From Tom's Desk


"Age-Ins" and Social Media

“Age-ins" are changing the face of Medicare Advantage marketing.


More comfortable with all things mobile, beneficiaries turning 65 and enrolling in Medicare Advantage for the first time are using online shopping tools at three times the rate of earlier cohorts.


Notice I'm not referring to the website. Word has apparently gotten out of the questionable value of government star ratings. Overall institutional mistrust is also playing a role.


No, these folks are clicking on targeted adds on social media.  And if your organization is relying on traditional marketing channels you're certain to miss out.


This open enrollment period will reveal that those organizations who have formed a strong association with local insurance agent networks who have raised their visibility on social media will be the ones with outsized enrollment and retention rates.


And don't just assume your insurers are representing your products across social media channels. I performed a random audit of what I thought were the strongest Medicare Advantage agencies associated with selected clients of mine.


An astonishing number had no social media presence at all.




It's never too late to review your social medial presence and that of your agents. As the more tech savvy generations enter your target cohort, you'll risk being left behind if you don't.


You Should Know...

An Unanticipated Consequence of the CHRONIC Act

The next major statutory change to Medicare Advantage has passed the Senate. The Creating High-volume Results and Outcomes necessary to Improve Chronic care (or CHRONIC) Act (S.870), would, among other things, allow MAOs to include a "tele-health" benefit in their contract proposals.


But there is also a little discussed provision that will have a HUGE impact on Medicare Advantage enrollment---one which changes the manner in which primary care physicians (PCPs) are assigned to traditional beneficiaries under the ACO program.


Currently, assignment of PCPs is based on selection by the patient themselves. With the new provision in the CHRONIC Act, PCPs can be selected for the patient by the ACO itself---and changed at any time.


ACOs are failing badly, and organizations have made enormous investments in time and treasure to get them up and running.  This provision is a "hail Mary" attempt to save the program by allowing organizations to shift patients to those primes who work most efficiently within the system.


Now imagine you're a Medicare patient seeking medical care.  You're enrolled in an ACO under your PCP, even though you have little understanding and even less interest in what an ACO actually is. Now imagine if that same ACO has the power to reassign you to a different PCP, one of their choosing, with little notice and what will certainly be inadequate notification.


How would you feel?


Then a friend tells you about a different Medicare program---Medicare Advantage. One where you can pick your PCP and only you can change it.  How much more likely are you to consider that new program?


If implemented and if this provision survives the certain backlash from beneficiary community, it will be the most effective sales tool for Medicare Advantage that ever existed.


We'll be following this closely as the bill makes it way through the House.  It has to potential to shift the entire beneficiary population to majority Medicare Advantage.

High-Value Insight

Sickle Cell Trait

What if I told you the presence of sickle cell trait (D57.3. RAF 1.4!) carried a risk adjustment?


It does. And the risk adjustment is enormous.


It's also a clear objective finding; either the patient has it or they don't.


You can't just go testing for it in order to pick up the RAF adjustment though. As a certified compliance officer dedicated to keeping you out of trouble, that's fraud and bad medicine.


Most patients are too young to have been tested at birth, ut as more and more  test themselves with OTC gene testing kits and bring you the results, this code does become relevant. Many patients may also have had genotyping done in the past for unrelated reasons, say paternity testing, and their sickle cell status has come up as an incidental finding.


Whatever the reason, submitting the code (say, as the result of a discussion of its significance during an office visit) will increase your monthly capitation by 150%---Making the cost of a few minutes of chart review well worth your time.


Look for it!

Q&A with Dr. Tom

My clinicians continue to underperform in their Medicare Advantage contract. They're not responding to our education, tutoring or guidance. How can we help them do better?


Check their compensation formula.


Clinicians did not become clinicians to hunt for risk codes. And without the proper financial incentives, they won't.




Make sure the incentives for your patients, your clinicians, your organization and your insurer are aligned.


Then call me.


I have helped primary care clinicians generate compliant, retainable seven figure incomes through education and mentoring.


It's what I do.


Contact me, let's talk.


I can do it for you too.

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