From Dr. Tom's Desk

 

Here are the results of a recent survey of healthcare executives courtesy of the unequaled Becker’s Hospital Review:
 
“For the survey, researchers polled 90 executives from major health systems. Of those 90 respondents, 27 percent plan to launch a Medicare Advantage plan in the next four years. However, only 29 percent of respondents with those plans are optimistic their organizations will be successful with the efforts.”
 
If you know one of these pessimistic executives and feel like giving them $100m in free revenue, share this next part with them.

  • Risk-share with your primes
  • Educate them in how the contract works
  • Create an environment wherein they can innovate how they can deliver efficient care.

There are vendors that will charge huge sums to help them set up a Medicare Advantage plan, but they’ll never give you any advice as valuable as that.
 
Share it and look wise.
 
Bonus Preening
 
I wrote in this space one month ago about the incredible opportunity the new Veterans Healthcare Freedom Act will offer to your Medicare Advantage performance.  It looks like CarePlan Health in Florida took my advice.
 
Similarly, my prediction about private equity homecare companies coming for your Medicare Advantage revenue, is also manifesting, though much faster than I thought.
 
Being a national thought leader is tough---especially one that can so accurately predict the future.  but so far, I’m doing an amazing job.
 
Thanks for coming along on the ride.

You Should Know


The leaders of the medical profession are clueless about how to succeed at Medicare Advantage.
 
I’m constantly amazed at how high-level folks from our “top” medical schools are appointed to the boards of new Medicare Advantage organizations, yet those organizations have absolutely no idea how to do well with the program.
 
The latest evidence?
 
An article from the New England Journal of Medicine voicing concerns that the new home care benefits created under the CHRONIC Disease Act will dissuade Medicare Advantage Organizations from enrolling seriously ill patients.
 
The authors manage to get it exactly wrong.
 
The ill patients are where the opportunities are. They can generate more revenue due to disease-weighted capitation adjustment. Equally important, these are the folks in whom care delivery improvements will result in greater savings---and greater gross revenue.
 
Sure, these new benefits will eat into your profit.  MAOs will almost certainly offset that with aggressive contract negotiation with some high level kickbacks to boot.
 
But dissuading MAOs to enroll in sick patients?
 
Only someone who doesn’t understand how to succeed with these payment systems would say something like that.
 
I know, I know---the authors can’t possibly be that misguided.  The article is probably a backdoor way to get traditional Medicare to offer the same services.  But if that’s the case, just say so, no need to bring Medicare Advantage into it.
 
If high-powered MAOs want stand-out performance, especially considering the edge large incumbents carry, they better start recruiting people to their boards who actually know how to win under these contracts.
 
They better recruit me.

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