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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Sunday Links

    An excellent use of your time.   Some excellent summaries have been coming across my desk this week—here are a few of the best:     Here is a summary of the new home care benefit, something that is going to be quite a center of cost if you are a Medicare Advantage provider. It’s well worth a read.         This is an excellent summary of the changes enacted by...

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Sunday Links

  Links:   Group 1 HHS Secretary Speech   Group 2 CMS Administrator’s Speech New Shared-Risk Payment Models   Group 3 Going all-in on Medicare Advantage Centene Oscar United Healthcare’s enrollment numbers   Subscribe to our newsletter now!   Tomism You can’t cure everyone, but you can care for everyone. Medicare Advantage pays you to care.  

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Sunday Update

Ahead of the curve!   Hospice Association Questioning Medicare Advantage “Carve-Ins” Carve-out= Hospice benefits not paid through the Medicare Advantage capitation Carve-in= Hospice benefits paid through the Medicare Advantage capitation   Carve-outs allow hospices to compete for business within the Medicare “marketplace Carve-ins force hospice to compete for business from private insurers   Thesis: Carve-ins will reduce payments to Hospice providers over time. Currently, Medicare decides what hospices will be paid. Look for case rates...

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Sunday Links

  Keeping you up to date, one Sunday at a time   Very Important: This is an excellent review of the evolution of Home Health payment models and how everything is evolving towards a single system—including Medicare Advantage. Considering that home health is going to be a burgeoning cost center beginning in 2020, this is background information you should be familiar with. If for no other reason than to demonstrate the vast breadth of your...

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Sunday Links

  We’re here for you!   Lifespark homecare goes all in on Medicare Advantage It’s a podcast but it demonstrates that the homecare benefit is already creating its own constituency. That was fast. Medicare Advantage hasn’t paid out a single dollar yet. Clearly, the benefit will never be eliminated. And if experience is any guide, MAOs are going to push the costs down to health systems and providers, especially since CMS is on the path...

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Sunday Links

The latest links that you need to know     Private insurers shouldn’t fear Medicare Advantage   So says Forbes.   Part of the full-court press for Medicare Advantage.   And they’re right.   The political influence that healthcare dollars will buy is limitless.   When healthcare is paid for by the government, healthcare decisions become political.   Medicare Advantage in some form is a horse to ride—until the money runs out or becomes worthless....

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Sunday Links

Your Fortress of Solitude   Private Medicare Advantage Could Hit 70% So says Forbes It won’t Not without explicit coercion of beneficiaries from the government. The emphasis on peripheral benefits will erode the core function of the program—covering  healthcare costs. If I’m wrong and the programs expands in its current form—it will provide a compliance free superhighway into the heart of the Federal Budget. It will bankrupt us all.     Two more firms entering...

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Sunday Links

    Your reference for excellence   Medicare-for-All would be a boon for private insurers So says Fortune magazine. How did Great Britain get universal coverage passed in the face of overwhelming opposition from doctors? “I stuffed their mouths full of gold,” explained the founder. Those who run insurance companies are infinitely more sanguine than physicians. They understand any Medicare-for-All structure that wins their support will be short-lived—the money will quickly run out. They like...

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