The title of this blog post says it all. It’s the most common question I get from people who experience my web presence. What exactly do you do? And I tell them, I teach clinicians and organizations how to drive. My first car was a 20-year-old Ford Thunderbird. It cost me $500. She was one sweet ride. She had two layers of stainless steel, was tricked out to almost 6000 lbs. curbside and it felt...
Read MoreJan was a delightful old man from Russia—and his health was declining due to his heart. Through data extraction and analysis, his healthcare delivery organization had identified him as a “high risk,” and a “potential high utilizer.” They put him on the list for their palliative care physician, a semi-retired internist who did house calls. The physician called Jan, made an appointment and went to...
Read MoreFive Hundred. Five Hundred—No more. The most experienced clinician caring for their patients in the best total-risk/value-based environment can excel with a panel of at most 500 patients. More than that and you will lose the intimate touch with your patients that is at the heart of value generation. The less experienced will only be able to excel with far fewer. ...
Read MoreThe Three Rules Rule #1 Everyone Gets Sick and Dies Rule # 2 In the end, clinicians can’t prevent #1 Rule # 3. As a result of #1 and #2, if a clinician is in a shared-risk contract, then the clinician will suffer financial losses. Everyone in a shared-risk contract has had it happen to them. The otherwise healthy patient, with whom you have no...
Read MoreIn a gold rush, the miners don’t make the money. The merchants selling them supplies do. In Medicare Advantage, those vendors selling you tools to passively extract risk codes from documentation are the modern day merchants in today’s Medicare Advantage gold rush. They will kill your margins with their purchase costs, subscription fees, and hardware requirements—not to mention the constant upgrades and the loss of productivity each one entails. You’ll only...
Read MoreManaged Care Medicaid is a different beast from Medicare Advantage. A different beast altogether. The risk scores are calculated differently. The margins are very, very narrow. Monstrously so. Despite this, with the right group of risk-sharing primes, you could generate a nice financial return on your time. Certainly, the return would be much greater than for fee-for-service Medicaid. All you need to do...
Read MoreThis week finally solves the mystery as to why I developed “Success Codes.” It’s joy. I experienced so much joy in caring for patients from disadvantaged populations. Intellectual challenge, resource management, and personal gratitude were only a few of the benefits. When it came time to build rapport, I usually found they had led pretty damned interesting lives. Anyone can successfully manage...
Read MoreIssac Thompson didn’t think he was doing anything wrong. He worked as a PCP in a medical practice with a large panel of Medicare Advantage patients. He saw all the inappropriate risk-coding requests. The letters from the insurance company: “We’ve reviewed your patient’s chart and determined that he has risk code XXX.XX, so we’re submitting it in your name.” (I’ve seen those letters personally about my...
Read More20% of the patients on your panel generate 80% of your costs. Your organization is probably spending a lot of money to identify those high-spenders. Data extraction and analysis, cost-scoring. It’s all expensive rubbish. You can go down your list of 500 patients and pick out the 25 that are going to cost you the most money next year. How? Because you know them. ...
Read MoreCoach Stu worked with the defensive line on my son’s football team. His words of wisdom will echo through the ages. “That’s not blocking, that’s two the sound of two butterflies having sex.” “Are you tired? Well, there’s a sport for people who get tired—It’s called baseball.” My favorite: “After the snap, if you rush right into the backfield like you’re an “All...
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