From Dr. Tom's Desk

Medicare Advantage is all about leveraging your strong relationship with your patients to reduce their care costs.
Yet electronic health records (EHRs), with all their statutory bells and whistles are not very effective relationship managers.  You have to wade through a whole lot of extraneous data to extract what you need to know.
That’s not surprising.  EHRs are more about data collection and billing submission rather than managing a prime’s relationship with a patient.
As a prime, don’t use your EHR to manage your relationship with your patients.  Use a CRM. A customer relationship manager.  Use
There are two types of people in the world.  The supermajority who look at the sentences above and say “what?” And the small minority of early adopters who say “wow!”
I’ve been beginning my deep dive into for my own business and every step of the way all I’ve been able to say to myself is that I wish I had this ten years ago when I was working my contract.
Those who use it know it has every tool imaginable for managing your relationship with your customer and tracking where they are on the journey you want them to go.
It’s exactly what you need to leverage your Medicare Advantage contract.
I know what you’re thinking. I understand HIPPA and that salesforce isn’t HIPPA compliant.  But that’s a barrier, not a counter-argument.
As I continue my deep dive into salesforce, I’m creating sample templates that a prime would use.  I hope somebody reading this beats me to it.

You Should Know

The press was abuzz with the most recent Medicare Trustee report announcing that annual tax revenue will fall short of covering the programs costs in 2026.  After much searching I found an excellent, hype-free summary here.
For all the talk of fiscal Armageddon and political posturing, the take home lesson is this:
Your Medicare Advantage revenue is in the cross-hairs.
Medicare’s funding problems can be taken care of with a combination of tax increases, fee-for-service payment cuts and means testing for beneficiaries---but ONLY if the issue of Medicare Advantage overpayments is addressed.
Every analysis pin points such overpayments as a key driver the funding deficit.
It is foolish to believe the politically difficult funding choices will be made without these overpayments being cut first.
What does that mean for you?
Look after your care delivery systems.  Make them as efficient as possible.
But how?
Large insurers have tried for fifty years to control costs from 30,000 feet.  Prior authorizations, pre-certs, step edits.
All have been tried, and all have failed---miserably.
What can you do differently?  Well you have a power that they do not.
Your primes---and their relationships with their patients.
Empower them. Give them skin in the game.  Unleash their talent.
Let them leverage that clinical relationship to guide their patients and curate their care.
Costs will drop like a rock.
Educate them in how the system works.  Don’t overload them with thousands of patients.
Make it your business to relieve them of any non-clinical responsibility you can.
Let them run.
When Medicare Advantage overpayments are slashed, many organizations who are after a quick buck will quickly fold.
You will not.
You will prosper.

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