PITTSBURGH, June 15, 2022 /PRNewswire/ — The Centers for Medicare and Medicaid Services (CMS) recently announced new rules to advance their “strategic vision.
According to Patrick Phillips, CEO of Cavulus, a leading technology provider in the industry, the new CMS rules further solidify the popularity of Medicare Advantage (MA) and Part D. They expand access to affordable health care and improved health equity through lowered out-of-pocket prescription drug costs and improved consumer protections.
Phillips says MA costs and benefits attract membership. Enrollment statistics have grown by 10% annually in recent years and within another year should represent 50% of all Medicare coverage selections.
However, Phillips acknowledges “the program is not without criticism because of its rapid growth. That’s why there are guardrails in place. CMS has levers they can pull via regulatory oversight.”
For example, the Cavulus CEO likes a new regulation that considers a plan’s past performance, and grants CMS the ability to deny new contracts or service area expansions for underperforming insurers. “This allows top performing plans to grow and restrains organizations that tarnish the program’s integrity”. As a result, he sees the gap between over and under- performing plans inevitably widening through competition.
In addition to countless new rules benefiting existing MA members, CMS also scrutinizes how plans are marketed to potential enrollees. Phillips points out federal agencies are addressing the use of third-party marketing organizations (TPMO) that have garnered attention via TV ads featuring celebrity spokespeople.
“Because our company facilitates MA marketing, sales, and enrollment processes we understand the problems,” said Phillips. “We are proud of how Cavulus has helped advance CMS’s mission, and that’s why we monitor all new regulations and incorporate them into our workflows. Our solutions enable oversight, CMS compliance, and uniformity in marketing messages.”
Phillips stresses MA plans are ultimately accountable for any downstream entity they utilize, including TPMOs. “Member-centric plans continue to gain interest from those aging into Medicare, while plans that are lagging are attracting more attention from CMS.”
ABOUT CAVULUS – Cavulus is a technology driven specialist in Medicare Advantage insurance solutions. The Cavulus Cloud-based Medicare Advantage Platform (Cavulus MAP™) unifies marketing, sales and enrollment operations, and is utilized by many of America’s top insurers, including several BlueCross/ BlueShield companies, UPMC Health Plan, Johns Hopkins, Lumeris and United Healthcare. For details visit: www.cavulus.com. Media Inquiries: 800-760-6915 – Email: [email protected]
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