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Sep. 24, 2019

By Jim Jones

The delivery of health care in the Medicare market is rapidly changing.

As more and more organizations become involved in Medicare, there is more competition than ever to win over patients and members. As a result, strides have been made in both the patient experience and clinical outcomes associated with individual care.

Even more exciting is that the overall cost of care is going down while the quality of care is going up. The Centers for Medicare & Medicaid Services (CMS), insurance carriers, insurance agents, accountable care organizations (ACO’s), providers and patients have all contributed to this positive change in the Medicare marketplace.

Leadership expert and author John Maxwell said it best when he said, “change is inevitable, growth is optional.” Let’s apply that thought to the Medicare market – the intersection of health care and health insurance – where change is constant. Change is inevitable … but is it true that growth follows just because things change? The answer is a resounding “no.” For providers wanting more Medicare patients, let’s take a look at how growth can also be inevitable by embracing the recent changes within the Medicare market.

For those entering Medicare for the first time or for those trying to determine annual elections, knowing what to do and how to do it can be a daunting task. Time and time again, research shows that by and large, people don’t understand Medicare and the choices and options available to them.

Medicare plans and regulations change from year to year. The more health care options and plans become available, the more choice Medicare beneficiaries have. But more choice for many people causes more uncertainty and confusion. So who can help beneficiaries select and enroll in a Medicare plan? Only a licensed, professional Medicare insurance agent or broker can actually enroll someone into a Medicare plan.

The insurance agent who specializes in the Medicare market must go through an annual certification that includes Medicare compliance regulations, product knowledge, ethics training and yearly CMS updates to name a few. This certification process and a dedication to the Medicare market empowers the agent to be a subject matter expert and empowers the Medicare beneficiary to get expert advice and guidance as they consider options from year to year.

Sometimes Medicare patients will approach their health care providers for recommendations or guidance on Medicare plans. Almost without exception, the providers I’ve spoken to have all basically had a similar response – “I don’t want to steer my patients into anything that I don’t know much about – but I want to be able to help them.”

That is why it’s so important for health care providers and Medicare-certified insurance agents to have a professional working relationship. The insurance agent can be a valuable resource to providers, clinical staff and patients alike. As an expert in Medicare, the agent can answer Medicare and Social Security related questions and help patients with proper health plan guidance. The provider and staff gets the upside benefits – patients get proper guidance, a value-added service is provided for their patients, and work is taken off their desks. In fact, we’ve surveyed a number of Medicare-eligible adults and resoundingly they have all said that having a referral to a Medicare-licensed agent from their health care provider is welcomed. In addition, they have also stated that they would like to have high-level conversations with their health care providers about which options will help them receive affordable, high quality care.

Dr. Jeffrey Shadle, a local physician in Plano, Texas who has seen impressive growth in his Medicare patient panel, says it best: “Patient growth does not happen by accident. It is a strategic decision made by the provider and communicated clearly to the clinic staff. Getting the entire staff involved is the key to success. Having a professional insurance broker, working in collaboration with my staff, provides the extra layer of service that I depend on to empower my Medicare patients and help grow my practice.”

Providers serve their patients. Agents serve their clients. When they come together – providers, patients and agents – a trusting, collaborative relationship becomes the driving factor in serving the Medicare beneficiary.

As the late U.S. Speaker of the House, Tip O’Neill, used to say, “all politics is local,” so can be said about health care. Even though it starts with a governmental agency the size of Medicare, it ends with a decision made by a Medicare beneficiary in their local community. If anything “takes a village,” it’s the collaborative relationship of providers, agents and patients working together.

Providers who have a working relationship with insurance agents provide their Medicare patients with a valuable service. Relationship takes time and trust. But if the end game is to serve patients with the best possible health care, a provider and an agent working together for the greater good of the Medicare beneficiary is a windfall to all stakeholders in the health care delivery system.

Jim Jones is the Associate Growth Officer for WellMed Networks, Inc. His passion is to help WellMed providers grow their Medicare patient panels and help WellMed patients experience quality, patient-centered health care with a focus on wellness and prevention.

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