Medicare Marketing’s Top Ten

By Lindsay Resnick, September 26, 2011

With compliance scrutiny at an all-time high, a selling-season that has been dramatically shortened, and bonus payments and year-round marketing directly tied to the CMS Star Rating system—managing Medicare Advantage aren’t getting any easier. Add to the mix a surge of baby boomers entering the Medicare marketplace at a rate of almost 10,000 every day and one thing is for sure…you better have your Medicare marketing house in order.

Below are our Medicare Marketing’s Top Ten success factors to help sharpen your approach and meet or exceed stakeholder expectations. 

  1. Understand the impact of CMS COMPLIANCE – Today’s Medicare marketers must understand and respect the important role CMS compliance plays in the member acquisition process. This means making sure the link between marketing, sales and compliance is as strong as possible, always supporting the spirit of CMS consumer protections.
  2. Be DATA DRIVEN to ensure a strong foundation – Always start with data. It needs to be sorted, cleaned, refined, and turned into actionable marketing intelligence. From building predictive models for most likely responders to variable direct response call-outs to optimize media buys, the goal is to bring a grow while continually lowering your cost per lead and cost per sale. 
  3. Modernize your AGE-IN process – With thousands aging into Medicare every day, new approaches are needed to attract today’s boomer-seniors. “It’s not your Daddy’s Medicare.” It takes a combination of meaningful education, sequenced messaging, and innovative approaches to outreach to connect with newly eligible beneficiaries. 
  4. RETAIN MEMBERS to increase ROI  – In a fiercely competitive Medicare market, aggressive “switcher” campaigns have become routine. The cost of acquiring a new member is 5X the cost of retaining an existing one. Loyalty-based member engagement plays a big role in a health plan’s long-term profitability under the label of member LifeTime Value. 
  5. STAR RATINGS impact the bottom line – As CMS deploys its 5-Star Rating across Medicare plans, marketing’s role is critical to ensure member communications reinforce customer satisfaction. Engagement marketing goes a long way in a plan’s ability to achieve the highest possible Star Rating and the bonus payments that go with it.
  6. CUSTOMER INTERACTION makes a key difference – Give beneficiaries a reason to engage and connect with a Medicare plan they trust. It’s all about them. It takes tested, personalized direct response marketing that create opportunities for one-on-one interaction to communicate value and answer a Medicare beneficiary’s most important question, “What’s in it for me?” 
  7. Don’t ignore DIGITAL MEDICARE – As more and more Medicare shoppers use the Web as their primary research tool, it’s essential to have a Medicare online experience that’s user tested, compelling, and built for seniors. From ease-of-navigation to the images and words on your website, it needs to be tailored to your Medicare audience.
  8. Consider MULTI-CHANNEL SALES that match customer preferences – Different Medicare customers require different doors of entry….some will call on the phone; others come in through a website; some prefer to respond via mail;  many like a discussion across their kitchen table; and, others may even desire a retail experience. A multi-channel sales distribution strategy is critical to success. 
  9. Understand your DIFFERENTIATED VALUE – Being the health plan of choice for Medicare beneficiaries is achieved by building trust, credibility and relevancy around your value proposition. This means understanding drivers that motivate prospects to select your plan, and an ability to get the most differentiated and preferred product offerings in front of them. 
  10. Measure MARKETING ROI to determine actual results – You can’t manage what you can’t measure! Combining sophisticated upfront data analytics, direct response discipline and flawless campaign execution can significantly lower member acquisition costs and increase retention. Tracking, analyzing and measuring results throughout the marketing cycle is a Medicare marketing must. 

Successful Medicare marketing hinges on educating seniors, defining value and creating motivated buyers. It takes learning as much as you can about your target market so you understand what’s important to them, what concerns them, and what they want from their Medicare plan. It will go a long way toward answering Medicare beneficiaries’ number one question—what’s in it for me?


Look Up! The Stars Are Aligning for Prevention and Wellness!

