Mktg Compliance Aligned 3.26.10

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Medicare Marketing & Enrollment 2010 Compliance and Marketing

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Mktg Compliance Aligned 3.26.10

  1. 1. Aligning the Odd Couple – Marketing and Compliance Medicare Marketing and Enrollment Strategies 2010
  2. 2. Disclaimer <ul><li>Content in this presentation is based on research and study of presenter through publicly available materials, personal interviews and online studies. Material is not to be duplicated or used in any other manner without the expressed consent of the presenter. Findings and opinions expressed are solely those of the presenter and not those of Windsor Health Plan, Inc. </li></ul>
  3. 3. Windsor Health Plan vitals <ul><li>Five states </li></ul><ul><li>183 counties </li></ul><ul><li>31,348 MA/MAPD members in eight HMO plans </li></ul><ul><li>44,408 members in PDP plan </li></ul><ul><li>Doubled enrollment three consecutive years </li></ul><ul><li>Two comprehensive audits (2007, 2009) </li></ul>
  4. 4. The Admiral Stockdale dilemma <ul><li>Marketing and Chapter 3 are enough </li></ul><ul><li>It really is all about communications and positioning </li></ul><ul><li>Navigating Compliance </li></ul>
  5. 5. Market landscape is changing Entrance of M&N Supplements New Supplement Plans Reduced MA reimbursements The fall of PFFS Expansion of HMO and PPO Recession fallout Group market opportunities Booming market Source: “A New Deal? What’s New for Medicare”?; Dawn McFerrin, Supplement to Sales Agent Journal , October 2009
  6. 6. Surveillance was formerly moderate
  7. 7. Intensity of oversight by OIG intensifies <ul><li>Since 2008: </li></ul><ul><li>353,730 CTM complaints </li></ul><ul><li>92 notices of marketing non-compliance for 2009 AEP </li></ul><ul><li>1,500 secret shopping events in 2009 AEP </li></ul><ul><li>Focused review of 400 random events </li></ul><ul><ul><li>Inappropriate compensation </li></ul></ul><ul><ul><li>Misleading tactics </li></ul></ul><ul><ul><li>Aggressive, lack of consent </li></ul></ul><ul><li>Outcome: </li></ul><ul><li>Strong recommendations on sales oversight and increased number of audits </li></ul><ul><li>CMS disputing deficiencies </li></ul>Source: Beneficiaries Remain Vulnerable to Sales’ Agents Marketing of Medicare Advantage Plans, OIG, March 2010
  8. 8. Accountability by CMS intensifies Scope of Horizontal Secret Shopping of Marketing Events During AEP Total number of horizontal secret shops conducted 811 Number of MA organization shops 762 Number of PDP organization shops 49 Number of shops allocated to high-risk organizations 409 Number of shops allocated to all other organizations 402 Minimum number of shops conducted for any shopped organizations 1 Maximum number of shops conducted for any individual organization 134 Overall Industry Performance for Horizontal and Vertical Events Total secret shops conducted 1,463 Percentage of organizations with violations 51.6% Percentage of secret shopping events with violations 52.2% Organizations issued notices for secret shopping violations 28 Source: Contract Year 2009 Marketing Surveillance Summary Report, CMS
  9. 9. Pressure intensifies with poor documentation <ul><li>Based on 170 complaints in one Regional Office: </li></ul><ul><li>33 percent of cases were resolved, closed inappropriately or duplicates </li></ul><ul><li>28 percent of resolutions were poorly documented </li></ul><ul><li>20 percent of cases were incorrectly categorized </li></ul><ul><li>About 12 percent of cases lacked specific information about at least one issue </li></ul>Source: CMS Assists Medicare Beneficiaries Affected by Inappropriate Marketing, GAO, December 2009
  10. 10. Snapshot poll of key MAO functions Source: Marketing and Compliance Poll, March 2010, n=40
  11. 11. Most plans under 50,000 MAPD members Source: Marketing and Compliance Poll, March 2010, n=40
  12. 12. All plans are under tight scrutiny Source: Marketing and Compliance Poll, March 2010, n=40
  13. 13. Most believe there is collaboration Source: Marketing and Compliance Poll, March 2010, n=40
  14. 14. Most see knowledge up and cases down Source: Marketing and Compliance Poll, March 2010, n=40
  15. 15. Regulatory halo effect Source: Marketing and Compliance Poll, March 2010, n=40
  16. 16. But not all levels agree on regulatory status Source: Marketing and Compliance Poll, March 2010, n=40
  17. 17. Lack of clarity leads to risk Source: Marketing and Compliance Poll, March 2010, n=40 Lack of Clarity Decisive Actions Audit risk remains prominent
  18. 18. Big disconnect on status of compliance
  19. 19. It could be as simple as motivations Compliance Marketing Sales Heartburn Heartburn 2 Heartburn Frustration Volatility Source: David McClelland (adapted), staff surveys Sales = Personal Power Marketing = Social Power Compliance = Expert Power Achievement Affiliation Power
