Our second and final day of the Medicare Marketing & Sales Summit kicked off with a high-energy keynote presentation by cognitive neuroscientists who explained how we can boost productivity in less time and with less energy. The morning also included first-hand accounts from several health plans in Puerto Rico on how they do more with less.
Here are the highlights:
How to boost productivity and performance
Keynote presenters, Dr. Sahar Yousef and Professor Lucas Miller, cognitive neuroscientists and MBA faculty, US Berkeley, kicked off the morning with a presentation that focused on how we can get as much done as humanly possible in less time and using less strength.
Human beings make three big mistakes when it comes to productivity and performance, Yousef said. But there are tips to overcome them, which will help increase productivity by as much as 25 percent and without working longer hours:
Mistake 1: Living in a messy digital environment full of distractions.
Humans are hard-wired to constantly scan our environment. Almost half of our brains are hard-wired to constantly process what we see and hear, Yousef said. So our devices and apps that constantly notify and interrupt us unnecessary drain our energy, our focus, our intelligence, and our cognitive band width and capacity.
Tips: Hide self-view during video calls and turn off (almost all) of the notifications on smart phones. Notifications are addictive so do a spring cleaning on all devices to only allow interruptions from the VIPs in your lives and not every application, she said. Make the devices less stimulating by going into black and white or gray scale mode. Power-down your phone at the end of the day or put the phone face down on a table in another room.
Mistake 2: Being a passenger and not a driver during the day.
Many people wake up and spend the first 30 minutes of their day checking their phone for messages and texts. And then it becomes a roller coaster of responding to messages and soon it’s 3 p.m. and they wonder where the day went. They don’t feel productive. Humans are fundamentally wired to seek reward and avoid pain, Miller said. Brains are short-term oriented, he said, but we live in a world throwing distractions and stimulation at us so we procrastinate. Miller said we are all dopamine addicts. Dopamine is responsible for allowing us to feel pleasure, satisfaction, and motivation. So, the trick is to turn slow dopamine into fast dopamine when we are dealing with complex tasks. Dopamine is not about reward, he said, it’s about motivation. We need to fend off distractions that are more motivating but don’t matter as much in the long run.
Tips: Write down one to three most important tasks to accomplish each day. Use 15- to 20-minute gaps in between meetings for the small, low important tasks. Build longer blocks of time to focus on the most important task until it is done.
Mistake 3: Relying on unstrategic scheduling
We are not the same as the day progresses and not all hours of the day are equal, Yousef explained. All humans have a biologically pre-set circadian rhythm and they all aren’t the same. This internal rhythm dictates our optimal time to fall asleep and wake up, as well as the peaks and troughs we experience in our daily energy levels. When we can carve out time during our peaks, we can be more productive.
Tips: Strategically design your day by protecting peak focus hours for strategic, cognitively intensive, high-value work. Schedule less important emails or administrative work during a lower-energy period of the day.
Lessons learned from the health plans of Puerto Rico
Three of the biggest Medicare Advantage plan competitors on the island joined us for a panel to talk about the challenges they face and how they do more with less.
Pictured left to right, Rex Wallace, Agelo Rexach, Ines Hernandez Roses, Ixel A. Rivera, Nilda Gonzalez.
Co -moderator Angelo Rexach, MS, Star ratings policy and analytics consultation for Rex Wallace Consulting, LLC, provided a snapshot of the Medicare Advantage market landscape in Puerto Rico so attendees better understood what the health plans face:
- Puerto Rico is Medicare Advantages 20th largest US jurisdiction by enrollment. According to CMS data from December 2024, 663,000 beneficiaries on the island elected a Medicare Advantage plan.
- The island has 304,000 Medicare Advantage members who are dual eligible (D-SNP) members. It also is one of the jurisdictions with the largest percentage of Medicare Advantage D-SNPs in the country (46 percent).
- Historically, Puerto Rico has been the jurisdiction with the highest Medicare Advantage penetration rate (84 percent). Medicare beneficiaries on the island must voluntarily opt-in to receive Medicare Part B coverage.
- Historically, the island has also been the jurisdiction with the lowest Medicare Advantage rates in the nation. For 2025, the base Medicare Advantage rates for Puerto Rico will stand 21 percent below the US Virgin Islands, 36 percent below the lowest state (New Mexico) and 41 percent below the national average.
