- 1,255
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?
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?
