mktg compliance aligned 3.26.10
TRANSCRIPT
Aligning the Odd Couple – Marketing and ComplianceMedicare Marketing and Enrollment Strategies 2010
Disclaimer
Content in this presentation is based on research and study of presenter through publicly available materials, personal interviews and online studies. Material is not to be duplicated or used in any other manner without the expressed consent of the presenter. Findings and opinions expressed are solely those of the presenter and not those of Windsor Health Plan, Inc.
Windsor Health Plan vitals
Five states 183 counties 31,348 MA/MAPD members in eight HMO plans 44,408 members in PDP plan Doubled enrollment three consecutive years Two comprehensive audits (2007, 2009)
The Admiral Stockdale dilemma
Marketing and Chapter 3 are enough It really is all about communications and positioning Navigating Compliance
Total CTM Complaints
050
100150200250300350400450
2006 2007 2008 2009 2010Complaints Mktg Misreps
Market landscape is changing
Entrance of M&NSupplements
New SupplementPlans
Reduced MAreimburs ements
The fall of PFFS Expans ion of HMO and PPO
Reces s ion fallout
Group marketopportunities
Booming market
Source: “A New Deal? What’s New for Medicare”?; Dawn McFerrin, Supplement to Sales Agent Journal, October 2009
Surveillance was formerly moderate
Intensity of oversight by OIG intensifies
Since 2008: 353,730 CTM complaints 92 notices of marketing non-compliance for 2009 AEP 1,500 secret shopping events in 2009 AEP Focused review of 400 random events
Inappropriate compensation Misleading tactics Aggressive, lack of consent
Outcome: Strong recommendations on sales oversight and increased
number of audits CMS disputing deficiencies
Source: Beneficiaries Remain Vulnerable to Sales’ Agents Marketing of Medicare Advantage Plans, OIG, March 2010
Scope of Horizontal Secret Shopping of Marketing Events During AEP
Total number of horizontal secret shops conducted 811 Number of MA organization shops 762 Number of PDP organization shops 49 Number of shops allocated to high-risk organizations 409 Number of shops allocated to all other organizations 402 Minimum number of shops conducted for any shopped organizations 1 Maximum number of shops conducted for any individual organization 134
Accountability by CMS intensifies
Overall Indus try Performance for Horizontal and Vertical Events
Total secret shops conducted 1,463 Percentage of organizations with violations 51.6%
Percentage of secret shopping events with violations 52.2%
Organizations issued notices for secret shopping violations 28
Source: Contract Year 2009 Marketing Surveillance Summary Report, CMS
Pressure intensifies with poor documentation
Based on 170 complaints in one Regional Office:
33 percent of cases were resolved, closed inappropriately or duplicates
28 percent of resolutions were poorly documented 20 percent of cases were incorrectly categorized About 12 percent of cases lacked specific
information about at least one issue
Source: CMS Assists Medicare Beneficiaries Affected by Inappropriate Marketing, GAO, December 2009
Snapshot poll of key MAO functions
Source: Marketing and Compliance Poll, March 2010, n=40
Most plans under 50,000 MAPD members
Source: Marketing and Compliance Poll, March 2010, n=40
All plans are under tight scrutiny
Source: Marketing and Compliance Poll, March 2010, n=40
Most believe there is collaboration
Source: Marketing and Compliance Poll, March 2010, n=40
Most see knowledge up and cases down
Source: Marketing and Compliance Poll, March 2010, n=40
Regulatory halo effect
Source: Marketing and Compliance Poll, March 2010, n=40
But not all levels agree on regulatory status
Source: Marketing and Compliance Poll, March 2010, n=40
Lack of clarity leads to risk
Source: Marketing and Compliance Poll, March 2010, n=40
Lack of Clarity
Decisive Actions
Audit risk remains prominent
Big disconnect on status of compliance
It could be as simple as motivationsAchievement Affiliation Power
Compliance
Marketing
Sales
Heartburn
Heartburn2
Heartburn
Frustration
Volatility
Source: David McClelland (adapted), staff surveys
Sales = Personal Power
Marketing = Social Power
Compliance = Expert Power
Common challenges among Marketers
“We feel like Compliance just drops our issues in CMS’s lap, and they just let the chips fall.”
“Compliance often stands behind the cloak of CMS.” “Compliance is not approachable or willing to negotiate.” “Compliance needs to work their relationship with the RO.” “Compliance is scared to death to re-file marketing pieces.” “Compliance feels a lot more like the ‘police’ than a ‘partner’.”
Source: Phone interviews with MAO Marketing and Compliance Departments, n=5
Marketing areas of opportunity
Take ownership of the regulatory communications process
Help Compliance position reporting, status and next steps
Let them walk in your shoes: Ensure Compliance understands business objectives Take them on a ride-along Make them rehearse the RO call with you Don’t be passive/aggressive
Structure affects confidence in compliant behavior
Challenges for Compliance
“Why can’t Marketing and Sales just operate within the guidelines? There is plenty of room.”
“We have to think about the entire organization and they just have one chapter.”
“The sheer volume of work is a problem for us.” “Even when we condense the guidance and offer a point-of-
view, we feel like Marketing is always looking for an ‘out’.” “We don’t think Marketing really understands how even the
smallest issue can affect a huge number of people.” “Our deficiencies show up on public websites. We get CAPs.
We get fined.” “We are under a lot of pressure without always enough
authority.” “There will be pain and suffering.”
Source: Phone interviews with MAO Marketing and Compliance Departments, n=5
Working together is a great theory
Source: Marketing and Compliance Poll, March 2010, n=40
Gaps still remain between the two departments
Source: Marketing and Compliance Poll, March 2010, n=40
Oversight
Knowledge
Leadership
Marketing areas of opportunity
Align your motivations and areas of struggle Evaluate the structure and operate around it
Matrix design works best Timelines and traffic systems create efficiency Affirmation is important
Create a clear value proposition for everything you ask of Compliance
Help make the Compliance Plan much more like an actionable Marketing plan
Have you given “power” to the expert?
Present materials and seek guidance through discussion Random audits for permission to contact Broker confirmation calls Medicare questionnaires Replacement forms for plan changes Create a contract year “readiness team” Random audit of sales allegation process and procedures Broker background checks – seven years Training, licensing and rapid disenrollment reporting Involvement in sales training or regular sales management calls Co-develop training, regardless of who delivers Provide measurable feedback from sales and verification calls Schedule regular meetings with Compliance with agenda and notes Provide Compliance with your reports for OPC meetings Help with policies, procedures, implementation timelines
Seven keys to Marketing/Compliance success
Recognize the business challenges ahead Recognize the risk of greater scrutiny together Build a communications and operations matrix Offer help in positioning in exchange for support Know your RO Collaborate on CMS communications/responses Recognize and support the “expert power” motive
Questions?
John M. SowellVice President, MarketingWindsor Health Plan, Inc.
7100 Commerce Way, Suite 285Brentwood, TN 37027