Category Archives: Deep Thoughts

Posted on by

Your Greatest Obstacle to Medicare Advantage Success

Greed.   Wanting too much, too fast.   This is the greatest obstacle to a high-performing shared-risk care system.   Be careful scaling anything up too quickly—pool size, care management—  overreaching is your greatest enemy.   It’s the close, trusting relationship with your patients that generates the real value in such a system.  That takes time to create.   True value-based care scales mightily but does so at its own pace.   Apply a fee-for-service,...

Read More
Posted on by

A Thought Experiment

What would happen to healthcare delivery if all the anti-competitive regulation—the ACA, HITECH, CON laws, healthcare expense deductions—all disappeared.   Imagine what would happen without all that regulatory capture.   How would healthcare be delivered?   What would happen to your organization?   Your compensation?   Your job?   Your patients?   Imagine that place.   Now go there.   Because that’s where you want to be.   Because that’s where we’re gonna go.  ...

Read More
Posted on by

I Wonder

  CMS just got badly spanked by the Government Accounting Office (GAO) regarding Medicare Advantage risk coding compliance. The reaction is going to be swift. And probably overboard. The clawbacks will be epic—up to five years worth. And at least a few fraud prosecutions will take place. Many organizations have paid big money to secondary vendors to extract these risk codes—manually or through their add-on EHR products. I wonder how much booked risk revenue will...

Read More
Posted on by

Arbitrage

When the actuaries determine how much a given illness is going to affect capitation in a value-based shared-risk system like Medicare Advantage, they look at the corresponding fee-for-service data and see what the costs have actually been. That data is made up of care delivered by an aggregate of clinicians—i.e. the average. You are not average. You are highly motivated to do an excellent job delivering the most beneficial care in the most efficient manner...

Read More
Posted on by

Bob Kocher was Wrong

Robert Kocher MD was the only physician on the President’s National Economic Council in 2009. He was one of the architects of health care reform—the ACA. He has publicly stated it was his intent for the law to force consolidation in healthcare delivery, believing it would enhance efficiencies and promote scaling of the most effective practices. He now says he was wrong. He openly acknowledges what five years of research into health care reform has...

Read More
Posted on by

Abundance

You need a mindset of abundance The scarcity mindset sees limited resources from which an individual must get their share.  Things are being done “to” them. They are not in control The abundance mindset sees only the opportunity for innovation generating infinite resources.  It’s proactive, optimistic. To succeed in a value-based, risk-sharing environment, you as a provider must develop a reflexive mindset of abundance. A sick patient is not a drain on your emotions and...

Read More
Posted on by

Shame

When speaking and writing on the issues of risk adjustment or physician compensation, I am often confronted by  “shamers.” Clinicians, administrators and patient advocates who tell me that it’s inappropriate for a physician to discuss “disease burden” and “revenue streams”—that it sounds callous and heartless, that it commoditizes patients and has no place coming from a healer. It’s a real barrier to innovative change. It took me a long time to get over it. Shaming...

Read More
Posted on by

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...

Read More