Always be skeptical of the “one quick trick” approach when trying to create lasting positive change. But here’s one that will absolutely work—guaranteed. Don’t allow pharmaceutical sales reps to detail your clinicians. Just don’t allow it. When I told my office manager I was no longer going to see sales reps in the office, she became uncharacteristically quiet and drew me into her office. “The staff is not going to like it.” She said. “They’ve...

Under most Medicare Advantage contracts, you’re given a small monthly capitation to support your cashflow until the twice-yearly settle-up of your risk-pools. It’s usually a pittance, $35/per member?/month. But it can go up. How do you increase it? Ask. If you’ve had good performance for several years, ask your insurance partner to increase your monthly capitation.  You might be surprised at the answer. Most Medicare Advantage insurers just want to make sure your organization’s pools...

What’s the biggest patient complaint about Medicare Advantage? It’s not the cost, or the complexity. It’s the incorrect provider listings. That’s right, listings of participating providers are grossly inaccurate. And that causes beneficiaries to make poor decisions about what plan to go with. It’s a huge problem. CMS is concerned that Medicare Advantage insurers may be intentionally misleading beneficiaries with incorrect information. You, as an organization with a Medicare Advantage contract, must be proactive to...