Sunday Links

Keeping You Ahead of the Curve



Thinking of Starting a Medicare Advantage Plan in 2021? Start Now.

I’ve been telling our faithful community that we’ve reached “peak” Medicare Advantage.

A month ago in my newsletter, readers will remember about not one but two clients who pulled out of the business of Medicare Advantage plan consulting due to a saturated market.

Now a high-quality outfit like Lumeris has to advertise for new business—telling.




A whitepaper covering multi-year Medicare Advantage contracts between the government and MAOs

This is interesting. The first time I’ve seen this issue seriously looked at.

Could this be:

Battlefield preparation in an effort to reduce costs for MAOs (multi-year contracting would be much cheaper than the yearly contracts done now. It certainly could play a role in a competitive bidding system, plus, the proposal itself may be yet another sign of a market on the precipice of consolidation).


A marketing ploy by the consultancy,



I’ll keep you informed.





Insurers REALLLLLLLYYYYYY don’t want to transition to encounter data.

The pushback is much stronger than I expected. Makes me think that CMS is up to something—and the fraud problem (which will be more expensive to pull off using encounter data) is even bigger than I think it is.

That would mean it’s pretty damn big.





Humana is initiating its own bundled payment program to ortho and neurosurgery cases

CMS discontinued Medicare’s own bundled payment program—mainly because it would have pushed providers into penury.

I’ll be interested to see what the pushback for this initiative will be.




The Pennsylvania State Hospital Association pushes back at having its members forced into Medicare Advantage plans.

The issues are local, but they’re sure to nationalize as the number of MAOs consolidate.

Present for your early reference. It may be an excellent template for what will happen to you.




The more you force your primes to practice a mix of value-based care and fee-for-service, the worse your overall performance will be.

And the more dissatisfied your patients will be as well.