Medicare Advantage enrollment and spending are expected to surge over the next decade, until more than 4 in 10 beneficiaries are in the program by 2028.

The MA enrollment rate is set to grow from 34% in 2018 to 42% over the next 10 years. As the share of the population on MA grows, public perception of Medicare could shift significantly, according to the New England Journal of Medicine (NEJM). 

"The Medicare of tomorrow could look much different than it does today—more like a marketplace of private plans, with a backup public plan, and less like a national insurance program. This may or may not be the program that people envision when they talk about Medicare for All," NEJM authors wrote in a recent report.

When the Medicare Advantage program was created, just 3% of the Medicare population participated. But both Republicans and Democrats have made policy decisions that increased enrollment significantly.

Beneficiaries have grown fond of MA plans due to their strong financial protections and the extra benefits they provide, like dental care and gym memberships. Yet those extra benefits are also set to take a toll on taxpayers.

Spending on MA beneficiaries is expected to almost triple, from $206 billion in 2018 to $584 billion in 2028, according to projections from the Congressional Budget Office. NEJM suggested that this public spending could become a more political issue as spending spikes, even though the plans are popular. 

"Policymakers could face tough choices in the future as they seek to balance competing demands to reduce the growth in Medicare spending and also provide plan choice and extra benefits," the authors wrote. "To achieve savings, they could, for example, reduce plan bonus payments and rebates. … Striking the right balance in payment policy from the perspective of beneficiaries, insurers, and the federal government is likely to remain a considerable challenge."

Insurers like UnitedHealthcare, Aetna and Anthem have reported huge windfalls from the government program that is administered by private plans. And new regulatory flexibilities have CEOs bullish about the future. The program is also attracting new startups like Oscar Health and Devoted Health.

Over the past decade, the program has grown from 21% of Medicare beneficiaries to 34%. But inequity issues are also likely to become more acute as MA enrollment grows, as not everyone has the same access to the same plans. Among other things, MA tends to have a smaller footprint in rural areas, according to NEJM, so beneficiaries in those areas are also more likely to be on traditional Medicare.

These disparities can be problematic not just because of the extra benefits MA plans provide but also because of their financial protections. Unlike traditional Medicare, MA plans are required by CMS to have an out-of-pocket limit; in 2018, the average enrollee had an annual limit of $5,215. This can make a huge difference to seniors, many of whom live on fixed incomes with high healthcare costs.

"More than one-third of all beneficiaries in traditional Medicare spent at least 20% of their per capita income on out-of-pocket health-related costs in 2013," NEJM wrote. "In addition, Medicare Advantage plans offer the convenience of one-stop shopping by covering all Medicare benefits; in contrast, most beneficiaries in traditional Medicare have wraparound supplemental coverage."

As a result of these changing expectations, future policymakers may either have to alter access to MA plans or change the benefits incorporated in traditional Medicare, NEJM suggested.

Source

 (Photo: Freepik)

The emerging role of Medicare Advantage, the private-plan alternative to traditional Medicare, is gradually changing the Medicare program in ways that have important implications for beneficiaries, providers, and spending. Fueled by policy changes adopted by both Democrats and Republicans, enrollment in Medicare Advantage plans has more than tripled since 2005, from approximately 6 million to 20 million beneficiaries. Between 2018 and 2028, Medicare Advantage enrollment is projected to rise from 34% to 42% of the Medicare population. At the same time, federal spending on behalf of Medicare Advantage enrollees is projected to grow from approximately $200 billion to more than $580 billion (not including additional Medicare spending associated with coverage of prescription drugs under Medicare Part D).

In this article, we begin with a brief comparison of Medicare Advantage relative to traditional Medicare. We then examine the extent to which the Medicare Advantage program is achieving goals with respect to benefits and out-of-pocket costs, plan choice, federal spending, and quality. We highlight areas in which more evidence is needed to better understand the implications of the shift from traditional Medicare toward private-plan enrollment, and we identify ongoing challenges.

Download the full article in PDF Here

Starting next year, Medicare Advantage plans will be allowed to pay for a wider array of health-related benefits including transportation and home health visits, Health and Human Services Secretary Alex Azar said on Wednesday.

And by 2020, HHS will extend the range of benefits even further to allow MA plans to cover benefits such as home modifications and home-delivered meals, he said. 

Why?

"These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too," Azar said. "If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be."

Azar (pictured left) was speaking in D.C. at a healthcare policy symposium focused on social determinants of health hosted by Utah-based Intermountain Healthcare and the Orrin G. Hatch Foundation's Hatch Center.

He was focusing on the agency's approach to social determinants a day after it was announced that CMS would begin allowing states to cover a broader range of mental health services under Medicaid. Specifically, CMS would consider Medicaid demonstration waivers covering short-term stays for acute care provided in psychiatric hospitals or residential treatment centers in return for states expanding access to community-based mental health services.

As he spoke, Azar also teased new focus areas coming from CMS' Center for Medicare and Medicaid Innovation (CMMI) for helping vulnerable populations.

“What if we provided more than connections and referrals? What if we provided solutions for the whole person including addressing housing, nutrition and other social needs all together?" Azar said. "What if we gave organizations who work with us more flexibility so they can pay beneficiaries' rent if they are in unstable housing or make sure that a diabetic has access to and can afford nutritious food? If that sounds like an exciting idea, then stay tuned to what CMMI is up to.” 

Azar said the moves are part of a broader push under the Trump administration to better harness the flexibility of existing programs to address social determinants that drive up health costs and hurt patient outcomes. 

“It probably won’t surprise you to hear that this administration is thinking about how to improve healthcare and social services while preserving what is unique about our American system: its decentralized nature and the key role played by the private sector and civil society," Azar said. “But it may surprise you that we are thinking about this very specifically in the context of social determinants of health. We are deeply interested in this question, and thinking about how to improve health and human services through greater integration has been a priority throughout all of our work."

Medicare Advantage (MA) plans are offered by private companies approved by Medicare and paid by Medicare to cover patients' benefits including hospital and medical insurance.

While the idea has been lauded by health experts, Kaiser Health News reported few seniors will actually be able to access these changes. Medicare officials estimate about 7 percent of Advantage members — 1.5 million people — will have access, KHN reported.

