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From Dr. Tom's Desk

Recruiting patients from underserved areas is a key strategy for your Medicare Advantage success.
The baseline capitation rates for Medicare Advantage beneficiaries can be as much as 20-30% higher in underserved counties compared to their better served counterparts.
Many of them are not covered by a Medicare Advantage plan.  They simply don’t have the local healthcare infrastructure.
But CMS is highly motivated to broaden the geographic reach of Medicare Advantage throughout the country, so waivers can be had.
That’s what we did when we wanted to extend our practice into another county. We provided our insurance partner with the demographics of our patient population and asked them to expand.  We set up a remote clinic, partnered with a physical therapy provider and created the required infrastructure to qualify under CMS’ rules.
We picked up 200 hundred patients our first day.
Eventually we picked up thousands.
Despite experiences like this, many organizations do little outreach into these areas, despite the economic incentives.
So, check the county rates for your catchment area.

If you have primes who are dissatisfied with the composition of their patient panels, they’re the first ones to reach out to.
If the counties in question aren’t served by a Medicare Advantage plan, let your insurance partners know of your interest in providing some clinician access in those areas. Usually an intermittently staffed remote site will do.
Sometimes that’s all it will take for them to apply to CMS to extend their service areas.
And since most of these high capitation areas are underserved, you’ll spend very little on marketing.

A little effort can lead to a big payoff---for health systems, clinicians and patients alike.

You Should Know

Telemedicine is going to be expanded big time in 2019.
The Federal Government has approved expansion of telemedicine services that can be offered through Medicare Advantage plans.
And they’re doing so at rates that rival the compensation you’re paying them -- that is, if you’re not risk sharing.
The role and benefits that telemedicine will provide to Medicare Advantage are still up in the air.  There’s plenty of data floating around demonstrating that it decreases care costs.
Be skeptical.
Nobody ever decreased healthcare spending by increasing access.  Medicine generates its own demand.  Under a total-risk plan, telemedicine may just make it easier for your patients to spend your money.
Your tactics?
If your providers are not restricted from outside work under their current employment contract, consider doing so now.  If you don’t lose them to telemedicine, you’ll at least lose part of their attention and engagement as they take calls between patients.
And when these new telemedicine services come out at the end of the year, hold off promoting them to your patients.  Wait and see if costs actually do decline as these services are generalized across the country.
Besides, if your primes are risk-sharing, they’re going to prefer that they themselves get first dibs on managing their patients after hours.

Tip from Dr. Tom

When your patient comes in for their annual assessment, take some time to ask them about their understanding about how their Medicare Advantage insurance works.  Chances are they don’t know.  And in explaining it to them, you’ll increase your bond of trust with them.  It’s in leveraging that trusting relationship that you’ll be able to optimize their healthcare delivery and keep costs down for everyone.
Copyright © 2018 Tom Davis Consulting, All rights reserved.

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