities (see early post blog post from today), it is apparent there is much to do to ensure readiness on all fronts.  

CMS recommends plans self-audit so there are no surprises. 

While CMS has not provided the timeline for reporting readiness, as always, the sooner you begin the more confident you will feel. 

Support materials are from CMS available for download here. 

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.   

2010 Marketing Guidelines Could Improve Communications

With the recently released 2010 CMS Marketing Guidelines, and the current AHIP conference, here’s one of guidelines that caught my eye: 

All plan sponsors that mail information to Medicare beneficiaries, prospective or enrolled, should include one of the three statements on any envelope or the mailing itself (if no envelope is being sent) that they are sending to Medicare beneficiaries regardless of the materials inside of the envelope. One of the three statements on the outside of the envelope or mailing itself should best fit the information being sent to the Medicare beneficiary which are:

1. Advertising pieces – "This is an advertisement;"

2. Plan information – "Important plan information about your enrollment; and

3. Health – "Health or wellness or prevention information."

On the surface, this sounds like an increase in cost. We’re confident that some planning can avoid that, and perhaps even create a way to reduce costs in the overall mailing piece, or improve the overall communication with prospects and enrollees.

I’m looking forward to continuing to discuss this and other CMS rulings throughout the week.

Note: The specific part of the guidelines referenced is section 50.6 - Plan Sponsor Mailing Statements on Envelopes/Mailing Itself.  ------------------------------------------------------------------------------------------------- 

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.   

Insurance Provider Shows the Way: Simple TIPS for Getting Started on Twitter

An industry leading insurance provider recently launched out into the Twitter world with their (here’s an article with more information: from the Cleveland Plain Dealer).

It’s inspiring to see Healthcare providers taking this step to better address customers needs, first by listening to what they are saying and then by responding and providing a gateway to answers, wherever those customers are seeking help.

Everyday people ask for advice on how to use Twitter - and sometimes even why they should bother.

The Why is easy:

• Twitter is a viable business information, interaction and customer service micro-blogging tool.
• You can gain access to a tremendous amount of information on Twitter.
• More and more companies will offer the Twitter option for Customer Service.

If that's not enough, some experts say there probably will come a time when a Twitter address is as common as email.

As with anything, getting started is hard.

Here are some tips that may help:

• Listen to the conversations that are taking place. Use keyword search (#yourname here) to identify what’s being said.
• Don't expect too much too soon. It takes time. And you will often hear from those with problems moreso than those that like what you do.
• Use the search tool to find topics of interest to you and people that follow you.
• Say something of interest ... join the conversation.
• Tell people you are on Twitter ... add it to your signature line on email.
• Stick with it. 

Twitter is a simple tool that enables better communication on all sorts of topics. It’s also your chance to better serve customers.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.   

Improving Results, Everyday

Improving results, everyday. It's a pretty straight-forward goal.

As a member of the Merrill Corp. team, I've worked with customers both large and small in interpreting Healthcare and Insurance regulations, meeting CMS requirements and improving processes to make compliance a simple part of the process and not a "trip to the dentist" (nothing against dentists', mine is quite good!).

In this blog, I'll be talking about just those things. And hopefully providing a few good insights and things to consider along the way.

I'll hope you'll join me in discussing CMS Compliance, Healthcare and Insurance regulations, and meeting and improving operating goals. It's not exactly a movie review, but it does impact companies, their customers, and you everyday.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.