Sunday Q and A

  Where you become an overachiever.     The “reality” of success in Medicare Advantage Written by a non-MD consultant who’s never had to take financial risk in his life. Population selection, data extraction, care limitation, case management. No mention of financially partnering with the primes. This works while the program is over-funded—indeed, it’s the model most Medicare Advantage Organizations use now. Once the funding gets cut back to the equivalent of regular Medicare—this model...

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Sunday Links

Where you come to get the knowledge first.     Medicare Advantage Beneficiary Premiums Lowest in 13 Years. That’s because the most valuable item an insurer can get from the beneficiary is not their money, it’s their signature.         Journalists file lawsuits to force release of Medicare Advantage audits. Medicare Advantage coding fraud will be the Enron/Maddoff/Sub-Prime scandal of the 2020s. It will do to healthcare what those did to the financial...

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Sunday Links

    What you need to know, when you need to know it.     Humana creates Telehealth system for Medicare Advantage beneficiaries told ya….     Why are Medicare Advantage Organizations moving more slowly than expected to integrate new benefits into their plans? Because they want to figure out which ones will make them money, This is a surprise to exactly no one who engages with this content. but that’s only half the story....

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Sunday Links

    Keeping you ahead of the curve. . .   The top ten states for baseline capitation payments It’s a handy little reference I’ve never seen before MAOs and their venture capitalist investors have followed this information for years, but instead of moving business to these states, they’ve lobbied CMS to alter the baseline in states with the most customers. The article states that setting these rates are a mystery—they are not. They are...

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Sunday Update

    All the news that’s fit to link     Iora Health expanding. Iora is one of the good citizens of the Medicare Advantage world. A VC funded start-up who leverages the power of the Medicare Advantage program AS DESIGNED for the benefit of patients and the clinicians who care for them. Follow their lead. Or, if you’re a prime, work with them. Either approach is good.     You may have read this: Home...

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Sunday Links

    Where you come for what you need to know.   Since we’re in the “doldrums” of the Medicare Advantage calendar, I’m going to take a moment to preen— I’ve been doing these updates on one platform or another for more than five years—Becker’s Hospital Review has started ripping off my idea. Their links are good, mine are better. The fact that you’re following me here makes you the best! Imitation is the sincerest...

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Sunday Links

  Where your smarts are!   Nice little story about how the home care industry sees Federal dollars driving its expansion. Important because the dollars to pay for home care will be coming out of provider’s pockets. Money quote:   “2019 is a very skinny, little, experimental year that is just reflective of some regulatory changes CMS made,” Medicare Advantage expert Anne Tumlinson, founder of Washington, D.C.-based research and advisory services firm Anne Tumlinson Innovations,...

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Sunday Update

  Everything you need to stay ahead of the curve.     Are we hitting “Peak Medicare Advantage?” The AMA is getting into Medicare Advantage More here. I anxiously await the AAFP and ACP to do the same.       More evidence that questions about overcoding are going mainstream ( timed paywall) Medicare Advantage fraud is going to make Bernie Maddoff look like a piker.         The home care benefit won’t...

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Sunday Update

    Where you can understand it all—in less than five minutes!   Medicare Advantage Market Healthy and Robust It certainly is—for now. A nice summary of the current state of affairs.     Hospitals call for overhauls of prior auth rules. Great insight into the PR campaign pushing back against tighter PA rules. Medicare Advantage was initially created to give CMS an agent at the point of care with skin in the game—the clinician...

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Sunday Links

How do know all this stuff?   The greater the number of Medicare Advantage plans in a given area, the higher the “quality” ratings and the higher the premium they charge. No surprise there. “Quality” ratings are extensively gamed and in a world of limited resources, such gaming would occur in areas with the greatest competition. Does suggest there is great opportunity in the mostly rural areas with less competition.     Confirmed:  Medicare Advantage...

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