Come and get it!     Most of the MA links across the web this week are consumer advocacy pieces written in local publications. They would all do better to simply refer patients here. –yet one more example of how Medicare Advantage has gone mainstream. The ACA was supposed to be funded by dramatic cuts to the program. If you made a bet in 2009 (as I did) that it would be the...

  Keeping you ahead of the curve     It’s open enrollment season! And in a reflection of the impact Medicare Advantage is having on our industry here’s Bloomberg’s take on the “mad rush” to enroll payment. They’re not wrong.         Another whistleblower lawsuit, this one instigated by a coder and, uniquely, includes coding companies. That makes 18 active cases involving allegations of coding fraud. Medicare Advantage will be the Enron/Madoff/Sub-prime of...

    Open Enrollment Season is Here!!!   The 2020 STAR Ratings are out! Who improved? UHC Who didn’t? Centene Five Starts earn you a 16% increase in you Medicare Advantage gross revenue. Considering that Medicare Advantage Organizations have been accused of keeping two sets of books for their quality stats,  interpret them with care. And understand that there’s been a tacit admission by CMS that the “bonus” model for the STAR system has resulted in...

  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...

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...

    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....

    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...

    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...

    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...

  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,...