WellCare Action Plan.........
- Thread starter InsuranceGuy29
- Start date
just-a-client
Expert
- 45
I also think this is outrageous, awful.
It strikes me that this strategy was already in place. The new CEO of Centene joined this past January, 2024. Wellcare's $0 to $0.50 bids were submitted to Medicare by June, 2023. And I don't think this fellow was promoted from within. Of course, some Wellcare geniuses last year came up with the plan, and the new CEO is on board with it to execute it.
He's the CEO of Centene, the parent which is big. Wouldn't the Wellcare division have its own senior staff, who are more likely behind this?
Demonize, but do try to figure out where the blame lies.
[EXTERNAL LINK] - CENTENE CORPORATION ANNOUNCES APPOINTMENT OF MICHAEL A. CARSON AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF ITS MEDICARE BUSINESS
Maybe he was this kind of guy at all his previous stints. You folks will probably be familiar with his prior firms.
Excerpt:
"Mr. Carson brings nearly three decades of seasoned leadership, operational and industry expertise in both the payer and provider space with a deep focus on and expertise in serving Medicare and dual-eligible populations. As the CEO of value-based primary and multi-specialty care start-up CareAbout, he led a fully delegated, risk-bearing Medicare and dual-eligible-focused care delivery organization. Mr. Carson also served as the CEO of Bright Health Plan and as the President and CEO of Harvard Pilgrim Health Care. He led the formation and rebuilding of Medicare businesses at both Amerigroup and Anthem, as well as served in transformative leadership roles at ConcertoHealth and other Blue Cross Blue Shield plans."
Any of those firms good to agents? What kind of tomfoolery does he bring to Centene?
"Value-based primary care" means - keep the services down! The synonym is accountable care, with always the buzzwords "providing the right care at the right time at the right place." This annoying expression is repeated everywhere you hear about Accountable Care Organizations (ACOs), and it's really nauseating, isn't it? Can't Medicare come up with any other words and not just repeat the same motto over and over, which every ACO similarly repeats in their own literature, over and over?
"Value-based primary and multi-specialty care" means referring internally, and as little as possible. And they'll argue the benefit is that keeping people in the same system makes care more integrated, avoids duplication of tests, etc. What they don't tell you is providers are paid incentives to refer internally.
In a way, ACOs are arguably worse than MAPD. Because with MAPD, the providers can and do push back against the insurer. But with ACOs, the providers themselves own, or work for, the organization itself, which earns bonuses if they provide less care than expected based on their enrollees health status. Where is the ability to disagree? The incentives are to agree, and the risks are you lose your job.
So there are typically things like skilled nursing facilities aligned with the ACO. Instead of the facility appealing if the organization wants a person out, the facility's finances are tied up with the organization.
Anyway, that's what he was up to. Not that this is unique - Medicare's goal is to get every enrollee in Original Medicare assigned to an Accountable Care Organization by the year 2030, which is damned soon! I think they are no more than 1/3 of the way there so far. Lots of people are seeing PCPs who are in ACOs, and don't know it.
Lots to be mad as hell about. Sorry for butting in again!
I hope for everyone's sake (yours, and the public's) that Wellcare comes to its senses.
It strikes me that this strategy was already in place. The new CEO of Centene joined this past January, 2024. Wellcare's $0 to $0.50 bids were submitted to Medicare by June, 2023. And I don't think this fellow was promoted from within. Of course, some Wellcare geniuses last year came up with the plan, and the new CEO is on board with it to execute it.
He's the CEO of Centene, the parent which is big. Wouldn't the Wellcare division have its own senior staff, who are more likely behind this?
Demonize, but do try to figure out where the blame lies.
[EXTERNAL LINK] - CENTENE CORPORATION ANNOUNCES APPOINTMENT OF MICHAEL A. CARSON AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF ITS MEDICARE BUSINESS
Maybe he was this kind of guy at all his previous stints. You folks will probably be familiar with his prior firms.