Companies offering MA plans both compete for patients and hold the risk for them, Azar said. "They've got incentives to offer benefits that are both appealing to their members and that will bring down healthcare costs whether those benefits are traditionally thought of as health services or not," Azar said. "The key is just that we need to give them the flexibility to do this, which we generally don't do."

https://www.fiercehealthcare.com/hospitals-health-systems/azar-and-social-determinants-health

(Photo: Pexel)

The robots are coming. And they're here to take your sales job.

At least, that's what we're afraid of. It might be true that technology can be integrated into many steps of the sales process. But, thankfully, it can't do everything.

For now, there are a number of skills computers can't learn, and one of those is our human ability to create empathetic connections with prospects and customers.

This is a key ability for the modern seller. Develop empathy and you'll enjoy more effective sales conversations. More importantly, you'll build a skill set that’s in demand and hard to replace with technology.

What is Empathy?

Quite simply, empathy is the ability to understand the emotional state of another person and respond appropriately. It doesn't mean you have to feel the same thing (that's sympathy).

Empathy is your capacity to sense what’s going on in someone's else mind and guess at the best way to engage based on your understanding of that perspective.

How Empathy Drives Sales Conversations

At its heart, sales has always been about the interpersonal engagement between two people. We always hear about sales professionals being "people people." That's simply another way of saying they’re empathetic.

When we talk about emotional intelligence, one of the most important things we're referring to is the ability to recognize, understand, and respond to the emotional state of others in an appropriate way.

Think about your sales interactions. Key steps include building trust, uncovering needs, and creating confidence. If you can't do those well you're not going to find a lot of success.

All of them are driven by sales professionals' ability to create a bridge with their prospects. By picking up on the subtle and not-so-subtle clues that our conversational partners apply, salespeople with high emotional intelligence can create stronger connections and more easily influence others.

This is especially important as sales processes get more complex and involve more people. It's critical to be able to understand the motivations and thoughts of everyone involved in the process. In a world where information is a commodity, you need to be more than a source of facts and figures.

You need to possess the ability to engage on an emotional level and become a resource for potential customers. If you want to guide them through their buying journey, it's imperative you connect on the human level.

Tips for Developing Empathy

Luckily, your emotional intelligence isn't a fixed trait. Much of your empathy is developed as you mature, but it's a muscle that can be exercised and improved. There are actually pathways in our brains called mirror neurons. They have evolved to recognize and respond to the hundreds of small, usually unnoticed, signals people give off when they interact.

Taking it a step further, as we grow up, we develop what neuroscientists call the Theory of Mind. It describes our ability to put ourselves in the place of someone else and see things from their perspective. It also allows us to understand others might have thoughts, feelings, and motivations causing them to do what they do. And it's why you can pick up on the unspoken signals of your friend and ask, "What's wrong?" before they even have to tell you they just had a bad day at work.

Building your ability to pick up on these signals, and learning how to interpret them, can pay huge dividends. And it's not complicated. You don't have to take special classes or training seminars.

In fact, your daily sales activities provide constant opportunities to build your capacity. Here are five exercises you can use to cultivate your empathetic skills.

Discover the 5 ways to develop Empathy here

(Photo: Pexel)

Nearly half of all new Medicare enrollees are signing up for Medicare Advantage plans, which now account for about 35 percent of the entire Medicare market.

The other 65 percent of Medicare beneficiaries are in what’s called original Medicare, which consists of Part A (hospital, nursing home) and Part B (doctors, equipment, outpatient expenses). Those patients usually have a private Part D drug plan, and a quarter have a private Medigap supplement policy.

Medicare Advantage (MA) plans must cover everything that original Medicare covers, and they can’t discriminate against people who are ill or have preexisting conditions. Anyone, regardless of their health, can get an MA plan or switch to one during open enrollment, which continues through Dec. 7.

Medicare rules have also changed and will permit anyone with an MA plan to switch to another MA plan or opt for original Medicare during the first quarter of 2019; those changes will take effect the month after they have been made.

As noted often in earlier Ask Phil columns, Medicare Advantage plans have lots of beneficial aspects to them, but also lots of yellow — if not red — lights for people to heed as they decide whether to enroll.

First, the positive features.

The “good”

A single insurance plan: MA plans offer all your insurance needs through a single insurance company plan. Ask anyone who’s had to manage three sets of documents – from a government-appointed contractor for original Medicare, a private insurer for Part D, and a private Medigap insurer – and the benefit of dealing with a single entity becomes clear. You might even call it an…advantage!

Additional coverage: Most MA plans go further than original Medicare and cover things that it does not, chiefly dental, hearing and vision care, along with health club memberships and an expanding list of attractive non-medical benefits such as transportation to doctors’ appointments and the delivery of nutritious meals to folks who are recuperating at home from hospital stays. These bells and whistles are likely to attract more MA converts. I’ll have more about them in a bit.

Lower costs: The greatest appeal of MA plans likely is their low costs. More and more MA plans are charging zero premiums after a person has paid the government their monthly Part B premium, which will be $135.50 next year for most individuals.

MA plans usually offer two or three ceilings on out-of-pocket spending – one for their Part D drug plans, one for in-network medical expenses, and often another one for out-of-network expenses. People with MA plans thus do not need Medigap plans and, in fact, it is illegal for an insurer to sell a Medigap plan for use with an MA plan.

The “bad”

Limited networks: The existence of medical provider networks is a big fork in the road separating MA plans from original Medicare. MA network limitations should be carefully explored by anyone thinking of an MA or considering whether to keep the one they have.

Increasingly, Medicare Advantage is offering expanded geographic coverage options.

People with original Medicare are covered for services from any doctor, hospital and other caregiver in the country that accepts Medicare. This includes nearly all caregivers, although it is true that it can be hard to find caregivers in some parts of the country who are accepting new Medicare patients.

MA customers, by contrast, are usually restricted to getting care from doctors and organizations included in their plan’s provider network. Most MA plans are HMOs, or health maintenance organizations, that have what are called narrow networks – relatively small groups of providers located only in the plan’s home market. Plans with broader networks and larger geographic service areas are known as PPOs, or preferred provider organizations. They provide more provider choice and cost more than an MA HMO.

