Medicare Advantage: A Unique Opportunity
One of the market opportunities for provider-sponsored groups (physician groups and integrated hospital system) and health insurers, is the establishment of a robust Medicare Advantage program.
Provider groups would want to do this to generate revenues and to provide their population a truly integrated experience. . . like Geisinger, Intermountain, or Kaiser
Health insurers who are not already in Medicare Advantage business should consider this opportunity as the Medicare Advantage programs are generating substantial revenues and profits for those insurers who are doing it well.
These plans are difficult to get right. . . but for those who do, they experience growth of insurance coverage at nearly twice that of other commercial health insurance offerings. By 2021, Medical Advantage programs will represent one quarter of the health insurance profitability and will insure approximately 25 million members.
Each year, new plans are introduced into the market place but interestingly not all of these plans are successful because these plans must be operated differently from other health insurance products. For those plans that are successful, they quickly gamer a population of subscribers.
The secret to success of these plans is: Enrollment Simplicity, Star Rating, Provider Network, and Population Management.
These are four items that you must get right to take advantage of this opportunity
Sales of competitive products through brokers and agents coupled with extremely quick enrollment process to lock in membership with CMS
Exceeding the member’s expectations in customer service and compliance with CMS guidelines
Population Management strategies that ensure not only the full elaboration of member problem lists but also gears strategies to help those members stay in control of their chronic illnesses
Offering a network of providers who you monitor to know that each is performing well for your membership
Why Chase Group?
Chase Group is a boutique consulting firm with deep expertise in Medical Advantage.
With over 30 years of industry experience, Chase Group Ltd. has provided a unique blend of experience managing strategic and business projects, designing and implementing innovative business solutions, and facilitating reengineering and performance improvement.
Here are specific clients for whom we have implemented large strategic Medicare Advantage initiatives.
We installed a new Utilization Management system aimed at supporting Population Management.
We designed and established a robust all inclusive population management system and all related integrations so that care managers would have the latest information to manage their patients.
Implemented several enhancements to the care management program and developed the rules and design of the overall medical management program.
We designed the new population management system for Geisinger including analytics and risk stratification. Also installed a real time enrollment system for Medicare Advantage.
Developed the real time enrollment process that eliminated delays and manual processes in enrolling medicare Advantage patients while timely paying brokers their commissions.
Designed and implemented the prior authorization process for prescription drugs with Express Scripts.
Implemented the new care management system as part of the population management strategy, implemented bravo owned clinics to better manage their population of Medicare patients. Built the clinical rules that targeted specific patients for assistance.
Worked on managing the PMO for Medicare Advantage and all projects being undertaken, including risk assessments, and Star Ratings.