By Cyndy Nayer, September 20, 2011

I’m thinking this evening of the amazing journey we’ve begun together, and I’m thinking about the conversation I had with Dr. Joycelyn Elders, former US Surgeon General, who will open our Annual Meeting and Innovation Summit on Nov 14.  Each of our phone calls is such a delight.  Imagine being able to call the woman who “explained” to Congress how teenagers need more guidance, and to ask her some of the hard questions on national health policy!

I’ve been very lucky in this career of mine.  I’ve been blessed to work with some of the most amazing folks at every turn.  What’s remarkable is that so many of us know the real gold in health care is not the care itself, but in making HEALTH the goal of our endeavors.  What’s exciting now is that many of us “passionate idealists” are working hard to make sure that the improvement in health is the #1 priority, and that health care becomes one of the tools to get there.

Each of us approaches this in different ways.  For instance, Brian Klepper, whom you often read about when you read my writings, is passionately moving the needle on Primary Care Providers, blogging on Health Affairs and causing a ruckus with the RUC (the panel that sets clinician reimbursement rates, the panel that is so very much under-represented by primary care physicians).  Brian’s efforts are getting bolder and growing stronger, and I am an ardent supporter of the efforts to be sure that Primary Care gets equivalent pay that shows their importance in the health engagement and promotion that keeps people well, working, and building healthier, prosperous communities.

Another good friend is Ron Loeppke, MD MPH, whom I’ve know for far too many years to remember.  Ron’s passion is now directed to his new job, as Vice Chairman of the Board, U.S. Preventive Medicine, Inc. (traansparency: I have the honor of serving on the board with Ron and so many of our mutual friends).  Ron is also the past Chair of the American College of Occupational and Environmental Medicine (ACOEM), and has chaired the Health and Productivity section for as long as I can remember.  Recently, Ron wrote an op-ed piece on the need for preventionists, and it’s posted on the ACOEM site.  Ron has been a driving force for linking worksite health to worksite performance, and we’ve had the joy of sharing many conferences, slides and ideas together.  As he says in the article:

The clinical science of preventive medicine focuses on wellness and health promotion and health risk assessment to keep people healthy (primary prevention); and early identification/diagnosis of illness through age/gender/risk appropriate screening and biometric testing (secondary prevention); as well as earlier evidence-based intervention/treatment to deter complications and the disabling impact of conditions (tertiary prevention). The preventive health care movement reaches well beyond the four walls of medical facilities to include workplace health and community health initiatives. 

I quote this as others in the space of value-based designs do not see the ROI of prevention and wellness.  But think about it:  if we can prevent the high cost interventions, if we can build intrinsic desire for health and accountability to save our health, the saved dollars will go far to build healthier communities.  The companies that tell me that they cannot focus on health, that they only want to get the costs down, are doing themselves, their families, and their communities a disservice.  Simply stated, if the company gets 80% or more of its workforce from the geographic community, then there is an 80% chance that the next person coming to get a job will have the same risk factors as the person who just left.  Want more proof?  Google Ron and start reading.

And on the topic of value-based designs, another friend I’ve been very much in contact with lately is Mike Critelli, the former CEO of Pitney Bowes who is now the Chair and CEO of Dossia, which is so very much more than a Personal Health Record.  Under Mike’s direction, Dossia is quickly growing into the family and community health management tool that I have been hoping for, building the capacity of families to “gather” into one record that the head of the family health improvement plan (usually the mom, folks, that’s been my story all along!), can manage.  With the strong support of a very talented group of programmers, community health improvement experts, international IT experts, and more that are too many to name, the group at Dossia is getting grand traction around the country, and I am, of course, delighted to have them on the CHVI board.  We share many strong ideas of accessibility and accountability, and then we work with our different constituencies to influence change as far and as fast as possible.

It’s stunning, isn’t it, that we expect an “engaged, accountable patient,” yet the patient gets no records, has virtually no decision-making authority except how much he/she is willing to spend out of his/her own pocket for care.  Yet, that’s not the accountable consumer we want.  We want a consumer who protects the health of herself, her family, her community.  We know, from research published by another renowned colleague, Dee Edington (of Univ of Michigan fame), that an engaged consumer of health has costs 30% lower than one who is unengaged.  We know that reducing risks from hi to moderate lowers costs 33%–that’s what happens when people are engaged, not entitled and waiting for the system to cure them.

