That first tranche of DCEs began participating in the model on April 1.
“We’re honored that Humana Care Solutions is one of only 53 organizations selected to participate in this innovative value-based model, which strives to accelerate the shift away from fee-for-service across the nation while providing greater financial consistency for providers,” Oraida Roman, VP of value-based strategies at Humana,said in a press release. “This is important and exciting work, to collaborate with clinicians and expand the availability of value-based care beyond Humana’s membership, and in a way that supports physician organizations during uncertain times.”
Broadly, the Global and Professional Direct Contracting Model gives private health care providers the opportunity to engage in risk-sharing arrangements with traditional Medicare, with the ultimate goal being a reduction of costs and an increase in quality of care.
The model was originally introduced in April 2019 as part of the shift to value-based care.
Additional providers originally thought that they’d have a crack at the innovative opportunity as well. But since the new administration, officials at the Centers for Medicare & Medicaid Services (CMS) and its innovation hub have decided to close the program to new applicants for now.
It’s still unclear when or if the program will begin expanding again, but insiders believe it will return to accepting new providers, albeit with some likely modifications.
Humana, which currently owns 40% of Kindred at Home, is one of a few DCEs with an established home-based care focus.
Kindred at Home, which will undergo a name change once fully owned by Humana, is one of the biggest home health providers in the country. It has locations in 40 states, serving 550,000 home health, hospice and community-based services patients per year.
Among the other home-based care direct-contracting entities are Minnesota-based Lifesprk and Huntington Beach, California-based Landmark Health.
Humana Care Solutions has partnered with about 420 primary care providers to participate in the direct-contracting model, according to Humana.
This allows Humana, which already has more than 2.7 million Medicare Advantage (MA) members across the country, to further expand its network.
“Humana Care Solutions will take on quality and cost accountability for the care of aligned Original Medicare beneficiaries,” the company noted in the release. “Furthermore, Humana Care Solutions will support providers with clinical and analytical capabilities to improve care coordination and drive a more holistic approach to patient care that goes beyond traditional clinical treatment.”
As it figures out next steps, providers outside of that group of 53 DCEs will have to wait their turn.
This is the third time since December that Humana has been granted the opportunity to participate in CMS models. It was also named an approved payer partner in the government agency’s Primary Care First Model and its Medicare Hospice Value-Based Insurance Design (VBID) demonstration.
Two-thirds of Humana’s MA beneficiaries now seek care from primary care physicians in some form of value-based agreement. The members involved in those agreements were less likely to be hospitalized or go to the ER in 2019 compared to those that weren’t.
Some policymakers have proposed redesigning Part D — Medicare’s voluntary prescription drug benefit — to protect beneficiaries from high out-of-pocket costs, realign financial incentives for the organizations that sponsor Part D plans, and reduce overall program spending.
Several changes have been proposed to the standard Part D benefit, including:
Creating a maximum out-of-pocket cap for beneficiaries when they reach the catastrophic spending phase of the program, something that currently doesn’t exist.
Ensuring that Part D plans are incentivized to promote drugs that offer the most value at the lowest cost — for example, by reducing government subsidies for reinsurance and shifting responsibility for large claims to plans themselves.
Requiring drug manufacturers to provide cost discounts.
In 2020, three bills were introduced in Congress that featured changes to the Part D benefit: H.R. 3, S. 2543, and H.R. 19 (see table). The two House bills were reintroduced in 2021.
Why do some policymakers argue for Part D redesign?
Since its start in 2006, Part D has undergone little change, even as Medicare spending on the prescription drug benefit has grown substantially, from $44.3 billion in 2006 to $102.3 billion in 2019. Most of this growth has been in the catastrophic phase of coverage — which begins when beneficiaries have spent $6,550 out of pocket. Medicare spending on Part D catastrophic coverage more than doubled between 2013 and 2017 to more than $59 billion, driven largely by the high prices of specialty drugs. Meanwhile, beneficiaries contend with a cost-sharing requirement in the catastrophic phase — 5 percent coinsurance — that can sometimes severely limit their access to these expensive medications.
Concerns about the sustainability of spending at this level spurred recommendations in 2016 for realigning Part D plans’ financial incentives. Currently, plans place high-cost drugs on preferred formulary tiers so that beneficiaries enter the catastrophic coverage phase as early in the year as possible — knowing that Medicare will subsidize claims at 80 percent for those beneficiaries.
