Make a “get to know you” visit.
Ask them how they are paid.
Ask them how well they understand the system under which they are paid.
The answers will tell you a lot.
Medicare Advantage is designed is a special way.
You and your clinicians have your interests aligned.
Like the pilot and a passenger both on an airplane, you both have skin in the game.
Under Medicare Advantage, you select a primary care provider (PCP) who coordinates all your care.
By PCP I mean a clinician like a doctor or a nurse practitioner.
All your healthcare will be coordinated through them.
She will be your personal medical advisor.
Your clinician might work in a practice she owns or work as an employee in a “system”.
Different systems pay their clinicians in different ways.
In a good system, your clinician has skin in the game just like Medicare Advantage was designed; she shares in the savings based on what is spent on your healthcare. She can make enough money that she can be responsible for a smaller number of patients and can take the time to work in your mutual interests.
In a bad system, the PCP is actually a figurehead.
She’ll get paid based on how many patients she sees and what she does with them.
To make the same money, she’ll have to see waaaaay more patients—and spend fewer time with each.
It’s designed that way.
These systems use their computers and non-clinician employees as a substitute PCP.
You still have to pick a PCP but it’s the system that’s actually responsible for your care.
You may want to avoid this set up.
At the very least it will cost you more out of pocket.
And as the specialty referrals pile up–a lot more.
Responsibility is spread out. Care is fragmented, duplicated and inefficient. The electronic health record, with all its inaccuracies, is your surrogate provider. In the hospital, you’ll never see the same doctor twice—the primary doc you choose might not even be allowed to see you there. And the ER becomes another substitute for access—even though at the same time you’re discouraged from using it.
Your PCP will be overworked and responsible for too many patients—too many to give you the time and energy you deserve.
Like Lucy in the chocolate factory.
Except it’s not funny.
And it’s your life.
You can spot these systems pretty easily.
They are rife with “Managed Care Champions” and speciality clinics for every individual ailment. A little focused care management after an illness is very important, but it should never replace your PCP.
You’ll notice that everyone on the front lines, from the office staff to the PCPs themselves, are hurried, disengaged, discouraged and not willing to really put themselves out for you.
PCPs will have a panel with way more patients than they can safely handle—waaaay more.
And it’s impossible to speak to your PCP after hours.
Im-poss-i-ble
The best way to tell though, is to simply ask your insurance agent.
Tell him what you’re looking for in a prime—they should be able to steer you the right general direction.
Once you’re in the office for a first visit, ask your prospective prime these questions:
“Do you financially participate in the cost of my care?”
“How does that work?”
The clinician should be willing and able to freely share this information with you.
If the answer to the first is “no” or the second is “I don’t know”, then either find a new PCP or dis-enroll from the Medicare Advantage program altogether.
If you don’t, you probably won’t like what you get.
Without your own personal clinician, swimming in such a system may even be dangerous.
Find a clinician you can trust, one with skin in the game, who’ll have the time and the inclination to sweat bullets for you. Who’ll collaborate with you in this one-size-fits-all-world to determine what’s the best care specifically for you. And then get it for you as efficiently as possible.
To get that trusted clinician in healthcare today, you’re either gonna have to pay for it yourself or through a shared financial risk system such as Medicare Advantage.
I get enormous pushback whenever I present this—but it’s usually from parties whose livelihood depends on the status quo.
There’s a lot of money at stake in keeping things the same.
If you aren’t comfortable with your clinician being paid out of the money she doesn’t spend on your care, I understand.
But unless you’re willing to pay for your own personal clinician out of your own pocket, understand that is only other choice is being a piece of chocolate–and your PCP will be Lucy.
I hope your don’t get spit out.