From Tom's Desk
Predicting the Future
Your faithful author has had a jaw dropping week.
He’s been evaluating the Medicare Advantage programs of various systems and clinicians.
As they awaken to the horror that is MACRA/MIPS, they're shifting their efforts to Medicare Advantage, essentially the last bastion of sustainability in the third-party-payer world.
They're putting enormous investments in time, money, and opportunity to upgrade care systems so they can jump on the Medicare Advantage bandwagon and grab some premium while the low hanging fruit can be had.
Many are betting their future.
Are these bets well-placed? What are the risks of being behind the curve? Are these they being played by their vendors and consultants as the greater fool?
Right now Medicare Advantage seems like the only bet in town. The funding is fat and the dollars are falling from the sky.
Don’t count on that continuing.
If your investments are based on the premise of those huge cashflows, you're taking an outsized risk.
Continuing the current level of funding will take some combination of increased co-pays, money printing, tax increases, and means-testing of premiums.
Even with that, current dollars will continued to be shifted to higher risk populations--patients who are going to take a lot more effort to generate the margins you're currently used to.
Investing resources like it's no tomorrow based on the premise of current funding patterns is simply bad business.
Build a sustainable, anti-fragile system—based on reliable coding, bottom-up cost control by shared-risk primes and engendering innovation in care delivery.
One that can thrive in any funding environment.
Don't predict the future, create it.