Arbitrage
When the actuaries determine how much a given illness is going to affect capitation in a value-based shared-risk system like Medicare Advantage, they look at the corresponding fee-for-service data and see what the costs have actually been. That data is made up of care delivered by an aggregate of clinicians—i.e. the average. You are not […]
How are RAF Scores Calculated?
RAF Scores What You Need to Know The more accurately and completely you represent the disease burden of your patient in your documentation, the greater your monthly capitation and the lower the chance of clawbacks. The relative RAF adjustments for different disease burdens are not necessarily intuitive. An amputated pinky toe carries triple the capitation […]
Every Person Deserves Their Own Confidentialist
One clinician’s Cri de Cœur.
How Medicare Advantage Works
Our Federal government can’t pay for all the healthcare coverage it promised under the Medicare program–the liability is now in the trillions. It created the Medicare Advantage program to try to decrease the costs of those promises. Under Medicare Advantage, private insurance companies agree to be fully responsible for the healthcare costs of patients who […]
Bob Kocher was Wrong
Robert Kocher MD was the only physician on the President’s National Economic Council in 2009. He was one of the architects of health care reform—the ACA. He has publicly stated it was his intent for the law to force consolidation in healthcare delivery, believing it would enhance efficiencies and promote scaling of the most effective […]
One Simple Trick to Dramatically Improving Your Performance
Ask Jim Ming or Dee Forshee owners of Ming Senior Services to serve on your plan’s board of directors. For over two decades from their humble small town, they have created, executed and grown one of top Medicare Advantage insurance sales and service organizations in the nation. In the nation. How? Supporting their clients with […]
Abundance
You need a mindset of abundance The scarcity mindset sees limited resources from which an individual must get their share. Things are being done “to” them. They are not in control The abundance mindset sees only the opportunity for innovation generating infinite resources. It’s proactive, optimistic. To succeed in a value-based, risk-sharing environment, you as […]
The Specialist Advantage
Procedure-dependent specialist are sensing the instability of their referral streams as they see primary care services fragment. And I’ve yet to meet one specialist division that’s satisfied it can thrive on internal referrals alone. Fortunately, as a specialist at the top of your field, you have a secret weapon. Your own skill. If you’re […]
Grow Your Panel
3 Steps to Accelerate Your Panel Growth Far Ahead of the Curve For a primary care provider, the fee-for-service model requires an an enormous patient base to be sustainable—thousands in fact. And with the additional overhead of MACRA and MIPS, that base is going to need to be even larger. In contrast, well run Medicare […]
How To Succeed at Medicare Advantage
Primary Care Clinician Edition Engage your patients and take great care of them. Grow your panel. Capture your risk. Control your costs. Educate yourself on your contract’s cashflow and follow it. If your organization doesn’t offer some sort of risk share with their clinicians, don’t worry. After your current leadership gets fired for underperformance, your […]