By shifting financial responsibility for these claims from Medicare to the plans themselves, some analysts believe that Part D plan sponsors — the organizations that contract with Medicare to offer plans — would be likely to negotiate more aggressively with drug manufacturers for better prices and formulary placement. Others argue that redesign isn’t necessary, pointing to the popularity of the Part D program and the fact that premiums have been stable for years. Opponents of the proposed changes also say they could lead to significant increases in the size of discounts manufacturers owe for certain classes of drugs.
Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 106 million people, including more than 42 million within its family of health plans.
Make sure to have Anthem in your portfolio for the 2022 AEP.Request details todayor call us at 800-998-7715 for more information.
Anthem Medicare Plans Extras
Anthem Medicare plans have benefits that support daily needs too, like money for over-the-counter health products. There are also plans that include dental, vision and hearing coverage, and a SilverSneakers membership, so you can take fitness classes at home or at a gym.
Essential Extras makes your life a little easier
With an Anthem Medicare Advantage plan, you can choose one service from a list of 10 Essential Extras. These are resources like rides and meals that make everyday life a little easier. Here are a few examples:
receive up to 30 rides to health appointments each year.
Personal Home Helper
have a health aide help with house work or other daily needs.
Health and Fitness Tracker
receive a fitness tracking device and access to a brain exercise program online that helps with memory, attention and more.
Learn everything about relationship selling, why it is still an important tactic to master and more.
As the world of sales continues to change and evolve, so has the number of sales tactics and various technologies to help teams close new customers and retain current ones. Many of the old school sales tactics don’t always necessarily work and having too many new ones in place can also cause challenges.
It’s a tough world for salespeople, especially in B2B. But there is also a wealth of knowledge and techniques out there that will help sales teams achieve success and reach their goals.
While it is easy to be inundated with information thanks to the internet and the thousands of sales gurus saying different things — there is still one sales tactic that every salesperson should still master: relationship selling.
What is Relationship Selling?
Anyone in sales might be familiar with the term and may even be perceived as an “old school” tactic, but it is still one that is incredibly important today. As the name generally implies, relationship selling is all about the connection and relationship a salesperson builds with their customers and potential buyers. A human interaction, where the salesperson generally cares about connecting with their customer or buyer.
Instead of salespeople solely focusing on the pricing of a product or services (or even all the details about said product or service), the priority is on the interactions and trust built between sales and the customer/buyer.
Of course, product details and pricing are important topics to discuss, but without building a rapport with a buyer, you can miss out on long-term revenue and much more. Additionally, relationship selling is generally used for companies who have longer sales cycles, expensive products or software, or things that require more commitment when it comes to purchasing.
Many times a software solution may take weeks or months for a decision made based on the buyer researching, comparing to competitors, working to get budget, etc. By caring about building relationships with potential customers and taking an interest in their world, it can significantly improve the odds of securing a sale and retaining that customer for the long-term.
Why Relationship Selling Matters
Typically, this sales technique is prominent for companies selling products and services that rely on repeat business from customers, such as insurance policies, but it also is valuable to B2B businesses in general.
There were a few stats for B2B that stood out in this article:
82% of B2B decision-makers think sales reps are unprepared
In B2B, 68% of customers are lost because of indifference or perceived apathy, not because of mistakes.
According to Gallop, only 46% of customers said vendors deliver on what was promised.
Those kinds of stats show why focusing on relationship selling and generally showing an interest in more than a sale is important.
Plus, with all the tools and sales technology it can be distracting and make it seem that those items are enough to build sales.
Current customers or clients
One of the main reasons relationship selling exists is to boost salespeoples’ personal connection to their customers and clients.
Without building a working relationship, customers may feel like they are just a number. Worse, they may not view you as a trustworthy person, especially if you aren’t delivering on things you previously discussed.
Now when it comes to re-signing a contract or continuing a working relationship, they may feel less important have a much greater chance of churn and moving on to a competitor. Costing you a long-term sale. But it can also affect the chances of up-selling them and hurt your word-of-mouth marketing to their colleagues, who may have also bought your product or services too. For B2B, word-of-mouth praise and recommendations can really elevate sales and deals.
