Cherry Picking Let's Talk

Oct 27, 2007

  1. MedSuppPro
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    MedSuppPro Guru

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    I've read a few threads about Cherry Picking. I have a limited opinion of which you should not depend upon for your marketing efforts. But, I question how carriers and agents somehow believe that non-captive agents can't ask for drug histories in order to help their prospects find their best plan!

    So I'm posting the following for an open slug fest of opinions -- what do you think? Nobody, should rely upon this posting as being CMS's final interpretation. CMS has the final say and can change their rules! It is possible that CMS has revised the information below. But, in CMS's (revised as of July 2006) Medicare Marketing Guidelines document they talk about carriers. Historically, carriers Cherry Picked with the old M+Choice plans. Read and comment about this:

    Persons Employed by an Organization to Market or with which an
    Organization Contracts to Perform Marketing It is of paramount importance to CMS that a beneficiary enrolls in a plan that the
    beneficiary chooses based on the beneficiary’s needs. CMS is aware that organizations sometimes use performance-based compensation, tying compensation of a person performing marketing to the volume or value of the person’s sales.1 Given such compensation arrangements, a person performing marketing may face financial incentives to steer a potential enrollee towards the plan offering the most compensation to the person performing marketing. Ensuring that a beneficiary selects the plan most
    appropriate to the beneficiary’s needs, as opposed to the financial interests of the person performing marketing, is important in the MA and Part D programs due to the variability between plans. Therefore, the rate of payment to a marketing representative should not vary based on the health status or risk-profile of a beneficiary. As a result, the rate of
    payment may vary between an MA plan, MA-PD plan and a PDP. Furthermore, rate of payment to a marketing representative may vary between one organization’s plans based on a marketing representative’s reasonable measure of service and industry standards.
    An individual performing marketing may be in a position to enroll healthier beneficiaries into specific health plans (or “cherry pick”). “Cherry picking” healthier patients is problematic because it distorts the market and can be viewed as discriminatory. Therefore an individual performing marketing must not “cherry-pick”.


    If you have anything to prove otherwise -- post it?
     
  2. CHUMPS FROM OXFORD
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    CHUMPS FROM OXFORD Guru

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    A bit unrelated, but I cherry pick all of the time with regard to individual health business.
     
  3. MIBizInsurance
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    Todays Options - 75% reduction in commish on plans sold in largest county in MI. Oh, Detroit happens to be in that county.

    Sure agents are bitting at the bit to sell that plan.
    /rolls eyes
     
  4. Cenla Agent
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    What is at issue isn't necessarily cherry picking. I don't have time to scour the CMS website right now, but what you need to look under is the regulations pertaining to asking the client health questions. It makes absolutely no difference whether you are captive or independent. Unless they have changed the rules from 2005-6, asking them for their rx info is prohibited whether it seems stupid or not. It's just like asking "how many times have you been in the hospital in the past year" when selling MA. That's just as pertinent to whether or not MA or Supp is better for them as what meds they are on is for choosing a PDP but it is likewise prohibited.
     
  5. Cenla Agent
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    That's an example of cherry picking, although it's not as transparent to the consumer. Today's Options is available almost everywhere but they only pay agents to sell it in certain areas. Humana is the only company I can think of in Louisiana that doesn't do it, although of course in less profitable areas the premiums are much higher. IIRC Secure Horizons is only marketing in 19 parishes of 66 this year and Wellcare 17, although it's an improvement for Wellcare since before this year they were only offering an HMO in Baton Rouge and no PFFS.
     
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