Challenge

In the early days of Medicare Advantage, many plans used outsourced service providers to handle their MA processing. Now that the program is becoming a much larger portion of their business, it is advantageous to own the systems and operations internally. The shift to insource the processing of a Medicare Advantage plan is a major undertaking, however, and comes with sizable financial and customer satisfaction risk.

Solution

Concord has led and supported several insourcing efforts at large and medium-sized plans. Our teams have deep experience in everything from marketing and enrollment to benefits and claims processing. Once the core processing is covered, our experts help clients enhance their STAR rating, manage risk adjustment, and implement a data strategy to tie the entire effort together.

We focus on several key factors that drive success in a Medicare Advantage program:

• Acquiring historical data from a current outsourced vendor and applying it to new or existing internal systems
• Building teams and processes for Medicare-specific functions like risk adjustment and STAR rating improvement
• Setting up non-traditional benefits and related vendors and support teams
• Defining and building teams to implement the technical platform transition
• Determining data and reporting strategy to support CMS-required reports and additional internal reporting functions
• Building a sales and marketing function, including web portals and marketing analytics
• Enhancing teams and functions such as Customer Service and Appeals to maintain or enhance STAR ratings
• Supporting the development of value-based care programs with key provider partners including incentive systems to manage costs and improve care
  

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