Need to drive MA plan membership? Don’t ignore your Marketing and Sales strategy

By Ben Kline, Business Development and Joel Andersen, Vice President, Marketing - Lumeris, September 19, 2017

After considerable due diligence, your organization has decided to launch a Medicare Advantage (MA) plan. You evaluated the market and current MA enrollment. You examined market competitors, such as provider-sponsored organizations, regional insurance firms, and large national organizations. You gauged potential competitor responses, trying to figure out if launching a plan would disrupt current market dynamics.

At this point, many organizations begin to shift their attention to enrollment and financial projections. As with any business endeavor, your organization needs to capitalize on its investment and understand where the membership threshold to breakeven lies. The sooner you can reach that membership threshold, of course, the better. However, many organizations fail to realize that the longer you go with low membership, the harder it becomes to garner traction. Meaning, your approach prior to launch and over the first year becomes increasingly important. You only have one chance to enter the market, and when you do, you want to capture your audience—providers, health systems, brokers, and consumers.

Based on our experience, most organizations underestimate, and often ignore, the importance of the sales and marketing strategy for launching a Medicare Advantage (MA) plan. Why? Some organizations that already manage insurance products in other lines of business may believe that traditional sales tactics will be sufficient for an MA launch. Others might think insurance marketing is purely an actuarial exercise and rely on the price point to drive membership.

From our experience in Medicare Advantage, two items are essential for growing membership:

  1. Sales and marketing must be involved, and part of, the strategic planning process. They should be involved in all critical strategic decisions regarding the product launch, including advising on the design of your benefit plans.
  2. A disruptive sales and marketing strategy helps you generate enrollment to ultimately win in your market. Successful plans pinpoint an unmet market need or gap in the market and leverage it—but this requires a highly tailored strategy.

Let’s walk through a common pitfall. In quite a few markets, we see the majority of new MA plans fall into the “me too” trap. They design their plans with a similar benefit structure and provider network to an existing MA product within the market. Their plan may have a slightly lower member cost share, but to the naked eye it appears identical to incumbent plans. To drive plan switching behavior among beneficiaries, you must provide a compelling reason to switch and those reasons must be visible to the consumer.

Many new MA plans also fail to realize that they are not just marketing against other market MA plans, but also against Medicare fee-for-service, Medicare Supplement insurance (Medigap), and standalone Prescription Drug Plans. While identifying competing benefit points is important, addressing the shortfalls of these other coverage options including how your plan addresses those shortfalls is critical. Educating the market on how your MA plan is innovative and transformative (and better than the status quo) can go a long way.

From here, it is critical to design a selling strategy that aligns with your sales channels. The more time you spend with your channel partners, the better. Handing off your new MA product to a series of brokers is not going to be enough. You will likely need to spend time educating your sales channel on Medicare Advantage, and the unique attributes of your plan. Moreover, how you design your product will dictate how you want to sell it. For example, you may have designed your product around a carefully crafted narrow network of providers. Narrow network MA plans call for an entirely different approach, and employment of classic MA sales and marketing approaches will often yield mixed results.

Medicare Advantage provides an attractive opportunity to deliver better care to seniors. To create a competitive advantage, don’t underestimate the power of a disruptive marketing and sales strategy.


Nine Things to Know About Current Opioid Misuse from a New SAMHSA Report

By Clive Riddle, September 15, 2017


The HHS agency  SAMHSA (Substance Abuse and Mental Health Services Administration) has released a new 86-page report: Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health, which among other things provides an updated peek at opioid misuse during the past year.




Here’s nine things to know from the report:

1. In 2016, approximately 11.8 million people aged 12 or older misused opioids in the past year,         representing 4.4 percent of this population.

2. About 891,000 adolescents aged 12 to 17 misused opioids in the past year, representing 3.6 percent of adolescents.

3. About 2.5 million young adults aged 18 to 25 misused opioids in the past year, representing 7.3 percent of young adults.

4. 8.4 million adults aged 26 or older misused opioids in the past year, representing 4.0 percent of this age group.

5. In 2016, approximately 11.5 million people misused prescription pain relievers in the past year, making it the predominant means of opioid misuse.

6. Among people aged 12 or older in 2016 who misused prescription pain relievers in the past year, the most commonly reported reason for their last misuse of a pain reliever was to relieve physical pain (62.3 percent.)

7. 53.0 percent of people who misused pain relievers in the past year reported that they obtained the pain relievers the last time from a friend or relative.

8. Another 36.8 percent of people who misused pain relievers in the past year indicated that they obtained pain relievers the last time through prescription

9. Another 6.0%  people who misused pain relievers in the past year bought the last pain reliever they misused from a drug dealer or stranger.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Centrist Democrats Turn to Pragmatism, Seek Bipartisan ACA Fixes

While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the Affordable Care Act, arguing that it could spur broader health care reforms in the future.

Morning Consult

Friday, September 15, 2017

CBO: ObamaCare uncertainty will lead to 15 percent hike in premiums

Premiums for ObamaCare's benchmark silver plans will increase by an average of 15 percent in 2018, the Congressional Budget Office (CBO) estimated in a new report released Thursday.

