Where you become an overachiever.
The “reality” of success in Medicare Advantage
Written by a non-MD consultant who’s never had to take financial risk in his life.
Population selection, data extraction, care limitation, case management.
No mention of financially partnering with the primes.
This works while the program is over-funded—indeed, it’s the model most Medicare Advantage Organizations use now.
Once the funding gets cut back to the equivalent of regular Medicare—this model will fail quickly and spectacularly.
Small and medium providers will quickly sell to the largest insurers—leaving providers with little choice but to accept a whole lot more financial risk in their care contracts.
If you do things right simply risk-share with your primes now, when the payment cuts come you’ll be anti-fragile and in a position of strength.
The President’s Medicare Advantage executive order
Everyone who’s paycheck depends on the program must read this document.
Watch this space and subscribe to my weekly newsletter for in-depth analysis.
If fully executed, this document will change the face of our world.
You better get a handle on all the new benefits your patients may be eligible for.
Providers are going to be paying for most of the cost.
Another MA plan sells out to United
A stealth market consolidation is well underway.
Look for Centene to be a big, big player in the next year.
Tomism
Treat your insurance partners as colleagues, but make sure they know you’re always checking the numbers.