Yes, I’m quite lucky, indeed.  Yes, I’ve used this opportunity to highlight the amazing work of my friends and colleagues AND to link to our upcoming summit, because I’m excited about our mission, and I’m excited that they will all be there with us.

Maybe, too,  as I watch the sun set over the beautiful SW Florida sky this evening, the stars really are aligning.  Perhaps we’ve squeezed as much value out of the delivery system as we can–and remember, most of the dollars, all $2.6 Trillion of them, are focused on the 10-20% of folks who are not so committed to health promotion or prevention.  Maybe now that the economics of health is so very important to understand, the stars are ready to assist.  Perhaps the stars, whose light has to travel so very far to be seen, have finally arrived in sight–and those of us who have spent so very many years promoting health, are finally being seen as well.  Perhaps the focus on outcomes allows all of us to ask the question, “How do we short-circuit the path to achieving these outcomes?”  and we can, finally, all get quiet while the stars’ universe responds, “It’s in the path to health promotion.”

It’s a wonderful night to dream of what could be, to imagine that there is a growing focus on health, outcomes, and healthy communities.  Tonight I’m not going to focus on this paradise’s need for jobs, affordable care, and primary care clinicians.  Tonight I’m going to hope and pray and dream of the US as healthy, prosperous, and job-wealthy.  I believe that’s what the stars are showing us.  If we’ll only look up, they will tell us that nothing is impossible.


A Penny (Or More) For Your Thoughts

By Kim Bellard, September 13, 2011

Let’s start with the non-news: a primary care physician association – in this case, the American Academy of Family Physicians – thinks primary care physicians aren’t being paid enough fairly and wants CMS to change the Medicare payment system.   It would be a surprise if any primary care physician organization argued any other position, and there is a lot of sympathy for the argument that primary care physicians are undervalued compared to specialists.   I’m sympathetic myself.

On the other hand, a new study in Health Affairs asserts that primary care physicians in the U.S. both are paid higher fees than primary care physicians in several other countries and also have higher incomes as a result.  The study, by Laugesen and Glied, further asserts that the higher incomes are simply the function of the higher fees, not due to higher practice costs, higher volumes, or medical school tuitions, as some have theorized.  The study also notes that the same type of gap exists for orthopedists in the U.S. versus in other countries, and that the income gap between U.S. primary care physicians and orthopedists is wider than in other countries. 

The fact of higher physician fees and physician incomes for U.S. physicians compared to their international peers is nothing new, and I’ve blogged about this previously.   With the ongoing and increasing pressures on Medicare and Medicaid spending, we can expect even more pressure on how we pay which physicians.  No one seems to be stepping up to say that they are overpaid.

A few other recent studies give me pause about this topic.  On of the most interesting was a study from Israel that concluded medical history and examination were more important than extra tests, particularly CT scans, in making a diagnosis.  The authors found that added tests only helped in about one-third of the cases, while adding significant costs and exposing patients to additional radiation and its attendant risks (see, for example, this nice summary).  This was in Israel, mind you, and one can only imagine how many more “extra” tests are performed in the U.S., given our culture to always do more and patients’ demand that everything possible be done, regardless of cost-benefit.  It’s nice to have it confirmed empirically that cognitive skills still trump technology most of the time. 

An example that dramatically illustrates this is a recent study about the effectiveness of “brain stents” to prevent strokes.  The study not only found the costly procedure was not more effective, but actually was worse for patients than those treated conservatively with drugs and advice.  Patients with the stents had more strokes and more deaths, to the extent that the study was halted prematurely once the results became clear.  Interestingly, this study is on the heels of another recent study indicating that heart stents were not more effective than medication, yet the number of such stents being performed hadn’t gone down once those results had become widely known.  The U.S. health system just seems to be in love with procedures and testing, not always to be benefit of its patients.