Historically, people who travel around the country a lot and have second homes in warmer climates have avoided MA plans because of network limitations. Increasingly, however, MA insurers are offering these “snowbirds” dual market and other expanded geographic coverage options.

The “ugly”

Managed care: One reason MA plans can offer more benefits and often charge less is because they can save money on medical expenses through their business agreements with members of their provider networks. The bigger source of savings, however, is that MA plans are managed care plans.

Original Medicare is what’s called a fee-for-service program. If you want a procedure that Medicare approves, it will be covered by original Medicare. MA plans, by contrast, would look for low-cost providers of such procedures. They usually require enrollees to get pre-authorization from their plan before approving coverage and may require less-expensive treatment alternatives.

The push toward Medicare Advantage

These controls are at the heart of criticisms that many advocacy groups, including the Medicare Rights Center, the Center for Medicare Advocacy, and the National Committee to Preserve Social Security & Medicare, have of MA plans.

Included in their concerns is the very clear preference by federal health regulators for MA plans over original Medicare. This tilt began during the Obama Administration and was driven by the desire to limit health-care expenses and improve the health of Medicare enrollees at the same time. Managed care became the preferred pathway for these efforts, and MA plans were favored because they already had many of the management tools in place to do so.

"Under President Trump, the preference for MA plans has become even more pronounced"

Under President Trump, the preference for MA plans has become even more pronounced, in large measure because of his administration’s preference for private insurance programs in favor of government-run efforts.

The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare, is implementing new MA benefits that are currently not available from original Medicare. Next year, not many plans will offer these new benefits, but they should be widely available in 2020.

According to Forbes, one insurer — Anthem — will be testing in several states new services that include home-delivered meals, transportation to doctor appointments, limited in-home support from a health aide and up to $500 for home safety devices.

Brent Sanders, who oversees Cigna MA marketing, said transportation benefits and home delivery of meals are “the two big ones” in terms of his firm’s non-traditional MA benefits next year. Some benefits will cost extra while others will not. Where available, such features will be offered as a package within Cigna plans but not available for purchase as individual benefits.

Christopher Ciano, head of Aetna Medicare, said Aetna is providing several new benefits and is expanding its MA offerings into hundreds of new markets. “Picking an MA plan should be a holistic experience for a customer,” he said in a phone interview. “You should look at all the critical benefits that are important to you. You can’t use just a premium or an out-of-pocket maximum” to make your choice.

Navigating the choices

Medicare’s online Plan Finder can help people compare things likes premiums and projected plan expenses. But it is not designed to make useful comparisons with non-monetary aspects of MA plans. Even when I knew a specific plan was offering new non-medical benefits, they often weren’t included in Plan Finder or not clearly explained.

Realistically, the only way to get a detailed understanding of MA benefits is to call individual insurers, and this is what insurers prefer anyway, so they can directly impress you with the virtues of their plans. Aetna and other insurers are beefing up their consumer communication programs.

“We don’t want beneficiaries to get into a plan and not understand it and not be satisfied,” Ciano said.

Consumers can get non-biased Medicare advice from the State Health Insurance Assistance Program (SHIP). SHIP counselors traditionally have been more equipped to help people with questions about original Medicare than private MA and Part D drug plans. But the growth of new MA benefits and the growing popularity of MA plans will require SHIP counselors to broaden their insurance skills.

In most respects, the new MA benefits available in 2019 will be a test run for the more significant expansion of MA offerings for 2020. Plan Finder, in particular, will need to do a much better job to help people find and compare plans with these new benefits.

Source

1. "Boiler Room": To get you hungry for success

A young Ben Affleck nails it with this classic "Boiler Room" speech. Fifteen years later and this interview scene still racks up thousands of hits on YouTube. Why? He's not joking.

Inspiring Line:

"You will make a million dollars within three years of your first day of employment at J.T. Marlin. There is no question as to whether or not you'll become a millionaire working here. The only question is how many times over."

2. Amy Cuddy: To remind you nonverbal cues are crucial to your success

Bow down to the queen of keynotes. Amy Cuddy brought in an impressive seven million views for this TED Talk, placing it among the top 20 TED Talks of all time -- and for good reason.

This video is full of interesting tidbits about the nonverbal cues you're giving every minute, every day. Her advice on "power posing" is invaluable when it comes to sales meetings. Remember: Your prospects are not only evaluating your pitch, but your confidence and how you carry yourself.

Inspiring Line:

"If you feel like you shouldn't be somewhere: Fake it. Do it not until you make it, but until you become it."

3. "Hidden Figures": To highlight the importance of being first

"Hidden Figures" is the true story of Katherine Johnson (Taraji P. Henson), Dorothy Vaughan (Octavia Spencer), and Mary Jackson (Janelle Monáe), three African-American women who serve at NASA as part of astronaut John Glenn's historic launch into orbit.

This clip highlights Jackson's fight to be allowed to attend classes that would further her work as a NASA engineer. Never underestimate the value of a well-worded, thoughtful speech in winning someone over.

Inspiring Line:

"Out of all the cases you're going to hear today, which one is going to matter a hundred years from now? Which one is going to make you the first?"

4. Steve Jobs: To encourage you to love what you do

Steve Jobs. Arguably the best salesperson of our generation explains what really makes us salespeople tick: The love of what we do. Remind yourself of this and you will succeed every time.

Inspiring Line:

"If you look at the ones that ended up being successful in the eyes of society, oftentimes it's the ones that loved what they did, so they could persevere when it got really tough."

5. "Friday Night Lights": To motivate you to work as a team

It has been said that sales is the ultimate contact sport. Football or sales, every day you go out there and hustle your way to the top. Whether you're in the locker room or sitting at your desk, this one pulls on the heartstrings.

Inspiring Line:

"Being perfect is not about that scoreboard out there. It's not about winning. It's about you and your relationship to yourself and your family and your friends. Being perfect is about being able to look your friends in the eye and know that you didn't let them down."

6. Motivational Montage: To give you a quick hit of all the motivational greats

A quick search for "motivational speech" will bring you 2,150,000 YouTube results, but when it comes to quality, Mateusz M is the king of catalyst. Mateusz has created an art of his own. "Dream" is a personal favorite. A montage made from the very best of "Into The Wild," "Rocky 4," "Seven Pounds," "Pursuit of Happyness," and "A Beautiful Mind," completes this piece of gold.