While relationship selling techniques are important for customers and clients, it also can affect potential buyers who are talking with you and closing in on a purchasing decision. It’s true that it is generally easier to keep a current customer than trying to securing a brand new one. But it is why relationship selling is even more important for new potential buyers.
Without trying to build a connection, the buyer may feel like they are only a bunch of dollar signs to you.
While you make get some sales that way, there’s not much trust or confidence built that way. People coming to you who are brand new don’t know you well and will generally start formulating an opinion of you right away.
Even if you have the best product or pricing, you can still cause a sale to not close because of your own selfish interests or lack of interest in their challenges.
Relationship Selling Techniques
Because the tactic of relationship selling has been around for quite awhile, there are plenty of techniques out there.
However, with the shift of technology, platforms, and industries, some of those techniques may not necessarily be useful.
Yet, there are many that still matter and new relationship selling techniques have also developed in the last few years. Let’s explore some of the ones all salespeople should be practicing for success.
Become an active listener
It’s easy for sales to ramble on because of excitement about the product and being focused on closing the deal.
But in order to find success and connect with a customer or buyer, you need to speak less and actually engage more in listening.
Prospects and customers will like you more, but it will help you understand what their needs are and their challenges. Thus, helping you tailor your pitch and solutions to them effectively.
Relate on a personal level
For relationship selling to work, you need to connect with prospects and clients on a personal level, essentially building a friendship. This doesn’t mean small talk, because that is all-too-common and doesn’t add value to the conversation.
Instead, learn about their outside interests, see what they are posting about on social media as talking points, follow their company news, etc. Start finding unique ways to spark a conversation where you both have common interests or can relate in some way. This helps build your profile as not just another salesperson, but an actual human being who has something interesting to say.
Keep your word and be honest to build trust
The second you break a promise, do not deliver something you said you would, or follow-up when you said, you are damaging your trust and reputation. Of course, things come up and life happens, but stick to any commitments or dates as best you can.
Building a positive working relationship with someone takes trust and you being reliable. If you are missing deadlines and not delivering what was promised, you can easily lose a sale or find your working relationship going nowhere.
Same goes with honesty. Salespeople sometimes unfairly are portrayed in a negative light, so some prospects will already tread lightly.
However, if you can be honest from the start about everything from pricing, solution fit, no hidden contract surprises, etc. your relationship will be off to a better start. Even if your product or services is not a good fit, say that and refer your competitors. You might lose that particular sale, but they’ll appreciate the honesty and may refer others to your product or services.
Don’t fake it until you make it – be real
I’m sure you’ve heard the saying before, “Fake it ‘till you make it,” but with sales, this is not the approach you want to take.
Your prospects and customers can tell when you’re are faking it for the sake of a sale, which is never good for a working relationship.
Being genuine is key technique and being a real person will go a long way in your relationship selling and connect with your prospects and customers. Plus, if you love the product or services and company you work for, being genuine should come naturally without a need to “pretend.”
As a salesperson, you won’t have all the answers and may make mistakes, but if you are being yourself an act like a normal human being you’ll be treated with more respect.
With Covid still hanging around there may be local restrictions on having an in person event. You should ask your local health authorities what type of restrictions may apply before scheduling an in person event. As a result of the restrictions, some carriers have opted to not allow in-person events. This means that many agents will be opting to hold a virtual event over an in person event.
Be sure to check with your carriers to verify what your options are, and to understand any rules they may have for giving a compliant virtual event.
PSM is proud to introduce America-Amicable to our portfolio of life carriers. With values centered around financial integrity, responsible management, a strong commitment to every policy holder, and more than 100 years of life insurance experience American-Amicable is positioned to meet the needs of your business.
Below are a few samples of the products available to our agents!
Clear Choice Whole Life - Final Expense Clear Solution Whole Life Financial Lifeline Modified Whole Life
In addition to the above, American-Amicable also offers an array of Term Life and Universal Life products. You can check out their full product list below:
The American-Amicable Group of Companies is headquartered in the historic ALICO Building in Downtown Waco Texas. With a focus on efficiency and service, we think this will be a great addition to your life insurance portfolio.
In the early months of 1909, an insurance company was formed in Waco, Texas that embarked on a mission of which changed the face and skyline of that city forever. An accomplishment to leave such a mark for the entire world to hear about and marvel well into the 21st Century.
