TAMPA, Fla. (March 28, 2013) — In February, the Centers for Medicare and Medicaid Services (CMS) announced reimbursement rates for Medicare Advantage (MA) Plans will be significantly reduced in 2014. Health plans need to be more efficient and nimble to be profitable – and that is why Medical Card System, Inc. (MCS) hired Cody Consulting.
MCS is one of the largest managed care organizations in Puerto Rico, offering Medicare, individual and group commercial health insurance and Medicaid to approximately 300,000 members. Roughly 72 percent of those eligible for Puerto Rican Medicare have chosen a private MA plan, and approximately 48 percent are dual-eligible on both Medicare and Medicaid (including special needs plan).
Health plans in Puerto Rico, like MCS, will be significantly impacted by health care reform dictating a 30 percent reduction in reimbursement rates for MA plans for the period 2012 through 2017. In looking for ways to cut costs, most health plans, including MCS, identify the Annual Election Period (AEP) as one of the most difficult – and potentially expensive – areas to manage.
“Health plans that are highly efficient with AEP are able to significantly reduce their SG&A expenses, maintain a more favorable standing in CMS’s Five Star Quality Rating, and place themselves in CMS’s good graces,” said MCS Chief Executive Officer Jim O’Drobinak. “That’s why we’re bringing in Cody Consulting to help us be as efficient as possible with our 2014 AEP.”
Tampa, Fla.-based Cody Consulting works with health plans throughout the country to cut costs and increase efficiencies. The firm is particularly skilled with improving marketing collateral management and navigating federal- and state-dictated compliance issues.
“With the extremely frequent changes in guidance from the Centers for Medicare and Medicaid Services (CMS) and state governments, it is more difficult than ever for health plans to navigate – and comply with – highly complex regulations,” said Deb Mabari, Chief Executive Officer of Cody Consulting. “Streamlining the AEP process can make a huge impact on a plan’s ability to survive.”
In addition to Cody’s consulting services, MCS will use the firm’s proprietary software, CodySoft®. CodySoft® is the only project management tool designed specifically for health plans and includes a function to ensure marketing materials are complying with CMS regulations.
Noelle Anderson Fox, APR
True Blue Communications