Inspiring Line:

"Greatness is not this wonderful, esoteric, elusive, god-like feature that only the special among us will ever taste. It's something that truly exists -- in all of us."

7. "Wolf of Wall Street": To get you fired up

This entire movie is full of outrageous monologues, but if you don't have hours to spare, here's a three-minute refresher. A quick recap of this blockbuster: Jordan Belfort (the real-life "Wolf of Wall Street") gets out of jail, writes a New York Times bestselling memoir, and sells the film rights to Red Granite Productions. The biopic grosses $392 million worldwide and Leo lands a Golden Globe for Best Actor. Everybody's happy!

The (Only SFW) Inspiring Line:

"So you listen to me and you listen well. Are you behind on your credit card bills? Good -- pick up the phone and start dialing!"

8. The Young Guru: To make you cry a little

The youngest motivator to grace this list, this six-year-old superstar's words of wisdom are so moving they have been made into dozens of autotune remixes. A T-Pain in the making.

Inspiring Line:

"Thumbs up everybody -- for rock and roll!"

9. Shonda Rhimes: To remind you to push past your comfort zone

For one year, Shonda Rhimes said "yes" to everything that scared her and got her out of her comfort zone. She's the powerful mind behind the hit shows Grey's Anatomy, Scandal, and How to Get Away With Murder.

Rhimes is passionate about her work and when she's in the zone, and deep in her work, she calls it a "hum." In her Ted Talk, she tells her story of how she lost her "hum" and what she did to get it back.

Inspiring Line:

"And a crazy thing happened: the very act of doing the thing that scared me undid the fear, made it not scary. My fear of public speaking, my social anxiety, poof, gone. It's amazing, the power of one word. "Yes" changed my life."

10. "Erin Brockovich": To highlight why you should play the long game

Erin Brockovich is a legal clerk and environmental activist who was instrumental in building a case against the Pacific Gas and Electric Company of California in 1993 despite her lack of formal education.

Julia Roberts famously brought Brockovich to life in the eponymous film, showing just what planning, hard work, and grit can do to turn a meeting or a deal your way.

Inspiring Line:

"By the way, we had that water brought in special for you folks."

11. "Glengarry Glen Ross": To make you feel like a closer

I'm just going to say it: This is the most iconic sales monologue of all time. Alec Baldwin completely demolishes this scene from 1992's "Glengarry Glen Ross." In terms of practical advice, you might be better off with Amy Cuddy but Alec instills a bit of good old-fashioned grit. Who's a closer? You're a closer!

Inspiring Line:

"A-B-C. A: always, B: be, C: closing. Always be closing!"

12. Amy Purdy: To challenge you to look at obstacles as opportunities

How do you respond to challenges? Amy Purdy, now a professional snowboarder, lost both her legs below the knee when she was 19 years old. She tells her inspiring story of recovery and how she drew inspiration despite facing a tremendous obstacle.

Inspiring Line:

"So the thought that I would like to challenge you with today is that maybe instead of looking at our challenges and our limitations as something negative or bad, we can begin to look at them as blessings, magnificent gifts that can be used to ignite our imaginations and help us go further than we ever knew we could go. It's not about breaking down borders. It's about pushing off of them and seeing what amazing places they might bring us."

13. "Braveheart": To inspire your courage

Alright, so Mel isn't really talking about sales here but it's too epic to not make the list. Channel your inner William Wallace while you work through those cold calls.

Inspiring Line:

"They may take our lives but they will never take our freedom!"

14. "Joy": To put a smile on your face

"Joy" is the true story of entrepreneur and QVC star Joy Mangano. During a tour of the QVC sound stage, executive Neil Walker (played by Bradley Cooper) explains what makes stars Joan Rivers and her co-host Cindy so great at selling.

He highlights their timing and the warmth they bring to their sales segments. It's more than just who they are and what they're pitching, it's that they're masters of knowing their audience and closing deals.

Inspiring Line:

"The stars, they always make the mistake -- they think it's about the face but it's not. It's really about the hands and the eyes."

15. Eric Thomas: To remind you, you've got to want it

How bad do you want it? Perhaps one of the most underrated speeches on this list comes from Eric Thomas, a motivational speaker, and youth activist. While you're at it, download this as an MP3 and put it on your gym playlist. Get your elliptical on.

Inspiring Line:

"Listen to me -- you will never be successful until I don't have to give you a dime to do what you do."

Bonus Inspiring Line (too great to leave out):

"When you want to succeed as bad as you want to breathe, then you'll be successful."

16. Angela Lee Duckworth: To help you build your grit

It takes grit to succeed in sales. In her TED Talk, Angela Lee Duckworth speaks about the power of passion and perseverance. She also emphasizes the need for a growth mindset to build grit. The growth mindset is the idea that "the ability to learn is not fixed, that it can change with your effort" and it was introduced by psychologist Dr. Carol Dweck.

Bonus material: Here's Dweck's Ted Talk that provides more detail about the growth mindset.

Inspiring Line:

"Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future, day in, day out, not just for the week, not just for the month, but for years, and working really hard to make that future a reality. Grit is living life like it's a marathon, not a sprint."

17. "Any Given Sunday": To stress no gain is too small

In this classic clip from "Any Given Sunday", Al Pacino's Coach Tony D'Amato fires up his players before a big game by explaining that life is a game of inches. We fight for what we want, inch by inch, to reach our goals. That's how we become successful. That's how we win.

Inspiring Line:

"Life's this game of inches. In life or football, the margin for error is so small ... the inches we need are everywhere around us ... on this team, we fight for that inch ... That's what living is -- that six inches in front of your face."

18. "The Pursuit of Happyness": To remind you no one can tell you what you can or can't do

In the Pursuit of Happyness, Will Smith's character is a father on the brink of homelessness trying to make a better life for his son. In this scene, he encourages his son to fight for his dreams -- even in the face of being told he "can't" do something.

Inspiring Line:

"Don't ever let someone tell you can't do something. Not even me, alright? You got a dream? You got to protect it."