On February 2, 1909, Amicable Life Insurance Company was chartered and began business on April 2, 1910.
The ALICO Building still remains a tower of strength and stability…remains an edifice all alone standing straight as a soldier in the skyline of Waco. A city with charm, a building with character…a city and a building waiting for new discoveries…
Today, the ALICO Building remains a vital part of the downtown business community. Providing the home office for American-Amicable Life Insurance Company of Texas and its corporate family, as well as providing rental office space. Through the years, as business office functions changed, the interior floors were altered to meet the market needs and the building continues to remain an attractive and viable office building.
Prospecting challenges often come down to mindsets, skill sets, and tool kits.
To produce better results, create better opportunities.
To gain more meetings, improve your overall prospecting approach.
The greatest challenge in sales is creating enough quality opportunities to reach your goals. Improving your results starts with identifying the obstacles to producing them. Use this post as a sort of diagnostic—it can help you discover the source of your prospecting problems and begin to do the work to improve your results.
Reaching the Roots
Here are a few root causes of poor prospecting results and earning too few meetings.
Lead Reliance:“The leads are weak? You’re weak.” InGlengarry Glen Ross, Blake was part of a dominator hierarchy, one that rarely inspires employees to do their best work. But he had a point. One of the reasons salespeople struggle to create the meetings that result in new opportunities is their high reliance on leads. Lead dependence causes all kinds of problems, including complaints about the quality of the lead and its qualification, leading to too few opportunities.
No Strategic Targeting:A lack of strategic targeting in B2B sales results in too little effort and energy exerted serving your dream clients. Even though it’s difficult, you must spend time on the targets who invest a great deal of money in your category and who derive massive value from what you do and how you do it. Targets are what direct your aim.
No Prospecting Sequence:Too many sales organizations and salespeople treat prospecting as an activity instead of a well-designed set of communications that lead to a meeting. While you should employ a “phone first” approach to your sequence, creating value should be the core of your sales approach, starting with prospecting.
No Nurture Sequence:When you are trying to win major accounts, it is helpful to nurture relationships over time, capturing mindshare by helping your future clients better understand their future decisions and how they should think about their future results. In competitive displacements, you need to play the long game, both tactically and strategically.
No Theory of Why Change:You find the worst prospecting results in sales organizations that lack a theory of why their prospective clients should change. The root cause of this challenge is a legacy approach to sales—one that falsely assumes decision-makers value learning about the salesperson’s company and enjoy answering the question, “What’s keeping you up at night?”
No Time Blocks:Endless distractions and tasks masquerade as work, but they have little or nothing to do with the primary outcomes salespeople are responsible for producing. If you don’t keep your prospecting time sacred, other tasks will crowd out prospecting—to your detriment.
Many sales leaders underestimate the number of methodologies necessary for a modern sales force and modern approach.
No Value to Trade for Meeting:Ask yourself this question: “How is your client going to benefit from meeting with you, even if they never buy anything from you or your company?” If there is no value proposition for the prospective client, there is no reason to take a meeting. The more value you trade for time, the more appointments you will generate.
No Commitment-Gaining Methodology:Selling is about conversations and commitments. Without a commitment-gaining methodology, you leave one of the critical outcomes of a professional sales force up to chance. And chances are good that your results would benefit from improving your ability to acquire commitments.
Inability to Handle Objections:Your contacts object to meeting requests because they don’t want to tell you that you sound like a waste of time. They’d rather be polite and offer you an objection. Unless you recognize the objection is masking the contact’s genuine concern, you will struggle to resolve that concern.
No Gatekeeper Strategies:The inability to get past the gatekeeper can make it challenging to create new opportunities. Without a set of strategies, tactics, and talk tracks, you will struggle to get meetings with some decision-makers who would benefit from what you sell.
These are the very human character traits or attributes that lead to success in sales and any other human endeavor. Failing to develop them leads to poor results.
Lack of Resourcefulness:Getting a meeting demands resourcefulness. You may benefit from treating it like a game, using your imagination and creativity to find a way to get your contacts to agree to a meeting. When you treat prospecting like drudgery, you produce fewer meetings and make it more difficult.
