CMS Rule Seeks More Oversight of TPMOs, ‘Chain of Enrollment’

Following up on its October 2021 “Third Party Marketing” memorandum warning of misleading tactics by some organizations, CMS in its latest Medicare Advantage and Part D proposed rule said it believes “additional regulatory oversight” is needed to protect beneficiaries from “bad actors” in this space. The agency observed that an increase in third-party marketing activities in recent years has been accompanied by a rise in marketing-related complaints from beneficiaries, such as those who do not understand how an agent or broker obtained their information.

While previous guidance and rules have focused more on MA organizations’ relationships with agents and brokers, the new proposed rule serves to address the prevalence of lead-generating entities that may not directly contract with MAOs but qualify as first tier, downstream or related entities (FDRs), explains Helaine Fingold, a partner in the Health Care and Life Sciences practice at the law firm Epstein, Becker & Green, P.C.

2022 Outlook: Plethora of ‘Granular’ Changes Will Drive MAOs’ Stars Strategy

With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be a landmark year in terms of changes to Medicare Advantage organizations’ star ratings strategies, industry experts tell AIS Health, a division of MMIT.

“There is so much earth-shattering change on the horizon that most plans are just not thinking about,” cautions Melissa Newton Smith, executive vice president, consulting and professional services with Healthmine, Inc. “We’re worried that COVID took up way too much airtime and that plans have lost sight of the forest through the trees in MA a little bit.”

New Google Maps Tool Shows Providers’ Network Affiliations

Google Maps will show users searching for health care providers which health insurance practitioners will accept — and health care insiders say that the new product could transform how patients access health care. However, they caution that Google, a division of Alphabet Inc., must be diligent about updating and refining the information it displays, especially if it hopes to expand its advertising and data analytics businesses into health care at a large scale.


In AEP Home Stretch, MAOs Make Final Push for Enrollment

With a bevy of plan options and supplemental benefits available to seniors and the omnipresence of multicarrier brokers, regional Medicare Advantage organizations are working doubly hard to get in front of potential and existing customers during this final stretch of the 2022 Annual Election Period (AEP). Complicating their efforts are continued slowdowns with mail delivery, which could impact brochures getting to Medicare-eligible beneficiaries before the AEP ends on Dec. 7, according to marketing experts.

Expecting Hot Medicare AEP, E-Brokers Beefed Up Internal Sales Forces

As the Medicare Annual Election Period (AEP) was in full swing last month, electronic marketing organizations (EMOs) like eHealth, Inc. and GoHealth, Inc. saw increased traffic to their online marketplaces and improved use of other digital tools. But both publicly traded firms, which posted third-quarter 2021 earnings in early November, have reported trouble converting telesales into enrollments and retaining members from the prior year — an area that is often seen as a weak spot for carriers that work with the large brokers.