Now, some observers might view the results from Israel and claim that, well, if it was your mother/spouse/child, surely you would want those extra tests as well, just to make sure, since in one of three times they did prove to be useful.  It isn’t easy, after all, to tell which of the three will benefit before the fact.  It’s a valid argument, and this attitude is typical of our health care system, where doing more is usually seen as better.  We don’t seem to have this attitude in all aspects of our life.  If, say, it turned out that police routinely arrested three people to find the one person who was guilty, there would be cries of outrage across the board.  We’d argue indignantly that the police need to take a little more time to be sure they had the right person before making arrests.  We seem to hold our policemen to higher standards than we do our health care practitioners, and I’m not quite sure why.

I enjoy watching the television show House, in which it’s grumpy, damaged lead physician plays Sherlock Holmes with baffling diseases, eventually putting together all the clues to (usually) save the patients’ lives.  Every time I watch it, though, I have two reactions – first, those poor patients, who are put through a bewildering and often painful array of tests and procedures before the Dr. House reaches his miraculous conclusion, and, second, who is paying for all this?  There’s never any real sense that Dr. House and his team ever worry about how much their efforts are costing, and there seems scant concern for what they put the patients through.  All House cares about is getting to the right diagnosis.  It’s great TV but a horrible patient experience.

So here’s my thought.  Let’s pay physicians more for the cognitive work, the so-called Evaluation and Management codes (“E&M”).  All doctors, any doctors, plus nurse practitioners and other physician extenders.  It’s less important which doctors get it than what we incent them to do, and what we should want them to do first and foremost is to use their intellect, training and experience to figure out what is or might be wrong with us.  “First do no harm” and all that.

We should give them not just a token increase but a major one – double, triple, pick a number, but make it a very noticeable one.  I would assert that the health care system won’t go bankrupt – well, more bankrupt – because of too many office visits, even if we start paying for e-visits and telemedicine visits, as we should.  It’s what happens from those office visits that we have to worry about – the prescriptions, the tests, the procedures and treatments that result.  Of course, we’d need to find a way to ensure that those added payments for E&M visits aren’t just additive, but actually help deter other inventions that are not truly necessary.

The pot of money available in health care is, for practical purposes, a zero-sum game.  Pretty soon employees are going to realize that their “employer contributions” for health care is their own money, and pretty soon the federal government is going to have a harder time paying for its health programs using deficit financing.  So whatever we increase in E&M payments will need to come from elsewhere in the existing spending.  For example, could we use “thinking time” as the unit of measure, so that a procedure which takes an hour to perform should get paid the same as seeing patients for an hour?  Alternatively, perhaps many tests and procedures should end up getting paid more like a commodity – more expensive initially as people learn how to do them and as the initial development costs get paid for, then rapidly dropping the price as volume increases and people get used to doing them.  We have a tendency to start out high and never drop payment levels.   Smarter people than me can figure out exactly how to make the offset, although the lobbying opposition will be very intense as every specialty fights to protect its turf.

We all like to think that the patient-physician relationship is sacrosanct.  So why not pay for it like we actually believed that?


Health Net Said: ACEP Said – A Dustup Over Emergency Room Use

By Clive Riddle, September 9, 2011

Yesterday Health Net released what they thought was a benign media statement on Emergency Room use, entitled “Know When the ER is the Right Choice for Care.” The health plan opened by stating “with flu season waiting in the wings, emergency rooms nationwide will likely soon be crowded with those who’ve been bit by the annual bug and who are mistakenly seeking treatment in the ER instead of in their primary care physician’s office or in an urgent care setting. In advance of these yearly throngs, Health Net, Inc. (NYSE:HNT) is working to increase awareness regarding when it’s appropriate to visit an emergency room.”

Jonathan Scheff, MD, Health Net’s Chief Medical Officer tells us “while emergency rooms play a vital role in our communities by providing lifesaving services, many ER visits are unnecessary” and goes on to say   “because the most serious cases are treated first in emergency rooms, those with non-emergency needs can expect extended waits.”

This wouldn’t seem like controversial stuff to most, but Health Net then goes on to state “the American College of Emergency Physicians (ACEP) points out that it’s in everyone’s best interest to reserve emergency rooms for those who are seriously ill or injured” and cites the ACEP’s list of warning signs for adults and for children a medical emergency that should demand immediate attention.

