Designed to enlighten and amaze
Which of the following patients offers you the greatest potential financial return under a full-risk Medicare Advantage contract?
A. A 65 year-old male with COPD
B. A 70 year-old female with Diabetes and an amputated toe.
C. An 85 year-old male with hypertension
D. A 60 year-old woman on dialysis, a remote history of lymphoma, Congestive Heart Failure, and left-sided weakness from a stroke.
E. A 67 year-old female with no medical problems at all.
The shocking answer below
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
The answer is D. A 60 year-old woman on dialysis, a remote history of lymphoma, Congestive Heart Failure, and left-sided weakness from a stroke.
The sicker your patient, the more you get paid, the more you can earn by keeping her healthy. Cherry picking healthy patients onto your panel is a guarantee that you’ll financially underperform.
That’s the beauty of Medicare Advantage. Once you understand how it works, it incentivizes you to do the right thing—like taking on the sickest patients, the ones that need your skills the most.
And everyone will win.