Betsy Seals boasts more than 20 years of extensive experience and has emerged as a prominent figure in the field of managed care. Her expertise has garnered national recognition, and she is widely regarded as a leader in the industry. Betsy’s insights have been featured in various esteemed publications, including USA Today.

With a well-rounded skill set encompassing strong leadership abilities, business acumen, and in-depth knowledge of regulatory and strategic aspects within the Managed Care realm, Betsy brings invaluable expertise to the table. Her focus lies in key areas such as mergers and acquisitions, compliance, sales and marketing, strategy development, the evolving landscape of supplemental benefits, and the design of innovative benefits to address social determinants of health (SDoH). Additionally, Betsy possesses a deep understanding of health plan operations, further enhancing her comprehensive grasp of the industry.

A Surprising Start

Betsy’s journey in the Medicare Advantage field began unexpectedly during her second year of college when she secured a job in Customer Service for SCAN Health Plan, a Medicare Advantage plan located in Long Beach, California. This opportunity provided her with valuable insights and knowledge about the industry. Building on her experience in Customer Service and Compliance at SCAN Health Plan, she ventured into the world of consulting by joining Gorman Health Group (GHG), a renowned managed care consulting firm based in Washington, D.C.

The transition to GHG marked a pivotal moment in Betsy’s career, as it solidified her path in Medicare Advantage. Over the course of 14 years, she had the privilege of learning from some of the industry’s most influential thought leaders while working in various positions within GHG’s consulting division. Betsy’s dedication and expertise eventually led her to the role of Chief Consulting Officer, a position she held until 2018, before embarking on new endeavors.

Perseverance through Uncertainty

Despite the challenging circumstances, Rebellis Group was launched on February 3rd, 2020, just before the onset of the Covid-19 pandemic in the United States. In hindsight, Betsy acknowledges that had they known what was about to unfold, the team might have reconsidered the timing of the launch. The industry, along with the entire country, experienced a period of uncertainty and darkness in mid-March when the pandemic took hold. There were moments of panic and critical discussions among the founding partners regarding the future of the company.

However, after careful deliberation, the team decided to persevere, holding onto their belief in their ability to adapt, innovate, and navigate the evolving landscape of healthcare and consulting. Looking back now, more than three years later, Betsy expresses immense gratitude for the determination and foresight they possessed during those challenging times. Rebellis Group has not only weathered the storm but has also achieved remarkable growth over the past three years. Additionally, the company has been privileged and honored to attract some of the industry’s most talented executives and consultants who have chosen to join the Rebellis team, further contributing to its success.

Staying Ahead of the Curve

Betsy recognizes the importance of staying updated and well-informed in her field. To achieve this, she relies on a variety of sources on a daily basis. These sources include CMS (Centers for Medicare & Medicaid Services) guidance, industry articles, and blogs, as well as data analysis. These resources provide her with the latest information and insights into the managed care industry.

However, Betsy considers her team to be the most valuable source for staying connected to the pulse of Medicare Advantage (MA). As an expert model consulting firm, Rebellis Group has a team of practice area leaders who are the foremost experts in their respective fields. Engaging in conversations and discussions with these leaders allows Betsy to tap into their wealth of knowledge and expertise, gaining valuable insights into the ever-evolving landscape of MA. By leveraging the collective expertise of her team, Betsy ensures that she stays ahead of the curve and maintains a comprehensive understanding of the industry.

Closing the Equity Gap

Betsy strongly believes that the managed care industry is currently at a crucial juncture where the effective utilization of data, technology, and an enhanced understanding of Social Determinants of Health (SDoH) can make a profound impact on the Medicare population.

Compared to five or ten years ago, there has been significant progress in comprehending health literacy, health equity, and how these factors influence longevity and overall quality of life. This increased awareness has shed light on the need for innovation to address the equity gap within the vulnerable population served by managed care. The paramount concern for any Medicare Advantage (MA) leader should be how to create better health outcomes tomorrow than what exists today.

