Be the smartest one in the room.
ACOs are very unhappy about being forced to take risk
Two reasons why this is so:
They foresee the loss of all their investment as the government “encourages” patients into Medicare Advantage.
They understand that when it comes to risk an ACO is the wrong tool for the job—you might as well try to drive a nail with a ham sandwich. The failure of trying either will be epic.
MAOs and Providers Enter into new Medicare Advantage Partnerships
These are all tactics to gain market share through expanding benefits or services. They are difficult to sustain. The patient who signs up for extras, will disenroll when said extras go away. Live by the goodie, die by the goodie.
Good care and a connection with your doctor though, that’s forever.
Show me a partnership that gives their primes skin in the game, teaches them the rules and mentors them through a revenue cycle and I’ll show you the horse to bet on.
Kiplinger’s on a mission to get your patient the best goodies. Give them the best care instead.
United going into Medi-Cal in search of dual-eligibles
This is for 2021.
UHC wouldn’t do this without extreme visibility. Resource shifts from aged in patients to dual-eligibles are here for a while—and possibly will get greater.
Oscar jumping into Medicare Advantage with the help of an investment from Google
Oscar thus far has not made the expected splash in its efforts to change healthcare. Perhaps with Google, this time it will be different. It’s tough, though to overcome the incumbent’s advantage. If only someone could show them one quick trick.
Health Affairs Blog tackles health care reform
An excellent, comprehensive review, if biased to the point that it papers over some pretty concerning counter-arguements.
I don’t have a dog in this fight but any system which tolerates a fraudulent overpayment rate of more than 20% is clearly not sustainable. I’ll need to see real compliance enforcement before I get excited.
And when it comes to coding compliance under Medicare Advantage—there is none.
The HIll wants to level the playing field between Medicare and Medicare Advantage.
(http://thehill.com/opinion/healthcare/399509-medicares-anniversary-is-the-right-time-to-demand-a-level-playing-field)
So many still don’t understand, CMS doesn’t want the financial risk of caring for chronically ill patients—it wants to offload them to private insurers, over-pay them to take the load and then slowly cut payments and increase benefits until the insurers cry “uncle.”
Can the insurers capture CMS rapidly enough to stop the payment cuts? Will CMS, in the end have the guts to actually cut the payments? Will the Medicare trust fund finally break under these new demands?
Stay tuned.
Tomism
“You don’t have to master all the risk codes to be successful at Medicare Advantage, just know the handful of ones you and no one else can identify—and be done with it.”