Lack of Discipline:Only bad things come from a lack of discipline. Those who cannot pick up the phone, follow their sequence, and do the necessary work daily will produce poor results. Those who only do the work sometimes will have uneven results.
Lack of Initiative:Professional selling comes with maxed-out autonomy compared to other business roles. No one is going to tell you to prospect, and there is rarely an immediate penalty for putting it off for a day or two. Over time, however, you will discover that you cannot cram prospecting into the last minute, especially when your competitors have been working faithfully to beat you.
Conflict Aversion:Professional selling comes with a small amount of conflict because business comes with some friction. Those who are uncomfortable hearing “no” or being confronted by a grouchy person—especially one with low blood sugar and too much stress—will struggle. Know that you can help that grouchy person by improving their results at work. Maybe send them a Snickers bar too.
Every business problem is a leadership problem—or it soon will be.
No Standards:When sales leaders provide no standards around prospecting and opportunity creation, they will get too little of both. If anything is acceptable, you can expect poor prospecting results. Leaders should expect their people to turn in their best performance—with the leader’s help.
No Accountability:You will never find great results without careful accountability. Setting high standards is valuable because it engenders a positive culture of accountability, described as a growth hierarchy. Leaders who don’t hold their teams accountable are failing them.
No Goals:Without goals, there is nothing compelling action—including the actions causing a sales force to grow, improve, and develop over time. Leaders who accept anything produce mediocre results. Leaders who expect more produce better results.
No Pipeline Meetings:Most leaders focus on winning opportunities without giving opportunity creation the same time and attention. A pipeline meeting ensures that you are creating new opportunities. The accountability for creating opportunities precedes the responsibility for winning them.
Do Good Work:
Make a list of the areas you might need to improve to generate more meetings and create more new opportunities.
Tackle these issues and obstacles by focusing on them one at a time, recognizing that you improve faster when you do the work of prospecting.
Put the same time and energy into creating new opportunities as you do into winning them.
Covid-19 overwhelmed hospitals in many metropolitan areas in 2020, and patients hospitalized with the virus often had alonger length of staycompared to other conditions. Healthcare costs overall, however,are expectedto be anywhere from $75 billion to $575 billion less than a normal year due to deferred care from the pandemic.
With such a dramatic decrease in costs, Medicare Advantage (MA) organizations now face a significant financial forecasting challenge in submitting their bids to the Centers for Medicare & Medicaid Services for the coming plan year. Perhaps aware of this uncertainty among MA organizations, in January, CMS released the final rule for its MA and Part D payment methodologies for the 2022 contract year, months earlier than in previous years.
While some of the changes in the 2022 final rule had been announced before Covid-19, several updates, particularly to the payment growth rate, were unexpected. The following are the top 5 changes in the MA and Part D final rule for 2022.
1. Effective payment growth rate higher
In the rule’s Advance Notice, CMS estimated that the effective payment growth rate for 2022 would be 4.55%, but that jumped to 5.59% in the final rule, resulting in a 4.08% increase in revenue. This is a good sign for MA organizations, indicating that CMS is not expecting a significant cost rebound after the major drop due to deferred or foregone care.
That does not mean, however, that health plans can remain complacent. Contract bids to CMS need to be based on the most current and accurate Hierarchical Condition Category (HCC) data available. If plan members have been avoiding in-person care, such as their annual wellness Visits, for a year or more, the risk of new care gaps or chronic conditions increases.
For example, 36%of Medicare beneficiaries this past summer reported foregoing their regular check-up and treatment for a chronic condition. This indicates that member outreach and engagement efforts need to ramp up this year to close care gaps and identify any new health challenges that may have emerged in 2020.
2. New risk score methodology finalized
Although payment growth will be higher than expected in 2022, this revenue increase may be offset for some payers due to changes in the risk adjustment factor (RAF) score calculation. As announced years ago, in 2022, the RAF score will be 100% based on data from the Encounter Data System (EDS) and fee-for-service claims instead of a blend of encounter data and Risk Adjustment Processing System (RAPS) data.
The challenge here for MA plans, again, is incomplete data to calculate an accurate score. With members foregoing care, HCCs could be missing or overlooked. Encouraging members to seek preventive care or chronic condition management can improve the accuracy of the scores, but MA payers can expect a small financial loss per member per year due to the EDS transition and incomplete data.
