Overview

We support health plans and administrators in every area, from CO-OPs and small regional MA plans to the largest national powerhouses. Each has its own unique challenges and priorities, and we pride ourselves on offering the same level of focus, dedication, and service to all.

Medicare

Medicare Advantage

MA plans have always had to contend with the 45-day chaos of AEP, when marketing reaches a fever pitch and membership growth is paramount. But since 60% of members now shop around each year, retention is just as important. Emerging competition, including the growth of private exchanges in the Medicare retiree segment, further contributes to a very dynamic and aggressive landscape.

Our flexible, responsive business model and compliance-driven approach can tackle challenges faced by MA, MAPD, and PD plans during the AEP. We have a long history of supporting 4- to 5-star plans with:

  • TELESALES & FIELD AGENT SERVICES
  • SALESFORCE.COM CRM SOLUTIONS
  • BROKER CREDENTIALING & MANAGEMENT
  • MEMBER & PROVIDER CUSTOMER SERVICE
  • CLAIMS ADJUSTING & RECOVERIES
  • APPEALS & GRIEVANCES
  • ENROLLMENT RECONCILIATION

Original Medicare

New regulations and reform can drive significant unplanned workload demands within the public sector. Contractors are often challenged to find the specialized resources to effectively handle these situations, while also meeting mandated service levels.

BroadPath provides a range of solutions to Medicare Administrative Contractors (MACs), DME Contractors, and other entities. Our highly experienced consultants can fulfill a variety of service needs ranging from simple workforce augmentation to fully-outsourced solutions including:

  • PROVIDER ENROLLMENT & REVALIDATION
  • PART A & B APPEALS (REOPENINGS & REDETERMINATIONS)
  • MEDICAL CLAIMS REVIEW (RN, LPN)
  • PROVIDER CUSTOMER SERVICE

Medicaid

Medicaid and CHIP enrollment have jumped almost 18% since 2013 with an additional 10.1 million people covered. Most of the growth has occurred in the managed care sector, and plans have been scrambling to keep up. With unique private option programs becoming more popular, commercial plans are having to adjust accordingly.

BroadPath has helped a number of Medicaid HMOs respond to the challenges of growth and associated risk management, including the Arkansas private option. Our Medicaid services include:

  • HEALTH RISK ASSESSMENT (HRA) ADMINISTRATION
  • CASE & UTILIZATION MANAGEMENT
  • MEMBER & PROVIDER CUSTOMER SERVICE
  • TELESALES & ENROLLMENTS
  • FIELD SALES SUPPORT

medicaid

Exchanges and Individual Plans

net-promoter

 

There were 11.7 million exchange enrollments by the close of the 2015 enrollment period, and that figure is expected to climb to 25 million over the next five years. In response, health plans have been recalibrating their end-to-end approach to consumers, placing more emphasis on sales, customer retention, and loyalty. In an industry plagued by image problems with Net Promoter scores ranked in the bottom 10%, there are abundant opportunities for acquisition.

We can bring tactical focus to your customer loyalty program with our high-quality, high-touch customer care services. These include:

  • TELESALES AND ENROLLMENT SUPPORT (FFM-LICENSED)
  • CUSTOMER RETENTION CAMPAIGNS
  • CUSTOMER LOYALTY PROGRAMS (NPS®, VOC, CSAT, FCR)
  • FIELD SALES SUPPORT
  • MEMBER CUSTOMER SERVICE
  • HEALTH INSURANCE CASEWORK SYSTEM (HICS) ADMINISTRATION

Cooperatives

CO-OPs were designed to broaden the coverage options available to consumers, inject competition into highly concentrated health insurance markets and provide more affordable, consumer-focused alternatives to traditional insurance. By some measures, they have been very successful. Collectively capturing over 500,000 enrollments in their first year, and now over the 1,000,000 mark, they have become a viable player in the insurance marketplace.

But a number of forces are exerting pressure on CO-OPs. Some have been suffering from low enrollment and struggle with under-funded marketing programs. Others are experiencing heavy losses due to higher than anticipated medical expenses. In order to survive, CO-OPs need to simultaneously cut operating expenses, attract new members, and retain their existing base.

We are a dedicated CO-OP partner with a passion for helping drive success. We’ve worked with several leading plans providing turnkey support in sales, customer care, and operations, and we continue to grow our service capabilities and CO-OP footprint. We offer:

  • TELESALES CONTACT CENTER
  • FIELD SALES SUPPORT
  • MEMBER CUSTOMER SERVICE
  • MEMBER LOYALTY PROGRAMS
  • CRM AND MARKETING AUTOMATION
  • HEALTH RISK ASSESSMENT (HRA) ADMINISTRATION
  • CASE & UTILIZATION MANAGEMENT
  • CLAIMS PROCESSING & ADJUSTING
  • PROVIDER CUSTOMER SERVICE

Provider-Sponsored Plans

Prov-Spon-plan

There are 107 provider-led plans nationwide covering about 18 million members. About 8.9 million are enrolled in Medicaid (24% of all Medicaid enrollments). These plans have always created significant volume and cost advantages to provider systems, but have had difficulty competing with larger plans and with public acceptance of narrow networks. The growth of public and private exchanges and increased adoption of narrow networks has tipped the scales back in their favor. Provider-led plans are growing yet again.

Most plans self-perform or rely on TPAs to perform core operational functions, but we often provide end-to-end sales and marketing and/or seasonal surge support to provider-sponsored plans. Common services include:

  • TELESALES & FIELD AGENT SERVICES
  • SALESFORCE.COM CRM SOLUTIONS
  • MARKETING AUTOMATION
  • BROKER CREDENTIALING & MANAGEMENT
  • MEMBER CUSTOMER SERVICE
  • ENROLLMENT RECONCILIATION

BlueCross® and BlueShield®

As the most recognized brand in the country BCBS plans comprise 36 independent companies in all 50 states, collectively providing coverage to over 105 million members. While each plan benefits from strong brand recognition and cooperative national agreements like BlueCard, BCBS plans also face unique challenges. Increased competition, industry consolidation, high administrative costs, and rising medical expenses are shaking the foundation of “business as usual” for large and small alike.

BroadPath understands Blue. We have worked with almost 50% of the national, regional, and local BCBS plans on a variety of engagements over the years, helping them tackle complex projects in claims, customer care, and sales. Our capabilities include:

Telesales & Field Sales
  • Go Blue Campaigns
  • Stay Blue Campaigns
  • Enrollment Support
 
Claims & Plan Administration
  • IPP/ITS/Blue Squared Adjustments
  • Over-payment Recovery & Adjustments
  • FEP Administration
  • HICS Administration

telesale-field sales1

Commercial Group Plans

InsuranceMarketSegNew

With over 155 million Americans receiving coverage through group plans, employer-sponsored insurance will remain predominant for years to come. However the market dynamics within this sector are shifting. ACA has accelerated growth of self-insurance with renewed emphasis on the ASO model. Private exchanges have the potential to redefine how group coverage is sold, driving plans to compete for members even after deal closure with the employer.

The lion’s share of our business has always come from the group market. We can support existing operations while you onboard large new accounts. We can help improve service levels on underperforming lines of business. Or we can support you during any number of work overload situations in any functional area.  Capabilities include:

  • CLAIMS & BENEFITS ADMINISTRATION
  • OVERPAYMENT RECOVERY AND ADJUSTMENTS
  • TELESALES AND FIELD SALES SUPPORT
  • RETENTION CAMPAIGNS
  • MEMBER CUSTOMER CARE
  • PROVIDER SERVICES
  • ENROLLMENT
Get started today.

Find out what BroadPath can do for your organization.

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