CareMgmt 11//08

CMSAudits12/4/08

• With demise of PFFS, PPO space will become very crowded very quickly
• Key to position for middle- to upper-income segments and group retirees 
• Contractual leverage with providers key to risk adjustment too
• There is a right way to operate an MA-PPO
• Must consider retiree group strategy
• Examine impact of PFFS demise in your market – and go after those affected
• MIPPA emphasis on LIS presents HMO/SNP boost
• SNPs now limited opportunity if not already offering
• MSAs likely to remain niche product

• Understand aspects and key issues for applicable Medicare Advantage product offerings
• Evaluate important strategic issues regarding products in the Medicare Advantage portfolio
• Address the impact of the demise of PFFS in their marketplace and develop strategic responses
• Consider the limitations of SNPs and MSAs in future benefit years
• Develop applicable MA-PPO and Group Retiree product strategies
• Plan for provider network considerations relating to these strategies
    

• Health Plans, Provider Networks, Consulting Firms, Employers and Vendors to the Industry
• C-Suite Executives
• Product development leadership
• Marketing & sales leadership
• Strategic, planning and development leadership
• Medicare and Government program leadership
• Retiree Benefit Managers
• Consultants
• Others monitoring Medicare Advantage activity
   

Jeffery Fox
 President, Gorman Health Group, LLC

Jeff Fox, President with Gorman Health Group, LLC, is one of the nation’s leading experts in government program market analysis, product design, health plan marketing and sales operations, and provider-friendly contracting.

Jeff served with FHP of Arizona from 1989-1993 as a sales representative and was in the top 5% nationally with his sales efforts. He joined Health Net of Arizona in 1993, becoming Vice President of Government Programs in January 1998. During this period he oversaw all sales and marketing, enrollment, customer service and appeals and grievances for Health Net’s Medicare products.

Jeff was directly responsible for Health Net of Arizona’s overall compliance with CMS (formerly the Health Care Financing Administration (HCFA) regulatory requirements, and maintained compliance records exceeding 98.5% during his tenure.

In November 2001, Jeff was promoted to include all contracting and provider relations duties for all product lines.

Jeff also served with Prudential Health Care in Texas, where he had statewide responsibility for their Medicare product, as well as the development and implementation of the national marketing campaign for Prudential’s Medicare product and AARP Medicare supplement business.
 

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