19. "The Office": To show you the power of passion in creating a compelling message

If you're a fan of the office, you're likely familiar with this inspiring clip. Dwight's prank-prone coworker Jim, coaches a nervous Dwight before a big speech he must give to other paper salespeople at a Northwest conference. What Dwight doesn't know is that Jim has coached him with speech notes from infamous dictators. Dwight delivers the speech and puts so much heart into it, the room is inspired -- a reminder that when you're passionate about something, it's infectious (even if it's a little ridiculous).

Inspiring Line:

"Some people will tell you salesman is a bad word. They'll conjure up images of used-car dealers and door-to-door charlatans. This is our duty to change their perception. I say salesmen and women of the world unite. We must never acquiesce, for it is together, together that we will prevail."

Source

Last month CSG Actuarial reported the 3rd quarter 2018 Medicare Supplement enrollment results for UnitedHealthcare.  They now have updates from other market leaders Aetna, Humana, CNO Financial, and Torchmark, summarized below.

Aetna Reports Results for 3rd Quarter 2018

For 3rd quarter 2018, Aetna reported Medicare Supplement member in-force counts of 775,000, up 18,000 from 2nd quarter 2018 and 42,000 over the past 12 months.  The 18,000 increase in membership during 3rd quarter 2018 was double the membership growth in 3rd quarter 2017.  The table below shows Aetna’s Medicare Supplement enrollment counts by quarter since 4th quarter 2011 and annual increase in Medicare Supplement enrollment counts by quarter since 4th quarter 2012.  CSG Actuarial projects Aetna’s overall Medicare Supplement sales at 4th in the overall market over the past 12 months.

Humana Reports Medicare Supplement Results for 3rd Quarter 2018

Humana reported 3rd quarter 2018 Medicare Supplement lives of 246,600, a 2.1% increase over 2nd quarter 2018 and a 5% increase over 3rd quarter 2017.  The 5,100 increase in membership during 3rd quarter 2018 was 132% higher than the membership growth in 3rd quarter 2017.  The table below shows Humana’s Medicare Supplement enrollment counts by quarter since 1st quarter 2011.  Humana also reported 2nd quarter 2018 Medicare Supplement premiums of $129 million, up 7% from 3rd quarter 2017.  Based on estimates from CSG Actuarial, Humana’s sales ranked 7th in the market over the past 12 months.

CNO Financial Group Reports Medicare Supplement Sales in 3rd Quarter 2018

CNO Financial Group (parent company of Bankers Life & Casualty, Washington National, and Colonial Penn) reported 3rd quarter 2018 Medicare Supplement sales of $13.9 million, down 3% from 2nd quarter 2018.  For the past 12 months CNO Financial Group reported Medicare Supplement sales of $61.1 million, ranking in the top 10 in the Medicare Supplement market.  CNO Financial Group also reported 3rd quarter 2018 Medicare Supplement earned premiums of $204 million, equal to results from 2nd quarter 2018.

Torchmark Reports Medicare Supplement Sales in 3rd Quarter 2018

Torchmark reported 3rd quarter 2018 Medicare Supplement annualized new sales of $13.4 million, up 32% from 3rd quarter 2017.  For the past 12 months, Torchmark reported Medicare Supplement annualized new sales of $72.7 million, ranking in the top 10 in the market.

Source

Benjamin Franklin once said, "Experience keeps a dear school, but fools will learn in no other." In other words, you can rely solely on first-hand experiences to gain sales knowledge -- but it might be painful.

To dramatically cut down on your learning curve, pick up some sales books. A read penned by a selling expert will offer you all the benefits of personal experience without negatively affecting your quota or efficacy.

Picking a book can be tough, as there are thousands to choose from. Enter: This reading list. Hubspot has curated the top-ranked books from Amazon's sales best-sellers. Whether you want to ask better questions, prospect more effectively, lead your sales team, or become an all-around better salesperson, there's a pick here for you.

Here is the list:

1. "The Challenger Sale: Taking Control of the Customer Conversation"

Matthew Dixon and Brent Adamson

According to a study of thousands of sales reps across multiple industries and geographies, the most successful put their energy toward delivering valuable insights -- not becoming their prospect's friend. Join the ranks of the top performers with Adamson and Dixon's signature Teach, Tailor, and Take Control methodology.

Review excerpt: "This is an excellent book, with provocative insights and useful information for salespeople looking for ways to break out of the pack."

2. "The Challenger Customer: Selling to the Hidden Influencer Who Can Multiply Your Results"

Brent Adamson, Matthew Dixon, Pat Spenner, and Nick Toman

CEB's latest research reveals even Challenger salespeople struggle to close without the help of a very specific type of customer stakeholder: The Mobilizer. In this book, you'll learn how to identify Mobilizers, engage them, and work with them to get deals over the finish line.

Review excerpt: "What a great follow-up to the Challenger Sale. (It) provided me with additional insight on how to approach selling to a group of stakeholders. It has real data, real studies and real tactical strategies. If you're in the B2B space, this book is a must!"

3. "New Sales. Simplified.: The Essential Handbook for Prospecting and New Business Development"

Mike Weinberg

Looking for a one-stop guide to bringing on new business? Look no further. In this book, Weinberg lays out a proven formula for finding prospects, developing the relationship, and reaching a mutually beneficial agreement.

Review excerpt: "I loved the stories, the irreverent tone, and the honesty of this book. But what I appreciated most was that it delivered on its title -- this book really does simplify what you have to do successfully acquire new customers."

4. "The Psychology of Selling: Increase Your Sales Faster and Easier Than You Ever Thought Possible"

Brian Tracy

Learn how to harness psychological principles in the sales process while simultaneously getting a dose of personal motivation.

Review excerpt: "‘The Psychology of Selling' is a superb, practical, easy-to-read return to the fundamentals of professional salesmanship for novices, journeymen, and seasoned, top-performing salespeople. More than common sense placed into form, it serves as an instructional blueprint -- or as a road map -- to establish, build, grow, and maintain a successful sales career."

5. "The Science of Selling: Proven Strategies to Make Your Pitch, Influence Decisions, and Close the Deal"

David Hoffeld

Hoffeld's advice is based on the latest research in behavioral economics, social psychology, and neuroscience. You'll learn a science-based approach to asking questions, securing incremental commitments, resolving objections, reducing your competition's influence, and more.

