From Tom's Desk
What Medicare Advantage Can Learn From Direct Patient Care
There is a limit to how many patients a single clinician can effectively care for under a shared-risk system.because it’s the relationship between the prime and the patient that generates the value.
Together, they decide what care is appropriate, desired and needed—-and the clinician (if incentives are aligned through risk-sharing) makes that care happen as efficiently as possible.
But that type of relationship takes time. Time to develop and time to administer. And time is finite; time doesn’t scale.
No amount of technology will speed or deepen that connection—-and anyone who tells you otherwise either works for you or is trying to sell you something.
As a clinician’s skill and confidence grows, the number of patients they can effectively care for increases—-to a point.
After that point, even the most skilled clinician will suffer a decline in efficiency, effectiveness and satisfaction.
It's tempting to scale by having primes simply load up on more patients. It’s tempting too for primes to try to make more money by loading up on more patients.
But it eventually that number grows too large and becomes self-defeating.
What is that number?
Look at the practices of clinicians who perform direct patient care.
If their practices grow too large, some patients will leave, feeling they aren’t getting their money’s worth.
They have a functional cap on the number of patients---a "sweet spot" of around 500 is the norm.
That sort of direct price-signaling is absent in third party payment systems like Medicare Advantage, but you can still see it in your financial results. Pay close attention and limit the panel size you expect from your Medicare Advantage providers.
If your product is growing, get more clinicians. Educate your current clinicians that they have a “sweet spot” in the number of patients they can care for. Let them learn it the hard way if they must. That way you can bring on and mentor new clinicians without triggering a fear of competition.
But don’t try to grow by simply slapping on more patients on an already overloaded edifice—-that’s the one sure way to underperform.