From Tom's Desk

Stop Pestering Your Primes

If you're a horse-person you know that you have to be consistent in how you cue your horse.

In the hands of a confident rider, a horse is a wonder to behold.

Give signals inconsistent with your goals and your horse quickly becomes nervous and skittish---and much less efficient to ride.

Below I refer to a recent study which suggests that about half of beneficiaries admit they don’t usually comply with the recommendations and incentives of their Medicare Advantage plan.

To someone not in the exam room, it sounds counter-intuitive, but it's an idea increasingly supported by the literature.

Even though an MA plan offers incentives for exercising, weight loss, blood pressure, and blood sugar control, most patients seldom respond with positive change.

Yet, health systems spend vast amounts of time and effort hectoring their primes on the performance of their patients in achieving healthy habits---even as we know that there is little a prime or a plan can do to create positive change.

Well, there is one thing.  Risk-share with your primes. That lays the foundation for the close, therapeutic relationship through which positive change can occur. 

But most systems don't want to do this. They want their primes to see as many patients as they can so they can submit as many risk codes as possible.

These same systems also hector their primes over healthy living metrics that the research increasingly shows the docs have little impact at all.

These systems are giving their horses mixed cues.

So stop the hectoring. Align incentives based on your goals. Revenue generation. Patient numbers. Coding expertise.

All can be done in a very STARK compliant manner and will result in improved performance for your plans.

Be consistent and the productivity of your primes will be a wonder to behold.


You Should Know...

Incentives Don't Matter to Patients

There have been a few studies in the media recently suggesting that plan incentives for patients to adopt healthy living habits have little effect.

Here's the latest.

For those up us who spend time in the exam room, these results are no surprise.

15 minutes of dietary counseling with the patient can do little against the avalanche of food advertising they see every day.  

There’s no sub-group analysis which compares those beneficiaries cared for under a shared-risk model and those in which the primes take no financial risk at all---I would hypothesize the shared-risk docs make more of an impact.

 I'm told those sub-group studies are on-going and you'll see the results here when they're reported.

In the meantime, take these results to heart and don't judge your system's success based on healthy lifestyle adoption,  focus instead on what's under your control---access, good care, compassion.

Mastering those is hard enough.

Don't beat your head against a door that won't open.


Tips From Tom

Risk-coding is too important to leave to the prompts in your EHR. 
Have a peer work closely with your clinician for a “masters experience” in risk coding. Pay them a stipend to undergo the training. Test them for true mastery. Award them a “Masters” rating. Bonus their compensation based on this recognition of their expertise---it’s all perfectly STARK legal.
If you’re not going to risk-share, at least get creative about aligning incentives.
Fee-for-service tactics won’t be effective in a data-based world.

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