Excerpt:
"Mr. Carson brings nearly three decades of seasoned leadership, operational and industry expertise in both the payer and provider space with a deep focus on and expertise in serving Medicare and dual-eligible populations. As the CEO of value-based primary and multi-specialty care start-up CareAbout, he led a fully delegated, risk-bearing Medicare and dual-eligible-focused care delivery organization. Mr. Carson also served as the CEO of Bright Health Plan and as the President and CEO of Harvard Pilgrim Health Care. He led the formation and rebuilding of Medicare businesses at both Amerigroup and Anthem, as well as served in transformative leadership roles at ConcertoHealth and other Blue Cross Blue Shield plans."
Any of those firms good to agents? What kind of tomfoolery does he bring to Centene?
"Value-based primary care" means - keep the services down! The synonym is accountable care, with always the buzzwords "providing the right care at the right time at the right place." This annoying expression is repeated everywhere you hear about Accountable Care Organizations (ACOs), and it's really nauseating, isn't it? Can't Medicare come up with any other words and not just repeat the same motto over and over, which every ACO similarly repeats in their own literature, over and over?
"Value-based primary and multi-specialty care" means referring internally, and as little as possible. And they'll argue the benefit is that keeping people in the same system makes care more integrated, avoids duplication of tests, etc. What they don't tell you is providers are paid incentives to refer internally.
In a way, ACOs are arguably worse than MAPD. Because with MAPD, the providers can and do push back against the insurer. But with ACOs, the providers themselves own, or work for, the organization itself, which earns bonuses if they provide less care than expected based on their enrollees health status. Where is the ability to disagree? The incentives are to agree, and the risks are you lose your job.
So there are typically things like skilled nursing facilities aligned with the ACO. Instead of the facility appealing if the organization wants a person out, the facility's finances are tied up with the organization.
Anyway, that's what he was up to. Not that this is unique - Medicare's goal is to get every enrollee in Original Medicare assigned to an Accountable Care Organization by the year 2030, which is damned soon! I think they are no more than 1/3 of the way there so far. Lots of people are seeing PCPs who are in ACOs, and don't know it.
Lots to be mad as hell about. Sorry for butting in again!
I hope for everyone's sake (yours, and the public's) that Wellcare comes to its senses.
MedicareWAA
Guru
- 447
It might be different with Part D but way more than one third of MA sales are brokered. Carrier direct sales aren't as common, ex Humana. And a ton of the brokered sales are made by big call centers that aren't owned by the carrier.
I'm just going on what I've read multiple times . Don't shoot the messenger. Only the carriers know the truth . But I'll say this . I've seen this happen 2 times recently . Client calls back of card to united about something about their plan . They're transferred to sales and switched . I'm no longer aor . In old days happened many times and i was still aor . What happening is carriers are now switching these members to outside call centers they own to keep the commission in house. I'm certain Humana is doing this with Ifg they own . One agency head i know tracked down many members they lost to this bs . In the end the carrier few mb's as there clients and the agent is nothing
MedicareWAA
Guru
- 447
$600 WellCare MA overrides … a bit much. But they can't pay for PDP.
- 1,183
This is the only language they will understand..
ValeRosso
Guru
- 637
Im going to a Wellcare training event soon...cant wait to tell all the managers and director of sales there how excited I will be to move as many people as possible away from Wellcare 
Love it. I hope they TANK.Im going to a Wellcare training event soon...cant wait to tell all the managers and director of sales there how excited I will be to move as many people as possible away from Wellcare
MouseMouth
Expert
- 31
Wellcare cannot move clients to another plan that will, going forward, exist under new contractual rules. They can certainly cancel the existing plans (non-renew) and hope to capture the clients with a very attractive offer, which they would have to do with internal sales or online enrollments. The fact that they will not do this is the proof that their intention is to steal the agent's contracted renewal commissions.
Im going to a Wellcare training event soon...cant wait to tell all the managers and director of sales there how excited I will be to move as many people as possible away from Wellcare
Why would you waste your time to go to the event? I mean, if you aren't going to write their plans and will move those you have away, just do it. Save your valuable time for something else. You can always email them to let them know.
