Silverlink In the News

NEWPORT BEACH, CA - On Nov. 15 health plans can begin enrolling individuals for Medicare Part D plans, which go live on Jan. 1. With $540 million worth of new benefits and 42 million potential enrollees, the program provides a lucrative opportunity for payers.

Easy money? Not by a long shot. Medicare Part D is a complex program fraught with regulations. Add to the mix the target population of elderly people who will need a lot of education and hand-holding, and you've got an administrative nightmare waiting to happen.

The majority of players in this market have already implemented various solutions to handle such processes as enrollment, premium billing, fulfillment, identification and reconciliation. Others are focusing on call-center technology investments for communication and education.

Miami-based Preferred Care Partners, a state-licensed provider-sponsored organization with a Medicare+Choice contract, has the potential to capture a lion's share of Medicare Part D, given the large Medicare population from Dade County HMOs.

The PSO determined that its needs centered on automation, according to Robert Robledo, vice president of information systems for Preferred Care.

Part of the health plan's challenge was having a limited legacy payer system. With the help of TriZetto's Facets administration system, Preferred Care can create fields that CMS is now requiring.

Facets' Part D capabilities include enrolling according to CMS's new requirements, interacting with CMS data rules and supporting direct payment.

"Part of the value of a good technology partner is that the partner keeps up with the thousands of pages of regulation changes," said Gail Knopf, vice president of TriZetto.

Robledo also pointed out the need for having a good communications systems in place to not only deliver information to members but also to develop close relationships with both providers and members - a huge differentiator in this competitive payer market.

Stan Nowak. CEO of Burlington, Mass.-based Silverlink, agreed, saying, "This particular population needs significant communication. Clients are looking for smart ways to communicate clearly and simply to this age group the relative complexity of this program. The companies who lead will find innovative ways to communicate the right information to the right people at the right time." Nowak added that for managed care plans Medicare Part D is a major learning experience for the entire healthcare industry. "It's really all about serving individuals and consumers as opposed to serving groups," he said.

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