Graduation Year

2021

Document Type

Dissertation

Degree

D.B.A.

Degree Granting Department

Business Administration

Major Professor

Jean Kobongo, Ph.D.

Co-Major Professor

Richard Tarpey, DBA

Committee Member

Alan Hevner, Ph.D.

Committee Member

Matthew Mullarkey, Ph.D.

Committee Member

Gert-Jan de Vreede, Ph.D.

Keywords

Agent, Expert Rating System, Healthcare

Abstract

The purpose of this study is to help navigate the U.S. Healthcare system in a way that maximizes value and minimizes risk to Medicare Beneficiaries. We do this through the creation of a tool that will aid in the selection of an independent health broker. Brokers are the trusted resource who have the responsibility and expertise to optimize client value through needs analysis, education, and expectations setting. Beneficiaries need help with life impacting health and wellness decisions and ongoing support across the continuum of care. The qualitative research included interviews of industry experts with combined Medicare experience of more than 100-years. We found brokers are an integral part of the healthcare supply chain and provide an additional resource to an industry that is resource constrained. Broker actions impact multiple participants beyond the client to include members of business, government, and society. Little is known about brokers even within the industry. Brokers can positively impact quality of care but can also do harm by limiting access or disrupt access or disruption of services. Theoretical implications include providing the ability to include the broker as part of the value chain and extending the lens of Agency Theory to view brokers in the Medicare Advantage Program. The rating tool may reduce intermediary opportunism by better aligning goals and reducing agency costs. Future researchers will now be able to consider the broker as part of the numerous and ongoing efforts to better understand enrollment and disenrollment factors within the Medicare population. Practical implications mean Medicare Beneficiaries may experience a better interaction when interfacing with the healthcare system. Health plans can use the broker distribution channel to increase quality and Star Ratings as evaluated by the government. Higher quality brokers promote existing Centers for Medicare and Medicare quality initiatives. Originality of the study results from identification of a unique problem not covered by the literature. Medicare Advantage broker best practices are little known. Now, there are two artifacts to address that problem. The Broker Best Practices Framework and Expert Rating Tool to aid in selection of a higher quality broker based on utility. The tool is designed for adoption into the CMS star rating system and to promote the known relationship between satisfaction, quality, and cost.

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