From Dr. Tom's Desk

 
For organizations that actually risk-share, who actually train and mentor their clinicians, asking their PCPs to care for too many patients is the greatest barrier to success.
 
When considering cost control, nothing beats the influence a personal relationship between patient and doctor can generate.  But even with the leverage that technology tools provide, it’s impossible for a PCP to have an effective relationship with thousands of patients.
 
A ninja PCP, an elite top performer (a.k.a. one who has been mentored by me) can care for as many as 1000 patients. 
 
But a PCP who’s poorly trained or inexperienced can often only manage a panel of 100 and grow from there---that is, if they don’t get discouraged and quit first.
 
As organizations expand into the risk-sharing space, it’s not uncommon to see them suddenly dump panels of hundreds or thousands of patients onto primes to manage---and to do so with little preparation.
 
The first thing I tell them is to start slow. I advise them to segregate out 100 or so MA patients for each of their PCPs and share risk only on that subset of patients. Then, as their expertise grows, increase the number of their risk sharing patients.  Even if the PCP has a thousand patients assigned to them through the insurer, I advise the organization to take the financial responsibility on for most of them themselves and start the PCP off with a more manageable number.
 
It’s a great way to ramp up---and create a stable of ninjas of your very own.

You Should Know


As open enrollment heats up, a nice study has been published that can inform your long-term strategy.
 
The more MA plans in a given market, the more generous the benefits those plans offer and the lower the local beneficiary dis-enrollment rates.
 
Intuitive but nice to have it confirmed.
 
Your response?
 
Take your performance numbers to those insurers with whom you have commercial relationships but who have not yet offered their MA products in your community---or who do have MA products but only offer a limited number of plans.
 
Show them what you can do for them if they invest in your market. Not only will your patients have more choices, but the performance of your plans overall will dramatically improve---enrollment, retention, patient satisfaction.
 
Provider network creation and management is greatest barrier to market entry that insurers have to overcome. Show them they’ll have a partner with a track record of success and they’ll be interested.
 
That’s what we did in our incredibly successful practice. We convinced our insurance partner to expand into an adjacent market using only our current performance as a guide. As a result, more patients received great care and both of us were even more successful.
 
Your only cost is the time spent encouraging your insurance partners to jump in and swim---a couple of meetings and an e-mail or two.
 
And with this research, you now know that the return on that investment will be amazing.
The best combination of metrics to give your PCP the best performance.

Tip From Tom


Appeals for care denials by Medicare Advantage Organizations are usually not that time consuming for staff, are successful on the first try more than 75% of the time, and rarely involve the PCP personally.
 
From a patient’s viewpoint, going the extra mile for them is priceless.
 
And since your ability to control their care costs rests on the quality of your relationship with them---going the extra mile is priceless for you, too.
Can telemedicine fill the gap when Samantha loses her doctor?  She learns more than she bargains for trying to keep her family safe. Share her journey.

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