  20. 20. Common challenges among Marketers <ul><li>“ We feel like Compliance just drops our issues in CMS’s lap, and they just let the chips fall.” </li></ul><ul><li>“ Compliance often stands behind the cloak of CMS.” </li></ul><ul><li>“ Compliance is not approachable or willing to negotiate.” </li></ul><ul><li>“ Compliance needs to work their relationship with the RO.” </li></ul><ul><li>“ Compliance is scared to death to re-file marketing pieces.” </li></ul><ul><li>“ Compliance feels a lot more like the ‘police’ than a ‘partner’.” </li></ul>Source: Phone interviews with MAO Marketing and Compliance Departments, n=5
  21. 21. Marketing areas of opportunity <ul><li>Take ownership of the regulatory communications process </li></ul><ul><li>Help Compliance position reporting, status and next steps </li></ul><ul><li>Let them walk in your shoes: </li></ul><ul><ul><li>Ensure Compliance understands business objectives </li></ul></ul><ul><ul><li>Take them on a ride-along </li></ul></ul><ul><ul><li>Make them rehearse the RO call with you </li></ul></ul><ul><ul><li>Don’t be passive/aggressive </li></ul></ul>
  22. 22. Structure affects confidence in compliant behavior
  23. 23. Challenges for Compliance <ul><li>“ Why can’t Marketing and Sales just operate within the guidelines? There is plenty of room.” </li></ul><ul><li>“ We have to think about the entire organization and they just have one chapter.” </li></ul><ul><li>“ The sheer volume of work is a problem for us.” </li></ul><ul><li>“ Even when we condense the guidance and offer a point-of- view, we feel like Marketing is always looking for an ‘out’.” </li></ul><ul><li>“ We don’t think Marketing really understands how even the smallest issue can affect a huge number of people.” </li></ul><ul><li>“ Our deficiencies show up on public websites. We get CAPs. We get fined.” </li></ul><ul><li>“ We are under a lot of pressure without always enough authority.” </li></ul><ul><li>“ There will be pain and suffering.” </li></ul>Source: Phone interviews with MAO Marketing and Compliance Departments, n=5
  24. 24. Working together is a great theory Source: Marketing and Compliance Poll, March 2010, n=40
  25. 25. Gaps still remain between the two departments Source: Marketing and Compliance Poll, March 2010, n=40 Oversight Knowledge Leadership
  26. 26. Marketing areas of opportunity <ul><li>Align your motivations and areas of struggle </li></ul><ul><li>Evaluate the structure and operate around it </li></ul><ul><ul><li>Matrix design works best </li></ul></ul><ul><ul><li>Timelines and traffic systems create efficiency </li></ul></ul><ul><ul><li>Affirmation is important </li></ul></ul><ul><li>Create a clear value proposition for everything you ask of Compliance </li></ul><ul><li>Help make the Compliance Plan much more like an actionable Marketing plan </li></ul>
  27. 27. Have you given “power” to the expert? <ul><li>Present materials and seek guidance through discussion </li></ul><ul><li>Random audits for permission to contact </li></ul><ul><li>Broker confirmation calls </li></ul><ul><li>Medicare questionnaires </li></ul><ul><li>Replacement forms for plan changes </li></ul><ul><li>Create a contract year “readiness team” </li></ul><ul><li>Random audit of sales allegation process and procedures </li></ul><ul><li>Broker background checks – seven years </li></ul><ul><li>Training, licensing and rapid disenrollment reporting </li></ul><ul><li>Involvement in sales training or regular sales management calls </li></ul><ul><li>Co-develop training, regardless of who delivers </li></ul><ul><li>Provide measurable feedback from sales and verification calls </li></ul><ul><li>Schedule regular meetings with Compliance with agenda and notes </li></ul><ul><li>Provide Compliance with your reports for OPC meetings </li></ul><ul><li>Help with policies, procedures, implementation timelines </li></ul>
  28. 28. Seven keys to Marketing/Compliance success <ul><li>Recognize the business challenges ahead </li></ul><ul><li>Recognize the risk of greater scrutiny together </li></ul><ul><li>Build a communications and operations matrix </li></ul><ul><li>Offer help in positioning in exchange for support </li></ul><ul><li>Know your RO </li></ul><ul><li>Collaborate on CMS communications/responses </li></ul><ul><li>Recognize and support the “expert power” motive </li></ul>
  29. 29. Questions? <ul><li>John M. Sowell </li></ul><ul><li>Vice President, Marketing </li></ul><ul><li>Windsor Health Plan, Inc. </li></ul><ul><li>7100 Commerce Way, Suite 285 </li></ul><ul><li>Brentwood, TN 37027 </li></ul><ul><li>615.782.7938 </li></ul><ul><li>[email_address] </li></ul>

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