Re: medicare Advantage plans

[Guest guest]

I generally get 5-15% above medicare for these plans

 

Medicare Advantage plans are paid a premium that exceeds medicare average costs--yet I am paid the Medicare fee schedule for all my services. Lot more hassle with MA plans due to PPO rules and prior auth and network restrictions.

Anyone receive a higher payment for MA patients?

Mike Jongerius

[Guest guest]

yesI have a small plan I work with  I told them I could not understand the contractIt  was a newfangled approach they were trying  to do  right ,but augh!they said we wish we had somethign simpleI said  you do?

they said yesI said I do and I proposed a dollar a day capitation  (thank you IMP cohort  1 and  Egly)I get it I get a check once a monthI have to still sned in HCFAs they need claims to keep track. but I do not wrangle over money

After one yr we are now setting up an   incentive  They are my only bright light They are a few places in New England-MArtins point Health CareThey in fact have two other plans they sell( they also staff and run  health centers) and they will steer MORE people my way  now

The necessary ingredients are:You need a plan you can talk toThere are fewYou need a rep AND to  talk to them you need  data  Why would they pay you more? Can you prove you keep people from being readmitted??

No data no leverageUse HowsYOur health MAybe they will believe it ( small chance) Join an IPA if you have one  Get plan dataI had data from medicaid in my state and  now  from the plan that  pays me capitation

After one yr I have access now to a site with MArtins point  that shows me risk adjusted data  /my panel /who has been in/ their  pcp costs/ overall costs etcNO data no leverage I think So it propagate s  itself- I had data so I got money so now they have a site where I get really nice data so I can get money...

 Let me not imply I make as much as many of you

IT is a small plan--

 A candle on t he other side of town when what I need is blazing light overhead.May need a smidge of magic powder.Jean

 

Medicare Advantage plans are paid a premium that exceeds medicare average costs--yet I am paid the Medicare fee schedule for all my services. Lot more hassle with MA plans due to PPO rules and prior auth and network restrictions.

Anyone receive a higher payment for MA patients?

Mike Jongerius

--      MD          ph    fax