Saul Marquez, Host at Outcomes Rocket Podcast

Streamlining Medicare Advantage Plan Operations

Monday February 15th 2021

Streamlining Medicare Advantage Plan Operations

Outcomes Rocekt for Convey Health Solutions


According to the United Nations, 1 in 6 people in the world will be over age 65 by 2050. In the United States, Statista reports that as of 2020, 16.9 percent of the population was over 65 years old, and that figure is projected to reach 22% by 2050. With a large percentage of Americans getting old, we can expect more and more people to seek out affordable care options for their health needs, and one of these affordable options is Medicare. 


Medicare is a primary care insurance for a large number of seniors. Based on the fact sheet released by the AARP (American Association of Retired Persons), there are 44 million beneficiaries of the Medicare program, and one of the 10 beneficiaries depend solely on the Medicare program for expenses. 


Although the traditional Medicare program offers great benefits, a market for expanded opportunities for seniors, especially those who take prescribed medications has emerged in the form of Medicare Advantage plans. But even the Medicare Advantage market is getting crowded as more payers offer plans and increase plan value for their members. 


With the Medicare market getting more competitive and healthcare regulations getting more complicated, it can be difficult for payers to stay ahead of the curve while ensuring customer satisfaction. 


Convey Health Solutions delivers the solutions businesses need to create better experiences for their customers and partners.


Helping Americans navigate Medicare


Convey Health Solutions  is a leading healthcare technology and services company committed to providing clients with healthcare-specific, compliant member solutions utilizing technology, engagement, and analytics. 


For Tom Pelegrin, Senior Vice President and Chief Revenue Officer at Convey, one of the things that set Convey apart is its expertise. “We bring a level of expertise and capability that is specific to the Medicare market,” he said in our podcast interview. 


Convey focused on certain chronic conditions when it was first founded in 2001 and though the company has grown since then, it didn’t lose sight of the goal to help people navigate the complexities of Medicare. 


In fact, the company has acquired several organizations that can help achieve its goals.  

“We’ve looked for and been lucky enough to find organizations that we’ve been able to acquire that have contributed to this mission that we’re on in serving Medicare markets,” Tom added. These additional assets contribute to the success of the company in helping its clients. 


Creating better efficiencies in healthcare


In response to one of our favorite questions “What do you do different than what’s out there?”, Tom discussed the four different business units of Convey which include the following: 


  • Advanced plan administration – This group takes care of the administrative services and technology for Medicare Advantage, prescription drugs, employer group, and more. Convey delivers the support of technology and BPO (business process outsourcing) service there for health plans. 


Tom explained, “There’s a differentiator there. So the differentiator being that, again, we’ve built technology designed specifically to manage those regulations. And if you look at it from the build perspective, what we have done in the very beginnings of the organization is that we built this technology for our own internal use. So we never intended to have this technology sort of sold independently to health insurance companies. We built it for ourselves in becoming an outsourced organization to serve those health plans.”


  • Supplemental benefits administration – This segment delivers the end to end administration capability of the more popular supplemental benefits like Over-the-Counter Benefits administration or over the counter products. The differentiator for this business section is the advocate call center that provides support to members as they navigate the hundreds of products offered. The result is a seamless connection with the member, improving the member experience, and accurate reporting to both the CMS and the health plan. 


  • Value-based and payment accuracy unit which focuses on analytics and looks into data like social determinants of health (SDOH) to understand the behaviors, conditions, costs of care and drives change. 


According to Tom, Convey has acquired Pareto Intelligence, an organization that can ingest data quickly and from different sources, process it through analytics, and create actionable plans for its partners and customers. 

  • Advisory group – This is the fourth component, the unit that churns out the expertise. With the addition of Gorman Health Group and HealthScape Advisors, Convey has a better hold on matters of compliance, operations, and strategic standpoints. 


Improving outcomes and better healthcare experiences 


With hundreds of health plans competing for customer’s attention, it helps to partner with a vendor who has already proven its capabilities in driving business results. 


Convey’s flexible solutions for government-sponsored health plans help ensure compliance, improve customer experience, and support end-to-end Medicare processes resulting in better outcomes and improved customer experiences. 


To learn more about the amazing work Convey is doing, you can listen to my full interview with Tom here: https://outcomesrocket.health/tompelegrin/2020/12/


Written By

Saul Marquez

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