Hi, We’re Oscar. That simple statement dominates the Web home page for insurance upstart Oscar. Hi is not a word you see on very many Web home pages and certainly not on insurance home pages (insurers are notoriously shy, conservative types!), despite that fact that it is among the most common ways for two strangers […]
Millennials, age 21-32, are the new consumer group driving the shift towards patient-centered care. In order to meet their demands for a more personal healthcare experience, health insurers must first understand some of the unique behaviors of self-empowered millennials. Millennials research their symptoms online before visiting a doctor and turn to their social communities for […]
Finalized on November 22, 2015 after 18 months of discussion, the National Association of Insurance Commissioners (NAIC) approved an updated version of its Managed Care Plan Network Adequacy Model Act. Renamed the Network Adequacy Model Act, the name has been intentionally broadened to expand the applicability and scope of the Act to all network plans […]
Pre-2016 Medicare Advantage network adequacy guidance simply states that plans must maintain a network of providers “sufficient to provide adequate access to covered services to meet the needs of the population served” and establish written rules on timeliness of access to care in accordance with CMS standards. Of course, this ambiguity has led to numerous […]
The 2017 Final Call Letter to Medicare Advantage Organizations (MAOs) continued to emphasize the importance of provider directory accuracy and the increased monitoring and enforcement actions to commence due to preliminary data collected via the PNA Pilot Program that found severe violations with the Part D and Part C requirements. CMS stated, however, that they […]
Every year we hear the same refrain from customers driven by information from compliance: “We can’t allow any changes to addresses.” “Don’t run NCOA against my list.” “We have to mail to whatever address we have on file.” At the National Postal Forum in Nashville this past March, we participated in a roundtable discussing the […]
Consumers are demanding more frequent, personalized, meaningful communications from their health insurance providers, similar to the variety of touches they are accustom to receiving from retailers and other companies they purchase services and goods from. While many plans want to deliver more consistent and dynamic engagement, at the same time they must balance this initative […]
The healthcare market is in a time of unprecedented change. Competition is increasing, mass marketing approaches no longer suffice and consumers are looking for more from their health plans. Who’s leading this shift? Millennials. What do plans need to understand about reaching this generation? Well, for starters, millennials were raised during the era of the […]
With the Affordable Care Act came increased competition and the need for insurers to effectively deliver differentiating value propositions. A once highly commoditized market insurers took a transactional marketing approach is now becoming consumer-driven and necessitating plans adopt a relationship marketing approach if they are to remain competitive. What does that mean? A re-direction of focus […]
Beginning January 1, 2016, CMS will be strengthening their benchmarks for provider network data. This is due to a year plagued with consumer complaints regarding misleading provider network data in addition to CMS audits that have uncovered massive errors rates in provider directory resources. A series of high-profile health plan lawsuits have further brought attention […]