Medicare Advantage is a complex payment system.
I involves many actors in the system duplicating services—or even working at cross purposes.
This inefficiency wastes mountains of money—and could be the key to your success.
Have someone in your organization sit down, list your goals for your contract and all the specific interventions being performed to achieve those goals.
Examples of goals include increasing revenue, reducing hospital days, increasing the number of patients on your panel.
Examples of tactics include data collection prompts to doctors in your EMR, post-hospitalization follow-ups by care managers, directed outreach to patients about to turn 65.
This “listing exercise” is one of the first interventions I recommend when I’m engaged to improve an organization’s performance. It’s also the most productive.
The amount of duplication and unnecessary costs you’ll find will stagger you.
Care management is a common example. In most cases, the insurance company is doing a more effective job than your paid staff. And where that’s not true, the care managers from the insurance company are often working at cross purposes with your employees—and sometimes with your goal.
In this case, the decision to end care management was a tough one. But it was made easier with the knowledge of who’s was doing what. And it saved the organization a great deal of money with little loss in revenue.
If you’re running a Medicare Advantage contract of any size and haven’t performed this “listing” exercise, I suggest doing so immediately.
I guarantee there’s enough duplication and waste to make the cost of the project worthwhile—and the results will make you look like a genius.