BIP Fall 2024

A holistic approach to beneficiary care

Brokers’ and FMOs’ role in contributing to Medicare Advantage star ratings has never been more vital. By Darwin Hale

1. Continuous education. Stay informed about Medicare regulations and plan benefits to provide timely information. 2. Proactive communica tion. Regularly check in with beneficiaries to address their health needs and ensure they are utilizing their plan benefits. 3. Advocacy. Act as an advocate, helping beneficiaries navigate the healthcare system and access the care they need. 4. Collaboration with providers. Work closely with providers to ensure beneficiaries receive appropriate care.

The Centers for Medicare & Medicaid Services (CMS) creat ed the Five-Star Quality Rating system to promote and reward quality, ensure accountability and give beneficiaries the tools to choose high-quality plans. One of the most important contributions a broker can make is setting clear expectations. This begins with a thorough under standing of the plan’s benefits and limitations, ensuring that beneficiaries are informed about what they are entitled to and how to access services. Brokers also play a crucial role in managing a “wellness portfolio” for each beneficiary that includes routine check-ups, preventive care and the manage ment of chronic conditions. By maintaining regular contact, brokers help beneficiaries navi gate the healthcare system. This improves outcomes and enhanc es the beneficiary’s experience. Addressing obstacles Brokers contribute to star ratings by addressing and preventing potential issues. These include: Proof of coverage. It is crucial that the member receives proof of coverage within 10 days of enrollment. This document is essential for accessing care, and brokers help verify this, ensuring

Dr. Darwin Hale is a NABIP member, CEO and founder of Advocate Health Advisors, advising independent insurance agents serving seniors, veterans and employers.

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members know how to use their member ID card. Access to prescription drugs. When changing plans, members may face delays in medication access. Brokers edu cate members on updating their pharmacist in real-time, ensur ing fewer disruptions. Timely access to PCPs. Timely appointments are essen tial. Brokers help members find network providers, secure rou tine appointments quickly and navigate network changes. This expertise helps avoid unneces sary urgent care or ER visits. Best practices for brokers To maximize their impact on star ratings, brokers should ad here to these best practices:

By maintaining regular contact, brokers help beneficiaries navigate the healthcare system.

5. Feedback loop: Encour age feedback from beneficiaries to continually improve their experiences. Brokers and FMOs, working together, significantly impact star ratings. By managing wellness portfolios and optimizing phar macy benefits, brokers contrib ute directly to the achievement of high star ratings.

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