Betsy emphasizes that the focus should revolve around closing the equity gap and improving health outcomes for all individuals, regardless of their socio-economic backgrounds or other social determinants. By leveraging data, technology, and a comprehensive understanding of SDoH, MA leaders can drive initiatives to address health disparities and enhance the quality of care provided to the Medicare population. The ultimate goal is to ensure that everyone, regardless of their circumstances, has equal access to high-quality healthcare and achieves better health outcomes.

Unlocking New Possibilities

CMS has eased regulations  around  Special Supplemental Benefits for the Chronically Ill Subset (SSBCI), unlocking new possibilities. Betsy’s team leverages data and experience to address Social Determinants of Health (SDoH). They analyze data to identify prevalent SDoH factors and use their expertise to determine benefits that drive meaningful change and influence beneficiary behavior. This data-experience combination guides their efforts to improve health outcomes and tailor interventions to meet specific population needs.

Striking the Balance

Betsy’s perspective on balancing compliance with regulatory requirements and the need for flexibility and innovation in the managed care industry has evolved with her experience in Medicare Advantage (MA) and gaining a comprehensive understanding of running a successful MA plan.

In the past, Betsy viewed compliance as a black-and-white issue. However, she now acknowledges the importance of financial success for ensuring beneficiary access to care. While certain requirements have no room for interpretation, a broader view considers the need for flexibility and innovation to achieve financial goals while maintaining compliance.

When advising clients on difficult business decisions, Betsy presents the potential risks and rewards and poses the question of the organization’s risk tolerance. This approach allows clients to make informed decisions that balance compliance and strategic goals.

By considering compliance within the broader context of the organization’s success, Betsy helps clients find the right balance that ensures regulatory compliance while supporting financial viability and beneficiary access to care.

Revolutionizing Sales and Marketing Compliance

Betsy gained experience in Sales and Marketing Compliance during her early role as a compliance analyst. She highlights the significant changes that have occurred in the regulatory landscape for Medicare Advantage (MA) Sales and Marketing over the past 20+ years. The modern approach of data, predictive analytics, and social media has revolutionized the way organizations interact with their target members.

From Betsy’s perspective, there are two essential aspects to consider. Firstly, it is crucial to have a detailed understanding of the compliance requirements related to sales and marketing. Staying informed about the evolving regulations ensures compliance and minimizes risks.

Secondly, leveraging data is paramount for informing sales and marketing strategies. Betsy emphasizes that this goes beyond simple metrics like local market penetration rates or understanding competitors’ benefits. It involves utilizing data to answer key questions, such as identifying the significant Social Determinants of Health (SDoH) factors impacting target members, understanding plan choice drivers, determining effective Rewards and Incentives programs to influence beneficiary behavior, assessing the organization’s proficiency in managing chronic conditions like diabetes, and evaluating the likelihood of target population cohorts remaining enrolled in a chosen plan for more than one year.

By utilizing data-driven insights, MA organizations can refine their sales and marketing approaches, align services with member needs, and drive positive health outcomes and member satisfaction.

Key Advice for Emerging Leaders

Betsy’s first advice for someone starting out in the field of Medicare Advantage (MA) is to be a sponge. It’s crucial to actively listen and absorb information from various sources. In the beginning, the abundance of acronyms and specialized terminology in MA can be overwhelming, but taking the time to research and understand unfamiliar concepts is essential. By being curious and eager to learn, one can gradually piece together the puzzle and gain a comprehensive understanding of the industry.

When it comes to advancing in one’s career path, Betsy emphasizes the importance of resilience. Challenges and obstacles are inevitable, but it’s crucial to have the ability to adapt, pivot, and innovate. Being resourceful and resilient in the face of difficulties is key to overcoming them and moving forward.

Betsy also highlights the significance of qualities beyond intelligence and even expertise in achieving success in business. It’s not necessary to be the smartest person in the room. Traits such as being easy to work with, dependable, trustworthy, and ethical also hold great value. These qualities contribute to building strong relationships, fostering collaboration, and earning the trust and respect of colleagues and clients, ultimately playing a pivotal role in one’s overall success.

Website: https://www.rebellisgroup.com/