And it would seem Health Net might not have consulted and collaborated with the ACEP on their release.

ACEP fired back a media release the same day:  “ACEP Takes Issue with Statements Made Today by Insurance Giant Health Net, Inc. Regarding Emergency Visits.”  Dr. Sandra Schneider, President of ACEP tells us “the nation’s emergency physicians take issue with the efforts of health insurance companies to prevent emergency visits. It may save some money for them, but it’s bad for patient health and potentially life threatening. It also violates the spirit of the prudent lawperson law, which requires insurance plans to pay for emergency care based on whether an average person would believe they have the symptoms of a medical emergency.  In addition, emergency care represents less than 2 percent of the nation’s health care dollar, so preventing emergency visits will never put a significant dent in the nation’s soaring health care costs.”

The two organizations have different takes on using National Center for Health Statistics data. Health Net states  “according to the National Center for Health Statistics, of the more than 300,000 Americans who are treated in our nation’s ERs each day, the majority don’t require emergency care.”  ACEP cites “less than 8 percent of emergency visits are classified as nonurgent by the National Center for Health Statistics, which also says “nonurgent” does not mean unnecessary. Nonurgent visits can include broken bones and kidney infections that require treatment within two to 24 hours.”

Doctor Schneider closes with “these health plan tactics are dangerous because it puts people in situations of having to self-diagnose their medical conditions — out of fear the plans won’t pay, for example, when their chest pain turns out to be heart burn. Health plans send messages to their beneficiaries not to make any “unnecessary” emergency visits. But it’s not that simple — I’ve seen people with mild symptoms turn out to have life-threatening emergencies. ….This is a very simple message we want to share with all Americans — if you think you’re having a medical emergency, go to an ER immediately. Leave the diagnosis to the experts: emergency physicians.’”

Health Net, in its defense, closes with the tip: “for more information about when emergency care is needed, as well as about injury prevention, visit .” This web site, by the way, is operated by the ACEP Foundation.


The Health Care Employment Situation

Clive Riddle, September 2, 2011

With Labor Day upon us, I decided to click on over to the Department of Labor and see what was going on. As luck would have it, the DOL agency, the Bureau of Labor Statistics, was issuing their monthly report: the Employment Situation, today, so I decided to check out The Situation myself.

Interestingly, health care was mentioned in the opening paragraph of the BLS Employment Situation news release: “Nonfarm payroll employment was unchanged (0) in August, and the unemployment rate held at 9.1 percent, the U.S. Bureau of Labor Statistics reported today. Employment in most major industries changed little over the month. Health care continued to add jobs, and a decline in information employment reflected a strike. Government employment continued to trend down, despite the return of workers from a partial government shutdown in Minnesota.”

A couple of paragraphs down, I learned “Health care employment rose by 30,000 in August. Ambulatory health care services and hospitals added 18,000 and 8,000 jobs, respectively. Over the past 12 months, health care employment has grown by 306,000.”

So this month, while overall national employment was flat, health care added 30,000 jobs, and for the past year, health care has accounting for 24% of employment growth overall (1,259,000 jobs were added overall nationally during the past twelve months.)

Digging down into the detailed tables of the report, I compiled some numbers and learned that health care currently employs 14,127,500 and comprises 10.8% of total non-farm employment overall. Here’s how health care employment breaks down by their sub-categories:

  • Offices of physicians: 19.6%
  • Outpatient care centers: 5.1%
  • Home health care services: 9.4%
  • Hospitals: 39.4%
  • Nursing and residential care facilities: 26.5%
  • Offices of physicians: 19.6%Outpatient care centers: 5.1%Home health care services: 9.4%Hospitals: 39.4%Nursing and residential care facilities: 26.5%

These employment figures don’t account for health care’s overall employment impact, once you factor in vendors to the health care industry, health care insurance, medical schools, etc. For example, the report indicates Insurance Carriers employ 2,207,900 as of August, although health insurance is just a part of that.

Of course, while many of these health care employees will be working this weekend, here’s wishing a happy and safe labor day weekend for all.