What Can Medicare Advantage Do?

In honor of my first full year of blogging high-value, immediately actionable tactics for your success I’m going to put up my first ever blog post, so you can understand why I’m doing what I do.

Mr. Biondo

Mr. Biondo is a real person and a good man. He gave me permission to tell his story if I thought it might help someone.

When I first met Mr. Biondo he was not at all well.  He had lost a leg through misfortune. The bed sores from his outdated mobility equipment had let infection into his bones. He was smoking, depressed and in pain.  He was losing hope.

He came to my office in 2005 after firing yet another physician. None had wanted to take the time or risk to engage him or his many challenges. Too much effort, too little chance at reward.

Traditional Medicare had failed him—the program could provide neither the resources nor the flexibility he or his clinicians required to effectively meet his complex medical needs.

He had recently enrolled in a Medicare Advantage plan and asked me to direct his care.

Our Medicare Advantage contract at the time was total-risk, so it allowed us to mobilize 100% the resources to which he was entitled.  Through illness-based risk-adjustment payments and broad benefit design, we were able to create the systems he needed for his health to improve, and generate the means to sustainably fund them.

Now, I’m not a hero here, nor am I trying to portray myself as one; the surgeons and nurses, the therapists and the social workers, they did the heavy lifting.

It’s just that, for the first time, I was practicing within a system that freed me to innovate in the service of my patients; unleashing all the skills, all the experience, all the creative problem solving in which I had been long trained but constrained from practicing by fee-for-service medicine.

I didn’t have to worry about “level of service” or “location of care”,  “2/9 review of systems” or matching the correct code with the test—there was a job to do and I was finally free to do it—get Mr. Biondo better.

Yo Yo Ma and his cello.  Steven King and his pencil.  Vin Scully and his mic. That is how I felt.  Tools and the talent perfectly matched.  Dancing on air.

I looked around and could tell my partners felt it for their patients too.

Engaged and focused.

In the zone.

Healing.

It has been 12 years since I first saw Mr. Biondo.

He still has one leg.

But his sores are healed, his smoking ancient history and his infections long gone.

The social workers, care managers and I still keep a close eye on him, helping at need.

His pain is managed. His mobility scooter is new. With a special van, he can even drive.

With his pals, he hunts and fishes. He enjoys life.  He is my friend.

There are a million Mr. Biondos out there.

I can’t take care of all of them.

But you can.

I would love to show you how.