Clarity of Health Reform

The debate rages on regarding health reform and the focus has now shifted to the constitutionality of the legislation. A Virginia judge ruled the individual mandate was unconstitutional and a Florida judge ruled the entire legislation was unconstitutional. This has sparked the 26 states included in the fight against the health reform legislation to withhold from implementing the act. 

Such states as Alaska have openly commented they will not enact the legislation but begin developing their own plans for health reform within their state. Gov. Sean Parnell said the state would pursue lawful, market-based solutions of its own. That includes planning for a health insurance exchange, meant to offer a choice of health plans.

This action compelled the White House to quickly respond stating while the Virginia and Florida judge have sited unconstitutionality of the law the law must not be upheld and implementation must continue. 

The main theme cited was the cost savings associated with the Medicare payment reform on 100 million Medicare claims that are processed each month. As the constitutionality of health reform continues to be at the forefront it appears only a ruling by the Supreme Court can conclude the acts fate.

For more information, read the Associated Press article on the topic here and to learn more via webinar, 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.

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.

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.

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.