Puerto Rico is excluded from four federal health programs:
- Medicare Savings Program: Part B payment could be covered for D-SNPs members ($2,220 annually)
- Part D Low Income Subsidy: Over 400,000 members under 150 percent Federal Poverty Level would benefit to cover pharmacy benefits gaps (≈ $450 monthly)
- Supplemental Security Income (SSI): Could increase SS checks by more than $600 for over 300K,000 low-income Medicare beneficiaries
- Long Term Services and Supports: ≈ $700 per month to D-SNPs for in-home and institutional assistance
Despite these challenges, 99 percent of the Medicare Advantage members in Puerto Rico are enrolled in a 4+ stars plan with 5 percent quality bonus payment (10 percent for 52 out of 78 counties). All three of the carriers on the panel have contracts with over 100,000 enrollment and at least 4 Stars.
Medical Card Systems, Inc. (MCS)
Ines Hernandez Roses, chief medical officer, clinical affairs, said MCS is the biggest Medicare Advantage plan in Puerto Rico and has over 300,000 members. It earned 4 Stars in 2017 and has maintained that rating until 2024 when it became a 5-Star plan (a rating it also received for 2025). MCS has had record breaking growth in both their Medicare and commercial business.
Dr. Roses said that one way that MCS stands out among other Medicare Advantage plan is their CARE programs, which are member-centered and fully tailored to the needs of their population. The programs have been in place for 20 years and have included a focus on social determinants of health since 2007. “We started the first program toward identifying and coordinating access to social and economical barriers.”
She described the organization as quality-focused, one that looks at quality in every aspect of their operations including, service, care, clinical outcomes, claims processing, and enrollment. “Everything we do, all day, we have that focus. We also have a very strong relationship with our providers and that has been key for attracting membership,” Dr. Roses said. In addition, she said, the organization is very agile. Because MCS measures everything, it can quickly determine when they have to change direction.
“In summary, we emphasize peer management, a culture of quality, strong provider relationships, measure, measure, measure and then the agility to act,” she said.
Triple-S Salud (Triple-S)
Founded in 1959, Triple-S is the oldest and largest health insurer in Puerto Rico. Ixel A. Rivera, chief operations officer, said it’s the only company that serves all health insurance segments and serves nearly one out of every three people in Puerto Rico.
Triple-S operates as a not-for-profit to support access to quality and affordable care and is a leader in the commercial and Medicaid segments. It also is the only Medicare Advantage plan that belongs to the Blue Cross Blue Shield Association. The organization also has mutli-specialty clinics and a big medical practice group.
“Triple-S goes beyond health,” she said. “We believe in comprehensive care of the patients and want to feel as secure as possible. So along with our health business, we also have our property and casualty business and also life insurance."
In addition, she said that in 2017, Triple-S established a foundation after Hurricane Irma and Maria to address challenges related to social determinants of health. The organization has approximately 100,000 members enrolled and roughly 40 percent of them belong to a special needs plan.
To differentiate the plan from other high-performing plans, Rivera said that the brand recognition of Triple-S is a big factor. “Because we’ve been here for 65 years, people recognize we are her for them, we care form and the providers are happy to provide services to the members,” she said.
The organization also is innovative and tries to make access to care simpler. “It’s important that access happens smoothy and when its needed.”
MMM Healthcare
Nilda Gonzalez, VP quality management & Stars, explained that MMM Healthcare was incorporated in 2000 and she has worked at the organization for 20 years. The company was the first Medicare Advantage organization to serve Puerto Rico. “They always say that taking the first step is the hardest one to take and we have taken many first steps,” she said.
Among the firsts: A community program designed to promote physical fitness for enrollees, management services organization to support providers, a behavioral health department, and member clubs throughout the island that serve as social spaces for enrollees, and an HIE hub, which serves as a portal for providers to connect with the plan and among their peers, and a mobile app that provides information about their clinical status and how they can better access their benefits.
MMM Healthcare also was the first Medicare Advantage plan to reach 4 stars (2016). “And ever since then for eight consecutive years, we have been able to keep it up, making it up to 4.5 Stars, which is the level where any organization can earn the highest bonus and the highest rebates, which in turn become the benefits that we offer to beneficiaries,” Gonzalez said, adding it is the first and only plan to be accredited for health equity from NCQA.
To differentiate themselves from other plans, she said the plan puts the member at the center of all benefits. Because of the migration of many Puerto Ricans to the United States, many of their enrollees are alone with no support system. To address these needs, several years ago MMM Healthcare began to deliver over-the-counter medications and nutritional supplements to the members’ homes.
“Think about it. Nutrition is essential. If you can’t ingest food properly, how can you expect healthier outcomes. It’s just simple. We focus on what are the needs of enrollees, where are the gaps, and how can we meet the needs of those gaps.”