The CMS / CGI Partnership

The contract that most sports enthusiasts are pondering this summer is that of Lebron James. However, if you are interested in the healthcare / web development equivalent of this question you need not wait any longer.

This week, the Centers for Medicare and Medicaid Services (CMS) announced that it has awarded CGI Federal, Inc. a five-year, $73.2 million contract to redevelop three of their websites that enable Medicare beneficiaries to find information about their healthcare programs.

The three sites - www.medicare.gov, www.cms.hhs.gov and www.Mymedicare.gov - provides information for 44 million beneficiaries and receives a total of 500 million views a year. The sites are primarily focused on allowing consumers to view health claims information, compare health and drug plans based on quality measures and estimated costs, and create a report listing information that they can share with their healthcare providers. As an example of the importance HHS puts on the ability to navigate the site, the following video was released involving Secretary Sebelius walking viewers through the Medicare.gov:



The execution of this contract will be an extremely interesting task. It has been well documented that a large chunk of the healthcare reform package will be enacted and implemented over this period of time, and as new regulations are developed on items such as the role of social media, these three websites will have to be well managed.

CGI and CMS have had a long standing and successful collaboration, including projects like the Hospital Compare and Nursing Home Compare tools, which combine geographical data from Google Maps with healthcare provider quality-of-care information to help users locate and assess nearby healthcare facilities. Additionally, CGI was awarded the Enterprise System Development (ESD) contract, which covers systems development and integration, system and application engineering and technical support to improve the automated systems and agency-wide applications of the Health and Human Services Department.

However, this project will involve developing tools for the public at large, not a subset of experts in the industry. It is a different mode of thinking, but the potential is there for a new evolution of internet communication.

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.

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.

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

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).

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

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. 

-------------------------------------------------------------------------------------------------
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.

-------------------------------------------------------------------------------------------------
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.