Published on September 30, 2019 Jim Jones, CHFP, RHU Associate Growth Officer at WellMed Medical Networks
The delivery of health care in the Medicare market is
rapidly changing. As more and more organizations become involved in Medicare
there is more competition than ever to win over patients and members. As a
result, strides have been made in both the patient experience and clinical
outcomes associated with individual care.
Even more exciting is that the overall cost of care is going
down while the quality of care is going up. The Centers for Medicare &
Medicaid Services (CMS), insurance carriers, insurance agents, accountable care
organizations (ACO’s), providers and patients have all contributed to this
positive change in the Medicare marketplace.
Leadership expert and author John Maxwell said it best when
he said, “change is inevitable, growth is optional.” Let’s apply that thought
to the Medicare market – the intersection of health care and health insurance –
where change is constant. Change is inevitable…but is it true that growth
follows just because things change? The answer is a resounding “no.” For providers
wanting more Medicare patients, let’s take a look at how growth can also be
inevitable by embracing the recent changes within the Medicare market.
For those entering Medicare for the first time or for those
trying to determine annual elections, knowing what to do and how to do it can
be a daunting task. Time and time again research shows that by and large,
people don’t understand Medicare and the choices and options available to them.
Medicare plans and regulations change from year to year. The
more health care options and plans become available, the more choice Medicare
beneficiaries have. But more choice for many people causes more uncertainty and
confusion. So who can help beneficiaries select and enroll in a Medicare
plan? Only a licensed, professional Medicare insurance agent or broker can
actually enroll someone into a Medicare plan.
The insurance agent who specializes in the Medicare market
must go through an annual certification that includes Medicare compliance
regulations, product knowledge, ethics training and yearly CMS updates to name
a few. This certification process and a dedication to the Medicare market
empowers the agent to be a subject matter expert and empowers the Medicare
beneficiary to get expert advice and guidance as they consider options from
year to year.
Sometimes Medicare patients will approach their health care
providers for recommendations or guidance on Medicare plans. Almost without
exception, the providers I've spoken with have all basically has a similar
response - "I don't want to steer my patients into anything that I don't
know much about - but I want to be able to help them."
That is why it’s so important for health care providers and
Medicare-certified insurance agents to have a professional working
relationship. The insurance agent can be a valuable resource to providers,
clinical staff and patients alike. As an expert in Medicare, the agent can
answer Medicare and Social Security related questions and help patients with
proper health plan guidance. The provider and staff gets the upside benefits –
patients get proper guidance, a value-added service is provided for their
patients, and work is taken off their desks. In fact, we’ve surveyed a number
of Medicare-eligible adults and resoundingly they have all said that having a
referral to a Medicare-licensed agent from their health care provider is
welcomed. In addition, they have also stated that they would like to have
high-level conversations with their health care providers about which options
will help them receive affordable, high quality care.
Dr. Jeffrey Shadle, a local physician in Plano, TX who
has seen impressive growth in his Medicare patient panel says it best, “Patient
growth does not happen by accident. It is a strategic decision made by the
provider and communicated clearly to the clinic staff. Getting the entire staff
involved is the key to success. Having a professional insurance broker, working
in collaboration with my staff, provides the extra layer of service that I
depend on to empower my Medicare patients and help grow my
practice.”
Providers serve their patients. Agents serve their
clients. When they come together – providers, patients and agents – a trusting,
collaborative relationship becomes the driving factor in serving the Medicare
beneficiary.
As the late U.S. Speaker of the House, Tip O’Neill,
used to say, “all politics is local,” so can be said about health care. Even
though it starts with a governmental agency the size of Medicare, it ends with
a decision being made by a Medicare beneficiary in their local community. If
anything “takes a village,” it’s the collaborative relationship of providers,
agents and patients working together.
Providers who have a working relationship with
insurance agents provide their Medicare patients with a valuable service.
Relationship takes time and trust. But if the end game is to serve patients
with the best possible health care, a provider and an agent working together
for the greater good of the Medicare beneficiary is a windfall to all stakeholders
in the health care delivery system.
About the Author: Jim Jones is the Associate Growth Officer for
WellMed Networks, Inc. His passion is to help WellMed providers grow their
Medicare patient panels and help WellMed patients experience quality, patient-centered
health care with a focus on wellness and prevention. Jim can be
reached at jijones@wellmed.net.
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