Newer MA organizations may also need to reach out to partners with experience in the technical requirements to calculate accurate risk scores and avoid financial losses in the contract year.
3. Telehealth here to stay
Among the many other designations, 2020 may be known as the year everyone used telehealth, including seniors. Sixty percentof Medicare beneficiaries with a regular provider reported access to telehealth appointments. This adoption rate is likely to increase given that 82% of seniors also report that they have high-speed Internet access and91% of Medicare Advantage plan membersreport at least somewhat favorable telehealth experiences.
The Medicarepayment rule changesregarding telehealth enacted early in the pandemic remain intact in the 2022 MA final rule. For risk adjustment, CMS views telehealth-permissible codes the same as in-person codes, and that encounter data can be applied toward risk scores. This means MA organizations should continue to promote telehealth services to their members to encourage adherence to chronic condition management and preventive care. Encouraging telehealth utilization is important because while millions of seniors have obtained a full COVID-19 vaccine as of this writing, many millions more have not and may still prefer to avoid visiting their provider in person.
Telehealth will also be important for MA plans in addressing behavioral health and other social determinants of health. In a survey conducted last summer, nearly half (46%)of beneficiaries reported feeling more stressed or anxious, while 23% reported feeling more lonely or sad. Telehealth can help beneficiaries more easily connect with behavioral health providers.
4. New Rx HCC Model
The Part D Hierarchical Condition Category (RxHCC) model was updated in the 2022 final rule and may impact MA organizations’ bottom lines. For example, the risk score calculations will be based on 2017 diagnoses paired with 2018 drug data, each updated by three years. Like the RAF score, the RxHCC will be based solely on encounter data, which may be lacking for most organizations due to the delayed or foregone care. Regardless,estimatesshow an across-the-board risk score decrease for RxHCC, which means reduced revenue for MA organizations on drug costs.
However, plans can expect to recover those losses in the coming year as more beneficiaries resume in-person care.
5. ESRD Restriction Lifts
The 2022 MA contract year will be the first time individuals with end-stage renal disease (ESRD) will be allowed to enroll in a plan. Although increasing membership is the goal of every MA organization, ESRD is a very expensive condition to manage. The average beneficiary with ESRD cost$67,116in 2016 compared to $10,182 per beneficiary without the condition. Another report showed that costs for members with ESRD exceeded MA benchmarks in nearly46% of metropolitan areas. MA organizations need to ensure going into their contract bidding process for 2022 that they have the most accurate and timely data available on new members with ESRD to avoid unanticipated financial losses.
Returning to Normal
As evidenced by the MA and Part D final rule for 2022, CMS is planning that this year will be a post-Covid-19 transition year for MA organizations and beneficiaries alike, but not an avalanche of utilization after a long period of deferred care. The greatest uncertainty is members’ health status, which could impact MA organizations’ bidding submission process for 2022.
Fortunately, fully vaccinated members are likely to resume in-person care this year, which means MA plans can expect a more consistent and reliable stream of data to form financial projections. With the right data management, member outreach, and engagement tools, the transition from 2021 to 2022 will be smoother for MA organizations.
It’s no secret that Medicare Advantage (MA) plans are the fastest growing segment of the Medicare market. MA enrollment increased by 10% since last year – continuing a 14-year growth trend – to reach an estimated 22 million people.
From just 13% of new enrollees in 2004, MA’s market share has grown to more than 34% today and is projected to reach 42% by 2028. As more senior clients vote with their checkbooks – in favor of MA plans – many of the top senior-focused agents are taking steps to add MA plans to the product portfolio.
All the trends - the regulatory changes being advocated by HHS and CMS leadership, the demographics, the positive health outcomes for beneficiaries – point toward continued growth and popularity for Medicare Advantage plans. Increasingly, clients and prospects are going to want to work with agents who provide complete Medicare solutions, and that means being equipped to offer access to MA plans. Top agents are finding that it is well worth the extra effort to jump into this large and rapidly growing market.
If you are interesting in pursuing the Medicare Advantage market, please reach out to one of our Marketing Directors and they will gladly assist with everything you need. We appreciate your time and the opportunity to assist in growing your Medicare business. Call us today at 800-998-77715 or request info here..