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MA agent management for 2021 and beyond

Improving MA agent management

7 min read


MA agent management for 2021 and beyond

Convey Health Solutions

This post is sponsored by Convey Health Solutions.

As payers make strides to embrace digital tools that improve operations and member experience, there is still one area where they continue to struggle – agent management. Often, plans lack the right digital tools to make their agent management easier and more effective. This is a missed opportunity to streamline processes, and to better serve customers.

Plans that excel at agent management use a purpose-built system that enables agents and plan administrators to easily navigate through the agent onboarding and certification processes  in order to effectively enable agents to begin selling and marketing activities, as well as to improve their speed-to-market for their insurance products. Satisfied agents are in turn more motivated to find and welcome new members.

A successful and effective agent onboarding solution will enable agents to provide a better experience for new plan members and will streamline the member’s decision making process. PwC has found that positive customer experiences have a strong influence on purchasing choices, particularly in health care, as 78% of people cited it as an important factor in health care purchasing decisions.

But instead of embracing automated systems that can handle every aspect of agent management, many Medicare Advantage (MA) plans rely on manual processes, spreadsheets and other cumbersome documentation to onboard and oversee agents. In most instances, this can create an error prone onboarding process resulting in frustration and confusion for all parties. Other plans use multiple platforms — particularly for oversight — rather than a single, integrated platform for the agent onboarding and certification progress, which can result in ineffective workflows, delays and discrepancies.

As the dust settles after the Annual Election Period (AEP), health insurance plans have an opportunity to improve upon the prior year’s processes. The key for each health plan is to assess what worked and did not work for the selling season, which normally starts with the effective and timely onboarding of their sale teams and agents. Incorporating a low cost, purpose-built solution to replace cumbersome manual processes and disconnected systems will go a long way towards a more successful and effective selling season for years to come.

Onboarding considerations

Effective agent onboarding enables plans to set standards for how agents should interact with prospective members and for keeping up on regulatory requirements. Plans must make sure agents are contracted, certified, licensed, trained, appointed and ready to sell. This includes verifying that agents have satisfied at least three core certification components for Medicare sales: CMS training, product-specific training, and state licensing.

When plans use manual processes for these purposes, they may realize too late that an agent has failed to fulfill requirements for the current year. This also can be confusing for agents who often are unaware they were rejected during the certification process.

In addition, plans must report terminations of agents/brokers to the state when required and provide the reason for the discontinuation. But often when plans terminate agents, this is not reflected quickly and properly within plans’ systems.

Oversight obstacles

Once onboarded, agents must continue to meet CMS requirements or they will be deemed unqualified. If that happens, health plans are then required to reach out to members brought in by those agents and give them the option to disenroll. “That can be a pretty significant impact on business,” says Angela Burroughs, Director of product and service delivery at Convey Health Solutions. “This is one of the reasons plans need to be able to easily track the ongoing good standing of their sales force,” she adds.

One of biggest pain points in tracking agent status is the variety of rules at the state level, creating the risk of agents having an incorrect type of licensure or appointment process for the state where they are selling. Further adding complexity is the fact that rules are constantly changing, and plans often monitor these changes manually.

Commissioning challenges

Plans also deal with headaches in the area of commissioning. Many rely on staff to manage calculations, including tracking and making changes to multiple levels of the sales hierarchy, making annual updates to commission amounts and inside sales team compensations, and compiling tax information. This process ultimately leads to delayed and often inaccurate commission statements.

As a result, sales channels and selling relationships are damaged, which in turn can lead to lower sales performance. Static-free selling is especially important now, as competition increases the fast growing Medicare Advantage marketplace. Medicare eligible members continue to be inundated with new products and new plans to consider.  For 2020, 414 more plans were available than in 2019, and the average enrollee could choose from among 28 plans offered by seven carriers.

A better way

Plans that want to optimize agent management for 2021 and beyond need the ability to easily track every piece of the agent life cycle.

For onboarding, this means a smart, automated system that can provide agents with next steps within their workflow to move forward in the certification process. For example, if an agent finds certification was denied because they uploaded the wrong document, an alert clarifies how to rectify the issue.

A good onboarding system will also send alerts of any problems for the plan administrator to review before agents move forward. These alerts should include:

  • Background check failures
  • License verification failures
  • Failed appointment transactions
  • Notifications customized to the plan’s requirements

To aid in oversight, the system should link agents to the appropriate state requirements and monitor regulations to flag any changes, providing regular reports to the plan. If termination becomes necessary, the solution must ensure those updates are reflected immediately and accurately in the plan’s records, and in a list to the plan administrator.

Finally, plans should look for a solution that provides automated, customizable processes to track commissioning changes and tax information, making sure calculations are accurate and agents are paid on time. A high-quality automated system should be able to track multiple levels of hierarchy. For example, Convey Health Solutions’ Miramar:Agent solution can track up to five levels, which helps health plans paying out commissions through all the levels of contracting they have with external agency partners.

“While some plans have developed internal solutions, they typically manage a single piece of the pie,” explains Burroughs. “This makes it more difficult to maintain a complete, real-time view of agent status while reacting quickly to any onboarding hiccups, compliance shortfalls and commissioning changes. Instead, plans should be looking for an end-to-end solution that handles the entire agent oversight process, from onboarding to getting agents ready to sell.” This will ensure plans are enrolling agents and brokers properly and paying them accurately and on time.

Systems modernization is imperative for health plans to thrive in the consumer-driven market.  With a more efficient, accurate agent-management system that requires less work on the part of the plan, payers will benefit from stronger enrollment and streamlined processes that leave more time and resources to focus on patient care and plan improvements. This type of improved efficiency and compliance is not only desirable but is increasingly essential for MA plans that want to stand out going forward.

Convey Health Solutions focuses on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. Convey provides plan and member management, supplemental benefit management and advisory solutions for the rapidly changing health care world. Learn more.