The Hill

Thursday, September 14, 2017

Sanders Offers Medicare-for-All Plan Backed by 16 Senate Democrats

Sixteen Senate Democrats are flirting with a single-payer health-care system, marking a shift within the party on what was once viewed as a politically treacherous issue that attracted little support from lawmakers.


Wednesday, September 13, 2017

Stanford study: Three-quarters of opioid prescriptions written for 10 percent of patients

A new Stanford University study reveals a startling fact about the nation’s opioid crisis: A small minority of Americans account for the large majority of drug abusers.

Mercury News

Tuesday, September 12, 2017

Uninsured Rate Falls to Record Low Of 8.8%

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

Kaiser Health News

Tuesday, September 12, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.



Health Care's Juicero Problem

Health Care's Juicero Problem

by Kim Bellard, September 8, 2017

Bad news: if you were still hoping to get one of the $400 juicers from Juicero, you may be out of luck. Juicero 
announced that they were suspending sales while they seek an acquirer. They'd already dropped the juicer's price from its initial $700 earlier this year and had hoped to find ways to drop it further, but ran out of time. 

Juicero once was the darling of investors. They weren't a juice company, or even an appliance company. They were a technology company! They had an Internet-of-Things product! They had an ongoing base of customers!

The ridicule started almost as soon as the hype. $700 -- even $400 -- for a juicer? The negative publicity probably reached its nadir in April, when Bloomberg 
reported people could produce almost as much juice almost as fast just by squeezing the Produce Packs directly.


Moral of the story: if you want to introduce products that have minimal incremental value but at substantially higher prices, you're better off sticking to health care.

Take everyone's favorite target, prescription drugs. As Donald W. Light 
charged in Health Affairs, "Flooding the market with hundreds of minor variations on existing drugs and technically innovative but clinically inconsequential new drugs, appears to be the de facto hidden business model of drug companies."

As with prescription drugs, we regulate medical devices looking for effectiveness but not cost effectiveness -- and we don't even do a very good job evaluating effectiveness in many cases, according to a 
recent JAMA study

Take robotic surgery, hailed as a technological breakthrough that was the future of surgery. A robotic surgical system, such as da Vinci, can cost as much as $2 million, but, so far, evidence that they produce better outcomes is 
woefully scarce

Proton beam therapy? It's one of the latest things in cancer treatment, an alternative to more traditional forms of radiation therapy, and is 
predicted to be a $3b market within ten years. The units can easily cost over $100 million to buy and install, cost patients significantly much more than other alternatives, yet -- guess what? -- not produce measurably better results

Last year Vox 
used 11 charts to illustrate how much more we pay for drugs, imaging, hospital days, child birth, and surgeries than other countries. Their conclusion, which echoes conclusions reached by numerous other analyses: "Americans spend more for health care largely because of the prices."

We not only don't get a nifty new juicer from all of our health care spending, we 
don't even get better health outcomes from it.   

Health care's "best" Juicero example, though, may be electronic health records (EHRs). Most agree on their theoretical value to improve care, increase efficiency, and even reduce costs. But after 
tens of billions of federal spending and probably at least an equal amount of private spending, we have products that, for the most part, frustrate users, add time to documentation, and don't "talk" to each other or easily lend themselves to the hoped-for Big Data analyses. 

Many physicians might, on a bad day, be willing to trade their EHR for a Juicero. 

Jonathon S. Skinner, a professor of economics at Dartmouth,
 pointed out the problem several years ago: "In every industry but one, technology makes things better and cheaper. Why is it that innovation increases the cost of health care?" 

So we can make fun of Juicero all we want, but when it comes to overpriced, under-performing services and devices: health care system, heal thyself first.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Trump Administration Sharply Cuts Spending on Health Law Enrollment

The Trump administration is slashing spending on advertising and promotion for enrollment under the Affordable Care Act, a move some critics charged was a blatant attempt to sabotage the law.

New York Times

Thursday, August 31, 2017

5 Outside-The-Box Ideas For Fixing The Individual Insurance Market

With Republican efforts to “repeal and replace” the Affordable Care Act stalled, tentative bipartisan initiatives are in the works to shore up the fragile individual insurance market that serves roughly 17 million Americans.

Kaiser Health News

Wednesday, August 30, 2017

Pioneering Cancer Gene Therapy Gets Green Light — And $475,000 Price Tag

The country’s first approved gene therapy — approved Wednesday to fight leukemia that resists standard therapies — will cost $475,000 for a one-time treatment, its manufacturer announced.

Kaiser Health News

Wednesday, August 30, 2017

Advisory Board to sell healthcare, education units in $2.58 billion deal

Advisory Board Co said it would sell its healthcare business to UnitedHealth Group Inc’s Optum unit and education business to private equity firm Vista Equity Partners, for a total deal value of $2.58 billion.


Tuesday, August 29, 2017

Majority of Voters Support Medicaid Work Requirements

A majority of voters back the idea of tying Medicaid eligibility to employment status as the Trump administration weighs whether to give more states the power to impose work requirements on the government health program.

Morning Consult

Monday, August 28, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.