Review excerpt: "‘The Science of Selling' is the ultimate collection of evidence-based practices for sales ever collected in one volume. Until now, most of the studies in ‘The Science of Selling' have been scattered and tucked away in academic journals, (making them) virtually inaccessible to sales leaders. Most readers will find the material new, and I expect, quite surprising."

6. "The Sales Acceleration Formula: Using Data, Technology, and Inbound Selling to go from $0 to $100 Million"

Mark Roberge

Sales leaders aiming to scale their sales team and build a multi-million dollar business should definitely pick up this book, written by former HubSpot CRO Mark Roberge.

Review excerpt: "Every company -- regardless of its business and sales strategy -- will absolutely benefit from reading this book. The stories (Roberge) tells, the way his selling initiatives fit together, the combination of selling and technology he describes … even the use cases he lists make the approach he describes applicable to any sales organization -- however well-entrenched."

7. "Influence: Science and Practice"

Robert B. Cialdini

Cialdini reveals the six psychological principles that cause people to comply. Once you've incorporated these powerful concepts into your messaging, leading your prospects to say "yes" will be less challenging.

Review excerpt: "Whether you are on the selling or buying end of any transaction, knowing what Mr Cialdini discovered through years of research and testing will be to your financial advantage. (But) 'Influence' is not just about money. It is a guide to getting what you want or need in a fair and ethical manner."

8. "To Sell Is Human: The Surprising Truth About Moving Others"

Daniel H. Pink

If you're currently working in sales, you're probably well-aware the old playbook doesn't work. Pink offers fresh yet practical insights to modern selling, including how to move others, make your message clearer and more persuasive, and gain referrals.

Review excerpt: "No, this is not 'another' book about selling. I've read a lot of them, written a few of them, and I can tell you: This book stands alone in a special category."

9. "Secrets of Closing the Sale"

Zig Ziglar

This book includes more than 100 different ways to close depending on the situation and 700 thought-provoking questions to use with prospects. You'll also find suggestions from a hundred of America's most successful salespeople.

Review excerpt: "Ziglar teaches you, from the beginning, that there's no room for success in a salesman's career if he's taking the fast route, making the quick sale, and then locking the door behind him."

10. "The Only Sales Guide You'll Ever Need"

Anthony Iannarino

Iannarino shares his biggest lessons from 25 years of selling, including how to increase your self-discipline, get over your fear of the competition, be more resourceful, discover the buyer's true needs, and more.

Review excerpt: "Anthony Iannarino is my new sales guru. His book shows you exactly how to understand your offer and relate to your customer."

11. "The New Strategic Selling: The Unique Sales System Proven Successful by the World's Best Companies"

Robert B. Miller, Stephen E. Heiman, and Tad Tuleja

Every salesperson will benefit from learning how to reach "win-win" agreements, prevent sabotage by internal blockers, identify the four types of decision makers, engage senior executives, and more.

Review excerpt: "This book, in my opinion, found a perfect balance between theoretical framework and hands-on, immediately applicable knowledge."

12. "Cracking the Sales Management Code: The Secrets to Measuring and Managing Sales Performance"

Jason Jordan and Michelle Vazzana

Jordan dives into the critical activities and metrics sales managers and executives should implement and track to lead their teams to success.

Review excerpt: "I liked the focus on real-world quantitative management via metrics (and) would recommend this book to any sales manager who wants to achieve and measure results."

13. "Words That Sell: More than 6000 Entries to Help You Promote Your Products, Services, and Ideas"

Richard Bayan

Keep this informative manual at your desk so you can quickly find the perfect terms and phrases to grab your prospect's attention, create desire for your product, and ultimately, win their business.

Review excerpt: "After a brief primer on writing in which the author lays down basic writing principles, readers are free to comb through the book to find the words they need to make a big difference in the way they communicate with others."

14. "Book Yourself Solid: The Fastest, Easiest, and Most Reliable System for Getting More Clients Than You Can Handle Even if You Hate Marketing and Selling"

Michael Port

Port's book covers a range of strategies for earning more business, from building a powerful social media presence to developing a personal brand to perfecting your pricing strategy.

Review excerpt: "An excellent and enjoyable read. Michael Port lays out a fresh and honest approach to marketing yourself and your business. 'Be true to yourself' and the people you serve. This takes the pressure off of trying to contrive an image of someone (or something) that is really not you, and makes self-promotion almost natural!"

15. "7L: The Seven Levels of Communication: Go From Relationships to Referrals"

Michael J. Maher

If you're not generating warm introductions to potential customers, you're losing out on a valuable source of business. Discover the concrete steps that will win you referrals. Although "7L" is geared toward real estate professionals, its takeaways are applicable to any sales role.

Review excerpt: "Michael provides an easy-to-follow step-by-step system to create long-lasting relationships with clients and vendors that will result in an endless supply of referrals. This book has completely changed how I do business … I went out and bought 30 [copies to give] to my associates."

16. "Fanatical Prospecting"

Jeb Blount

Successful prospecting incorporates multiple touches across multiple channels. Pick up this book to learn how to text, email, call, and socially engage buyers.

Review excerpt: "Jeb teaches you how to prioritize your prospects and leverage social selling in your overall prospecting efforts. If you are thinking about a career in sales or you want to jump start what you are doing in your present job, then this is the book for you."

17. "Predictably Irrational, Revised and Expanded Edition: The Hidden Forces That Shape Our Decisions"

Dan Ariely

Have you ever been flummoxed by a prospect's irrational decision? Once you read this book, you'll have a new understanding for the assumptions and emotions behind the actions we take. Guiding buyers to the right choices will become far easier.

Review excerpt: "This is a fascinating look into how our brains process information. The author sets up experiments to test his hypotheses about how people respond under a variety of situations."

18. "Go-Giver, Expanded Edition: A Little Story About a Powerful Business Idea"

Bob Burg and John David Mann

This quick read reveals the importance of giving to business success. Not only will you walk away convinced that giving leads to receiving, you'll also know how to give to achieve your desired results.

Review excerpt: "Clear, entertaining, and immediately practical, this book has evolved my approach to business -- and life. When you go through your day focusing on how you can give and being open to receiving, you build stronger relationships and prosper on multiple levels."

