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HEALTH

Think Like A Surgeon

Health insurance brokers who are worried about the monumental changes that reform represents would do well to think like a doctor-a surgeon, to be exact. Implementing a major change is like a doctor performing open-heart surgery- you need to specifically diagnose what you are going to fix (solidify scope), prepare the patient (get the organization and data ready), conduct the operation (switch over to the new system and related processes), and recover (stabilize and fix glitches). Similarly, a good leader is like a doctor who is able to diagnose the strengths and potential weaknesses of the organization so you know what to watch out for and what you can leverage. Here is how to lay out your strategy and thrive amid all the changes coming your way.

1. Trust Your Experts

Enlist respected producers to better define your market and your cross-market. They are in the trenches- selling to make their living-and they know the pulse of the market best. Use feedback to refine your mission statement. Your mission statement should answer these three key questions: • Why am I in business? • What is my business? • Who is the customer?

2. Play to Your Strengths

Do a change readiness assessment- plan for the best, prepare for the worst. Take the time to identify your strengths up front; these serve as your back-up plan. Spend your time and money on activities that will generate business. Consider a broader organizational assessment-determine what works, then do it. It's all about the activity!

3. Rise Above the Noise

Getting synergy in your team is a must! Trust your team and reward the success you want. Manage expectations through activity. People want to be led; they don't want to follow.

4. Choose Your Horse

Be clear: Who are your primary markets and your cross-markets? (For example, a male turning 65 who has a spouse 62, their oldest kid is 40-45, their oldest kid is 20-25, and the spouse's parents are 80-84.) Determine the dominant buying motives for each one, and then market and train to that dominant buying motive. What primary, and then ancillary, products are right for your markets? Package your solutions together and diversify. Give your team enough time to succeed.

5. The Devil is in the Details

Details matter, make sure you get them right. Keep it simple-train your people on the things you want them to do the most, in the order you want them to do those things.

6. Make It Personal

If times are turbulent, team members may not care about what's best for "your" agency, department, company, etc. But they nearly always tune into WIIFM radio-"What's In It For Me?"

7. Keep It Light

Change is hard. Create and maintain esprit de corps to help pull the team through the darkest hours. Remember: you manage things and you lead people.

Timeline

November 2010 Post-Election Health Care Implications The new political environment creates uncertainty for health care reform, even as employers develop strategies for continued implementation. It is impossible to predict what the new Congress may enact, but much of the health care reform activity during the 2011-2012 legislative term could boil down to setting the stage for the 2012 elections. So, what can we expect in 2011?

Minimum Medical Loss Ratio for Insurers

Requires health plans to report the proportion of premium dollars spent on clinical services, quality and other costs, and provides rebates to consumers if the share of the premium spent on clinical services and quality is less than 85 percent (for plans in the large group market) and 80 percent (for plans in the individual and small group markets). Implementation: Requirement to report medical loss ratio, effective for 2010; requirement to provide rebates, effective January 1, 2011

Closing the Medicare Drug Coverage Gap

Requires pharmaceutical manufacturers to provide a 50 percent discount on name-brand prescriptions filled in the Medicare Part D coverage gap beginning in 2011, and begins phasing in federal subsidies for generic prescriptions that are filled in the Medicare Part D coverage gap. Implementation: January 1, 2011

Medicare Payments for Primary Care

Provides a 10 percent Medicare bonus payment for primary care services; also provides a 10 percent Medicare bonus payment to general surgeons practicing in health professional shortage areas. Implementation: January 1, 2011, through December 31, 2015

Medicare Prevention Benefits

Eliminates cost sharing for Medicare- covered, preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force, and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment. Implementation: January 1, 2011  

Center for Medicare and Medicaid Innovation

Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality. Implementation: Center established by January 1, 2011

Medicare Premiums for Higher-Income Beneficiaries

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels, resulting in more people paying incomerelated premiums. Reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual or $170,000/couple. Implementation: January 1, 2011

Medicare Advantage Payment Changes

Restructures payments to private Medicare Advantage plans by phasing in payments that are set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare-covered benefits than is required under the traditional fee-for-service program. Implementation: January 1, 2011

Medicaid Health Homes

Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home, and provides states that are taking up the option with 90 percent federal matching payments for two years for health homerelated services. Implementation: January 1, 2011

Chronic Disease Prevention in Medicaid

Provides three-year grants to states to develop programs that provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets. Implementation: January 1, 2011

CLASS Program

Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program). Implementation: January 1, 2011

National Quality Strategy

Requires the Secretary of the Federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to enhance the delivery of health care services, patient health outcomes and population health. Implementation: Initial strategy due to Congress by January 1, 2011

Changes to Tax-Free Savings Accounts

Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a health reimbursement account or health flexible spending account, and from being reimbursed on a tax-free basis through a health savings account or Archer medical savings account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20 percent of the amount used. Implementation: January 1, 2011

Grants to Establish Wellness Programs

Provides grants for up to five years to small employers that establish wellness programs. Implementation: Funding authorized beginning in fiscal year 2011

Teaching Health Centers

Establishes Teaching Health Centers and provides payments for primary care residency programs in community-based ambulatory patient care centers. Implementation: Funding appropriated for five years, beginning in fiscal year 2011

Medical Malpractice Grants

Authorizes $50 million for five-year demonstration grants to states to develop, implement and evaluate alternatives to current tort litigations. Implementation: Authorizes funding beginning fiscal year 2011

Funding for Health Insurance Exchanges

Provides grants to states to begin planning for the establishment of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of insurance by individuals and small employers. Implementation: Grants awarded starting March 23, 2011; enrollment in Exchanges begins January 1, 2014

Nutritional Labeling

Requires disclosure of the nutritional content of standard menu items at chain restaurants and food sold from vending machines. Implementation: By March 23, 2011

Medicaid Payments for Hospital-Acquired Infections

Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections. Implementation: July 1, 2011

Medicare Independent Payment Advisory Board

Establishes an Independent Advisory Board, comprising 15 members, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates. Implementation: Funding available October 1, 2011; first recommendations due January 15, 2014

Medicaid Long-Term Care Services

Creates the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non institutionally-based, long-term care services and establishes the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities. Implementation: October 1, 2011

Lloyd Lofton is managing partner of 7 Figure Sales Tools, Marietta, Ga. Lloyd may be contacted at [email protected] [email protected].

Cary J. Carney is the vice president of independent distribution for ING US Insurance's annuity and asset sales business, overseeing business development from the national marketing organizations, external wholesaling efforts and providing support for product development and marketing initiatives for the company's annuity business. Contact him at [email protected] [email protected].


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