An Unbiased Look at Healthcare Reform

No matter which side of the issue you are on, there is no denying that March 23rd, 2010 will go down as a notable day in the annals of the United States with the signing into law of the Healthcare Reform bill. Numerous presidents and legislators throughout history had made attempts at addressing this issue, and while many may still be wondering “what just happened?” it is clear that much change is on the horizon.

A number of people have a number of questions on how this bill will affect them, and while different changes will happen at different times, we have broken down the changes into two categories:

Changes forthcoming for 2010:

No annual caps or limits
No rejections based on pre-existing conditions
Young adults covered to age 26 on parent’s policy
Drug discounts for seniors
Tax breaks for small businesses

Changes that will occur by 2014:

Health Insurance Exchange
No discrimination allowed
Tax breaks for consumers
Medicaid expansion to include childless adults

There will be much debate to ponder over in the upcoming weeks, months and years. Time will advise us of the pro's and con's established within this piece of legislation. Let's always remember change is not easy but with change there is opportunity.

---------------------------------------------------------------------------------

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 Releases 2011 Draft Call Letter

The CMS 2011 Call Letter has a completely different look and feel this year. It is much shorter in both length and scope in how to direct plans and organizations to details with the Medicare Manuals for regulatory guidance and compliance factors.

Highlights of provisions in the Call Letter include:

• Announcements of a combined calendar listing with side-by-side key dates and timelines applicable to MA, MA-PD, Part D and cost-based plans. The calendar contains important operational dates for plans, such as the date that CMS will begin accepting bids, dates for non-renewing plans, and dates for beneficiary mailings.

• A provision encouraging sponsor practices to curb waste of unused drugs dispensed in the retail setting, information about reassignment, information about the release of data, information on the Medicare Enrollment Assistance Demonstration, and information on potential new B versus D coverage determination for beneficiaries with ESRD.

Jonathan Blum, Acting Director, Center for Drug and Health Plan Choice, writes this as a synopsis of the draft:

Attachment VI provides the draft CY 2011 Call Letter for Medicare Advantage (MA) organizations (MAOs); section 1876 cost-based contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of All-Inclusive Care for the Elderly (PACE) organizations; and employer and union-sponsored group plans, including employer/union-only group waiver plans (EGWPs). The Call Letter contains information these plan sponsor organizations will find useful as they prepare their bids for the new contract year.

The Advance Notice/Call Letter has been drafted assuming current law. If new legislation is enacted after this Notice is released and before the April Rate Announcement is published, CMS will incorporate changes in the Rate Announcement.

This is not the only CMS draft that has changes. Next week, we will review the 2011 Medicare Marketing Guidelines.

----------------------------------------------------------------------------------

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.

Will Rearranging CMS Spell Anything New?

With healthcare legislation news taking prominence over the past several weeks, buried in the news has been s the very important announcement of the reorganization of the Center for Medicare & Medicaid Services in the upcoming months.

The headline has been the naming of former Virginia Secretary of HHS Marilyn Tavenner as the first principal deputy administrator for CMS, a position that has been defined as the second highest position within the agency. Members of the medical community, such as the American Health Care Association have commended the selection of Ms. Tavenner, not only because of her experience within former Governor Kaine’s cabinet, but also for her 25 years working for the Hospital Corporation of America (HCA), as well as working her way up from staff nurse to CEO of Johnston-Willis Hospital.

In addition to the creation of this new post, the decision has been made to merge several of the CMS offices:

• The Center for Medicaid and State Operations will be renamed the Center for Medicaid, CHIP and Survey & Certification, and it will be led by CMS Deputy Administrator Cindy Mann.
• The Center for Strategic Planning will realign the Office of Research, Development and Information with the Office of Policy.
  
• The Office of External Affairs and Beneficiary Services will realign the Office of Beneficiary Information Services with the Office of External Affairs.

To comment on these changes before they have had the opportunity to be integrated would be irresponsible, but history tells us that a streamlining of this caliber has the opportunity to be either significantly efficient or potentially dangerous. Approximately 98 million people rely on CMS’s 4,400 employees for assistance with their Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), so above all else, this reorganization must be done with a communications strategy in place which will allow all customers to know how the process will affect them and all staff members to know what their new responsibilities will be.

The Real Debate in D.C. (Part 2)

Last week, we discussed the difference between the Bipartisan Summit and other, less publicized but more comprehensive events, such as the Managed Healthcare Business Forum.

As a follow-up, let's talk about some of the outcomes. There has been a great deal of coverage on the event with elected officials, but none on the other. So, here is first-hand account on some of the key topics discussed:

Health Reform: The discussions were much like what was happening across town. What are the next steps? Where do we go from here? What should we expect from our regulatory bodies and the current administration? The truth is that much is known and yet unknown at this point. It is expected by most that some type of health reform will be developed this year. However, the size, scale and price tag remain a mystery.

Streamlining Cost and Quality of Care: Cost reductions and the management of costs are at the forefront of all discussions. Being creative is essential, thus newer ways to incent (i.e. work with) providers are emerging, such as payment programs and quality metrics to determine performance within their patient base and to their peers. Most would see this as the old standard capitation methodology with a twist. However, when you delve deeper, you can see the potential cost savings and the new horizon for quality metrics reporting, monitoring and performance.

Health and Wellness of the Membership Base / Moving Health and Wellness to the Next Level: Health and wellness of our membership continues to be a key to any solution worth implementing, and therefore new ways to carve out components of our membership and incent them to actively participate in wellness campaigns is on the horizon more so now than ever before. There are two basic reasons:

1. To enhance/improve a members overall quality of life.
2. To streamline/enhance cost savings.
   

Examples of ways to accomplish this were discussed, including how to develop customized, well-rounded plans that would allow individuals to potentially lower their premium costs if utilized. So, if a member had diabetes, they would be in a plan specifically designed for them with tailored programs to facilitate education, wellness, and healthy lifestyle habits that would not only benefit them, but in a small way, help the industry become more efficient.

Service: This concept continues to be a major separator in the playing field. While price and benefits continue to be the top components, service is a close second. With a competitive price in the market place, service will be the key component that separates plans. Members are looking for "first call resolution" (as opposed to be being transferred multiple times) and a one-stop shop for answers. Those that can perfect (or come closest to) a model in which a single phone number can result in a live body that can handle all their needs will have a leg-up on competitors.

The event provided all that attended with an abundance of information, with the added benefit of zero television cameras, so ideas could be shared without 'post-event wrap-up commentary.' The next step is the hardest, though. We need to take these ideas and philosophies back to our respective corners of the world and turn them into solutions.

----------------------------------------------------------------------------------

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.