19. "DISCOVER Questions Get You Connected"

Deb Calvert and Renee Calvert

Learn how to structure your calls, ask thoughtful, intelligent questions, and help prospects come to their own conclusions about your product's value.

Review excerpt: "'Discover Questions' was excellent -- giving experienced and novice salespeople guidance on how to ask questions, drive the sales conversation, and show you care!"

20. "Little Red Book of Selling: 12.5 Principles of Sales Greatness"

Jeffrey Gitomer

This book is short, sweet, and to the point. Readers will learn to focus on why people buy and why it matters to the sales process. With entertaining illustrations and soundbites in every chapter, this book is easy to return to for specific helpful tips when you need them most.

Review excerpt: "Excellent book that focuses on selling the right way. Highly recommend this for anyone who is involved in sales and wants to expand their techniques so they close more."

21. "Think and Grow Rich"

Napoleon Hill

This book is beloved by many career salespeople. The result of nearly 20 years of research, Hill's book outlines 13 steps to success, including developing a definite purpose, building a positive mental attitude, and channeling the power of the subconscious mind.

Review excerpt: "This book is one that everyone must read. From the very beginning, it began changing my mindset and how I view life. Some books are filled with information on how you should be thinking, but this one shows how to create lasting change."

22. "Spin Selling"

Neil Rackham

"Spin Selling" shares the results of Rackham's 12-year, million-dollar research project examining effective sales performances. In his book, Rackham outlines his findings and shares the principles of SPIN (Situation, Problem, Implication, Need-payoff).

Review excerpt: "If you love sales, read this book and discover how to improve your technique. The research behind this book is exhaustive, and the technique is so organic you may discover you're already using it. In that case, you'll be able to improve your skills."

Source

In the most recent technical changes made to Part C and Part D plans for 2019, CMS codified the star ratings methodology in regulations. Now, CMS is proposing changes to these regulations, such as new definitions to clarify the meaning of terminology used in describing the star ratings methodology.

In addition, CMS is proposing several changes to improve program quality and accessibility of the Medicare Advantage (MA) and Part D Prescription Drug Program (PDP) Plan Quality Rating for measures other than Consumer Assessment of Healthcare Providers and Systems (CAHPS).

Cut Point Predictability and Stability

CMS proposes two enhancements to the current hierarchical clustering methodology that is used to set “cut points” for non-CAHPS measures. Cut points are used to separate a distribution of measure scores into distinct groups or star categories, such that each grouping accurately reflects true performance. These two enhancements would increase year-over-year stability and predictability for a plan’s cut points, but may also slow the programs’ ability to keep pace with changes in performance across the industry.

First, CMS proposes to modify §§ 422.166(a)(2)(i) and 423.186(a)(2)(i) to add mean resampling to the current clustering algorithm. Mean resampling would reduce the sensitivity of the clustering algorithm to outliers. In short, it would reduce the random variation that contributes to fluctuations in cut points and, therefore, improve the stability of the cut points over time. The second proposed enhancement is a 5% “guardrail” for all measures that have been in the Part C and D Star Ratings program for more than 3 years, whether scored on a 0 to 100 scale or an alternative scale. The guardrail would be a cap that imposes a 5% maximum allowable movement from the previous year’s cut points for each measure threshold. Thus, it would allow a degree of predictability.

Measure Updates and Other Adjustments

CMS also proposes changes to measures in the Star Ratings program for performance periods beginning in 2020 and 2021, including:

• MA plans controlling high blood pressure, to apply new hypertension treatment guidelines from the American College of Cardiology and American Heart Association by moving the blood pressure target to <140/90 mmHg;
• Medicare plan finder (MPF) pricing accuracy for PDP plans, to better measure the reliability of sponsors’ prices advertised on MPF;
• MA plan all-case readmissions, to assess the percentage of hospital discharges resulting in unplanned readmissions within 30 days of discharge; and
• MA and PDP plan improvement measures, to exclude any measure that has a reduction due to data integrity concerns.

Among other things, CMS proposed to add a provision that would assign a 1-star rating to the applicable appeals measure(s) if an MA organization or PDP plan sponsor failed to submit Timeliness Monitoring Project (TMP) data for CMS’s review to ensure the completeness of their independent review entity (IRE) data.

CMS is also adopting detailed modifications for the Star Ratings measures for MA and PDP plans in areas that have “experienced extreme and uncontrollable circumstances” like natural disasters. These modifications would apply at the contract level to mitigate certain negative Star Ratings effects on any contract within an “emergency area” during an “emergency period” as defined by federal law.

In sum, CMS recognizes the public’s “overall support for the use of the hierarchical clustering algorithm,” and now seeks to further refine the Star Ratings program to ensure that the methodology is stable, predictable, and free from undue influence of outliers. This rulemaking presents a significant opportunity for stakeholders to shape the rating methodology for quality and performance of MA and Part D programs. Comments on the proposed rule are due to CMS no later than December 31, 2018.

https://www.cmhealthlaw.com/2018/11/ma-pdp-star-ratings-proposed-technical-changes-for-2020/

Last week, the Medicare Rights Center and the National Council on Aging (NCOA) released a new resource on the expansion Medicaid-to-Medicare transition process. Our Expansion Medicaid Transitions Guide is designed, in part, to help advocates learn about their state’s transition process and better assist clients when they need to switch from expansion Medicaid to Medicare. The guide includes terminology, an overview of select state processes, and some troubleshooting steps advocates can consider when encountering problems.

Source

The 2018 midterm elections mean big changes are coming to Washington. When the 116th Congress convenes in January, it will be a divided one: Republicans will continue to control the Senate, but Democrats will have a majority in the House of Representatives for the first time in eight years.

With split-party control, any legislation will require bipartisan support in order to pass. The need for such consensus greatly decreases the likelihood that radical, disruptive bills will reach the President’s desk in the coming years, and effectively eliminates the acute threats to Medicare, Medicaid, and the Affordable Care Act (ACA) that have dominated congressional conversations since 2017.

With efforts to repeal the ACA, overhaul Medicare, and restructure Medicaid temporarily off the table—what does the future hold for these programs? Read our top takeaways from the midterms and our predictions for the 116^th Congress.

