Did you know that 31% of all patients enrolled in Medicare are in a Medicare Advantage Plan!!! Enrollment to Medicare Advantage (aka Medicare HMO) has been growing steadily over the past decade. With such a large growing population of insured patients, you would expect physicians and other providers to understand these plans well.
Unfortunately, medical schools, residency training programs, and many fellowship programs have failed to educate new physicians on this important insurance segment. Physicians often graduate looking like deer with headlights beaming at them when they enter the real world of practicing medicine and understanding insurance.
So, in this video, I am going to give you 5 facts about Medicare Advantage (MA) plans that you must know and how you can improve the quality of your life and your medical practice. With these facts, you will be able to grow your panel, have better relationships with the health plans, increase patient satisfaction, improve your revenue stream and understand how to provide even better patient care.
#1 MA Plans allows you to earn more while seeing fewer patients
Most physicians do not enjoy being rushed when caring for complex patients. A large panel of patients makes it difficult to spend the right amount of time per patient.
A panel of 400 patients can easily earn you a gross yearly income of $720,000 or more as a primary care provider… How is this possible? Physicians can contract with independent practice associations and receive a monthly capitation fee of $50 per member per month for the care of a patient population. If the provider coordinates care well, see their patients regularly, and promotes primary prevention of many chronic diseases additional bonuses can be made of $80-$150 per member per month.
#2 MA Plans want the primary care provider to succeed
Physicians enter medicine to care for patients while earning a great living. This road can be difficult if health plans fail to collaborate with provider groups. If a group of providers effectively treat patients and save money then health plans make money. Health plans recognize good providers by sending more patients to them. This is a win-win scenario and a potential jackpot for a medical practice. If providers are not cost effective, health plans can decide to not renew provider contracts or cancel contracts altogether.
#3 MA Plans can encourage office visits with incentives
Patients often avoid going to the doctor for various reasons. This can be a problem for patients who have chronic diseases that can only be discovered if their provider sees them. Patients who visit their providers often do better than those that do not. MA plans often encourage members to visit their provider by offering incentives like gift cards and reminder phone calls.
#4 MA Plans can be lucrative for specialty providers
If a specialist is looking to grow their panel, then joining multiple plans can increase the burden of their staff when obtaining authorizations and pre-certifications for procedures.
Focusing your efforts on one or two MA plans can allow you to learn how to be the most efficient provider in that plan. Cost effective specialist who has high satisfaction rating can be granted exclusive contracts for services by health plans. This could help providers guarantee their income and put more money on their plates and help make your patient funnel more consistent.
#5 MA Plans give you more insight on your practice
Understanding your patient population through the use of reports and technology can be very difficult when dealing with the government. Currently, individual Medicare providers cannot log into any system to see how their management is cost-effective. Understanding the financial impact of certain procedures and facility costs are key to cost-effective care.
MA plans make claims data readily available to all providers. This transparency helps promote best practices for better patient care.
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