The Biggest Risk to Your Medicare Advantage Risk Pool

What’s the biggest risk to your Medicare Advantage risk pool?


Experience teaches that greatest costs from your pool will come from iatrogenic illnesses, especially as related to drug interactions and side effects.

And with the pressure to check all the quality boxes growing, these costs are only going to get worse.

What to do?

Regular drug weans.

Take the time at your yearly visit to review every med your patient is on.

Each is guilty until presumed innocent.

Sure, every medication has benefits, the question is whether or not those benefits outweigh the risks.  And the more medications they’re on, the greater their risks.

As the number of meds stack up, it’s the interactions and intermittent compliance that’s going to hurt your patients—and your risk pool.

Your patients don’t want to be on a dozen meds, they’re looking to you to give them the greatest benefits with the least side effects.

That means limiting the number of pills they take, even if it means you drop off of a “quality” metric.

You don’t care. In a shared-risk system, your compensation is based on the value you generate, not on meeting some artificial measurement.

Drug weans are a win-win for you.

The patient will usually do better, and in a world when everyone is on more and more meds, they’ll love you for taking some away.  They’ll be the envy of their friends. As your reputation gets around, you may even pick up a few patients.

All because you took the time to stop a couple of meds that were probably doing more harm than good anyway.

Just another example of how, under Medicare Advantage, everybody wins.