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This year, during the annual Medicare Open Enrollment period, more than 60 million people on Medicare have the opportunity to choose between traditional Medicare and Medicare Advantage plans. In making this decision, they are encouraged to take into account a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks. A potentially overlooked consideration is access to covered services; specifically, how prior authorization may affect beneficiaries’ access to covered services.

Medicare Advantage plans can require enrollees to get approval from the plan prior to receiving a service, and if approval is not granted, then the plan generally does not cover the cost of the service. Medicare Advantage enrollees can appeal the plan’s decision, but relatively few do so. Traditional Medicare, in contrast, does not require prior authorization for the vast majority of services, except under limited circumstances, although some think expanding use of prior authorization could help traditional Medicare reduce inappropriate service use and related costs. Optimally, prior authorization deters patients from getting care that is not truly medically necessary, reducing costs for both insurers and enrollees. Prior authorization requirements can also create hurdles and hassles for beneficiaries (and their physicians) and may limit access to both necessary and unnecessary care.

In this data note, we examine the share of Medicare Advantage enrollees in plans that impose prior authorization requirements for Medicare-covered services.

Findings

• 80 percent of Medicare Advantage enrollees are in plans that require prior authorization for at least one Medicare-covered service (Figure 1).

• At least 70 percent of enrollees are in plans that require prior authorization for durable medical equipment, Part B drugs, skilled nursing facility stays, and inpatient hospital stays.
• 60 percent of enrollees are in plans that require prior authorization for ambulance, home health, procedures, and laboratory tests.
• More than half of enrollees are in plans that require prior authorization for mental health services.

In general, Medicare Advantage plans typically use prior authorization for relatively high cost services used by enrollees with significant medical needs, such as inpatient care and drugs covered under Medicare Part B. Prior authorization is also being used to limit access to services for which there has been evidence of fraud, such as durable medical equipment, and for services, such as home health, that have experienced disproportionately rapid growth in Medicare spending, at least in certain parts of the country. Beginning in 2019, Medicare Advantage plans will also be allowed to use prior authorization in conjunction with step therapy for Part B (physician-administered) drugs, which could result in some enrollees being required to try a less expensive drug before a more expensive one is covered.

Whether prior authorization serves as an appropriate tool for limiting use of unnecessary care or a worrisome barrier to medically necessary care is an important question for both lawmakers and beneficiaries. Recently, more than 100 Members of Congress sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator, Seema Verma, expressing concern about Medicare Advantage plans’ use of prior authorization, and asked CMS to collect data on the scope of prior authorization practices to enable better oversight. The HHS Office of the Inspector General (OIG) recently found that Medicare Advantage plans deny care – inappropriately – at relatively high rates. To the extent that the OIG findings are more the norm than the exception, they raise concerns for enrollees and questions as to whether prior authorization rules contribute to the relatively high rates of disenrollment among sicker Medicare Advantage enrollees.

Currently, CMS does not collect or disseminate plan-specific denial rates, as it is required to do for plans offered in the ACA marketplaces, nor assess the extent to which prior authorization rules affect enrollees’ access to various types of services. Greater transparency with respect to prior authorization could help explain how Medicare Advantage plans are managing care and costs, help beneficiaries choose among the many Medicare coverage options offered in their area, and help CMS carry out its important oversight responsibilities on behalf of the rapidly growing Medicare Advantage population.

Source

Your clients have worked hard their entire lives. And they’re ready to enjoy retirement. But, as people reach the age of 65 their risk for cancer and heart disease increases. Additionally, the costs associated with addressing these conditions can drain retirement or savings quickly.

THE NEED
Nearly everyone knows someone who has been affected by cancer or heart disease. Unfortunately, many believe that their existing coverage is adequate to cover all the expenses associated with these conditions. As costs and deductibles rise, seniors are feeling the pinch more and more.

TODAY’S REALITY

• Among seniors 65 and older, just 37 percent claim to have $1,000 available in savings
• The average healthy 65-year-old couple retiring in 2016 should expect to spend $377,000 on health care expenses over the course of their retirement
  
• The average annual cost of treatment for cancer patients rose 19 percent to $58,097 in 2014

SOLUTION

• Discuss options for covering out-of-pocket expenses: savings, assets or insurance coverage. Mutual of Omaha’s Cancer & Heart Attack/Stroke policies offer policies up to $100,000 with limited underwriting
• Living comes with a price tag. With advances in medical treatment, people are surviving cancer and heart disease more frequently
• Cancer & Heart Attack/Stroke policies fit in well with other products and protect income for a variety of expenses, from deductibles to prescription drug to travel or time off from work expenses
• With a variety of price points and options, there are numerous ways to provide clients the coverage they need

Make sure you are providing your Medicare clients insurance for all their health care needs. Request details here.

This Spring 2018, Mutual of Omaha began offering Mutual Dental Preferred and Mutual Dental Protection insurance policies with an optional vision care rider underwritten by Mutual of Omaha Insurance Company. The dental product is available in all states except: Maryland, North Carolina, New Mexico, New York, Virginia and Washington.

*Mutual Dental Protection not available in Alaska

While this product is positioned for individuals who are Medicare eligible the issue age is 19 – 99 for these policies. For more information and to see rates view the Dental Insurance Product and Rate Guide.

Medicare supplement and Dental Insurance – Better Together
You have a built-in target market. If you are selling Medicare supplement, there are a number of reasons you should be offering your Medicare clients a dental policy.

First, good dental care is important to overall health. But do you know Medicare doesn’t cover dental services? That means dental bills have the potential to take a bite out of people’s savings.

Second, there is a need among individuals age 65 and old for dental insurance.

• 87% of this group still have their natural teeth
• Due to cost, 1 in 5 of them has untreated tooth decay and fewer than half see a dentist even once a year
• Only 12% have dental insurance

Third, it is an easy sale. If you are taking a Med supp e-App the dental plans are quoted up front and with a few simple questions at the end of the app you can complete a dental sale. Also, all Med supp paper apps have the dental application included in the application book.  And with Mutual's mobile quote app you can provide your clients a quote on the spot.

Get Started - Make sure you are providing your Medicare clients insurance for all their health care needs.