From Tom's Desk

Shared-Risk Compensation Survey

Over the past three months, your humble scribe has been scouring the country trying to find Family Medicine opportunities which include some form of risk-sharing.



I used recruiters, cold calls and online forums to line up offers from any employer who takes care of Medicare Advantage patients to see what it is they have to offer.



In all, only 21% of the 100s of job offers I could find offered any form of risk sharing, and only 9% offered a total-risk package. Most of them were associated with confidentiality clauses, so I can't reveal their names here.



Interestingly, 100% had some form of metric-based risk built into their compensation. Seems like everyone is getting ready for MACRA.


Whether you're a recruiter, a clinician or an administrator---your tactic is to find the identity of these relatively few organizations who offer shared-risk as part of their clinician compensation system and follow them.


Because in the long game that is managed-care, they're going to be the winners.

You Should Know...

Stop-Loss Insurance Changes

Greater opportunity and greater risk coming are coming your way as CMS begins to implement the statues in the Twenty-First Century Cures Act passed a year ago.


Among the changes: increases in the allowable deductibles of the stop-loss insurance policies required for clinicians with 25% or more of their income at risk in shared or total-risk care contracts.


The increase in deductibles is designed to mitigate the cost of stop-loss insurance to the organizations who purchase them.


Sometimes that organization is the Medicare Advantage Organization itself, sometimes it's the clinician.


Either way, the higher deductible means the primary care provider will have more skin in the game.


The deductible for my policy on my total-risk contract was $10,000 plus 50% of any losses over that amount---pretty hefty.


It focused the mind wonderfully on efficient care delivery.


And if you pass the risk for the higher deductible on to your core innovators---your PCPs---you can expect greater innovation as well.


High-Value Insight

The Sick Patient Premium


The sicker the patient, the greater the opportunity.


As you work your Medicare Advantage contracts, remember this fact.


I know, it's the opposite of what you've learned while taking care of patients in a fee-for-service system.


In those systems, sick patients require lots of uncompensated time and "meet their metrics" with increasing difficulty.


But with Medicare Advantage, sick patients—-patients with many chronic illnesses—-are your chance for a big Medicare Advantage win.


Through capitation, you'll have the resources and compensation to actually address their health challenges in an effective way.


And as you succeed you'll generate outsized rewards, both financial and professional.


And you’ll also be well-positioned to provide those sick patients with great care.


So that's your high-value tactic for the week.


Don't shy away from the sick, embrace them, recruit them into your panel.


I know you're gun-shy about loading up your patient population with these challenging patients, but after a year or two of tremendous success, you'll have all your peers wondering what it is you're doing right.

Q&A with Dr. Tom

Now that open enrollment is over, my patients keep calling me about mistakes they made in choosing their Medicare Advantage plan.  What can I do?




It's all about helping.


When your patients are in distress and they haven't signed up directly with a reputable insurance agent, they'll have nowhere else to turn.


If you help them---serve as an ombudsman through your own personal collaborative network of Medicare Advantage insurance agents---you'll be the hero.


You'll avoid the care disruptions that can cost you metric points and cement their trust and loyalty to you forever.


And it's in that loyalty that true long value is generated.

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