October 9, 2023
What is VBE/HRA?
Value-Based Enrollment (VBE), also known as HRA is a CMS reviewed, integrated process that allows Florida Blue to collect custom health and quality data through a Health Risk Assessment (HRA) or social determinant of care questions for DSNP enrollees. This type of program has positive impacts on member retention and when used to its fullest potential there is also an opportunity for proactive identification of at-risk members to improve clinical outcomes. On average, this process takes 20-30 minutes. The enrollee may also be eligible for a $20 reward, based on effectuation, and must opt into the HealthyBlue Rewards program.
How VBE/HRA Works
- All eligible sales must be submitted using one of two sales tools:
- New for 2024 plan year- Connecture
- Florida Blue’s proprietary enrollment tool, SalesConnect, located within your AgentPoint portal by selecting the “Quote” icon
- New Florida Blue Medicare Advantage and DNSP plan submissions are eligible for payment on SalesConnect and new Florida Blue Medicare Advantage plan submissions are eligible on Connecture..
- Compensation will made based on the completion of the HRA by the member either by:
- Callback requested (either ‘Call Now’ or ‘Schedule Later’) from SalesConnect
- Online HRA submission from the Connecture tool
- VBE payments will be included in your regular payment cycle (weekly or monthly).
- VBE payments are subject to review and approval and based on submission date, can be expected on the first or second payment cycle following submission.
- Payments will be for new to Florida Blue Medicare MA enrollees.
- One payment will be made per unique Florida Blue Medicare plan enrollee based on the first VBE submission.
Connecture – New for 2024
- Once a new member is enrolled, Connecture will allow for the completion of the HRA to be active for four calendar days within the tool, if not completed at the time of submission.
- Note: The selling agent will complete the HRA post application.
- Compensation will be based on the completion of the HRA by the enrollee within the Connecture sales tool.
- Connecture HRA completion: $175
Sales Connect
- SalesConnect submission types eligible for VBE are:
- In-person
- Web Conferencing (such as a recorded Skype or Zoom call with screen share). Please note that Email submission type currently does not offer the VBE prompts for selection on behalf of the enrollee and therefore is not eligible for payment
- Once a new member is enrolled, the confirmation page in SalesConnect will prompt you to initiate VBE by selecting ‘Yes’ and then ‘Call Now’ or ‘Schedule Later’ on behalf of the enrollee.
- Compensation will made based on the completion of the HRA by the member by callback requested using SalesConnect.
Call Now: $150- This option should only be selected Monday through Sunday from 8 a.m. – 8 p.m. EST. If selected outside of hours of operation, payment will reflect Schedule Later (see below).
- Utilizing the contact information captured during the application process, the enrollee will be called by a third party within 15 minutes of selecting this option.
o The agent must conclude the sales appointment and cannot be present at the time of the call to complete the HRA.
Schedule Later: $50 - This option allows the enrollee to choose a future date and time that best works for them. Recommend scheduling within 10 days for the best experience for the enrollee. The enrollee will be contacted by a third party based on the contact info provided at the time of application.
- The enrollee with receive a call at their PRIMARY phone number provided in the application from a Florida Blue representative at (833) 783-1070. The caller ID will reflect Florida Blue.
- If the call center is unable to reach the enrollee, they will continue to make attempts to contact them for 7 days
Helpful Tips
Be Sure to include the following
- Effective Date
- Submission Type (Be sure to select In-person)
- Payment Preference
- Agent Acknowledgments
- Consumer Acknowledgments
After you complete the Enrollment Checklist, DO NOT close the window. Be sure to select yes for the Health Advocate Survey.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
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