As we move forward with Part 6 of our blog series, Healthcare 2030, we\nhope that we\u2019ve been able to detail why we advocate healthcare as a dominant\nbusiness segment of the United States. It\nis about to get crazier as we are just passing the midpoint of the Baby Boomer\ngeneration entering the Medicare program and their high healthcare cost\nconsumption years.<\/p>\n\n\n\n
Medicare has seen this unavoidable wave for decades. It has tried to push and incentivize Medicare\nbeneficiaries into more predictable managed care or Medicare Advantage (MA)\nprograms, also called Medicare Part C (more on MA in our next blog). <\/p>\n\n\n\n
During the last eight years, since the formation of the Affordable Care\nAct (ACA) also called Obamacare, Medicare has experimented with Affordable Care\nOrganizations (ACOs). Most ACOs have not\nbeen successful and there are many reasons why.<\/p>\n\n\n\n
Based on what we know, Medicare Fee-For-Service (FFS) structure is\nunsustainable and will most likely end by 2030 or soon thereafter. <\/p>\n\n\n\n
In an FFS Medicare structure, Medicare pays out more the sicker a patient\nis, without any limitation or maximum dollar amount. Medicare has little control and even less\npredictability or ability to manage the patient care. <\/p>\n\n\n\n
What most people do not understand is that Medicare or the Medicaid\nprogram for that matter, does not offer direct care, nor do they operate\nmedical offices or hospitals. Everything is effectively provided by for-profit\nor non-profit independent providers. <\/p>\n\n\n\n
Recently, Medicare has asked providers to submit applications for a new\nprogram called Primary Care First, as an alternative payment model. The idea is to allow providers, primary care\nphysicians, or groups to take on financial risks and effectively manage more\npredictable costs to Medicare. Medicare\nfor All will offer less oversight and reporting, plus offer potentially higher\nfinancial rewards for providers accepting partial or full financial risks for\ntheir patients. Furthermore, Medicare will pay doctors or providers a fixed fee\nper month called capitation.<\/p>\n\n\n\n
As of today, Medicare, beyond Medicare Advantage, is operated by\ninsurance companies and the ACOs we mentioned above operate Shared Savings\nPrograms (SSPs). Today, neither program\n(excluding MA) has proven consistently profitable, scalable, or predictable.<\/p>\n\n\n\n
We commend Medicare\u2019s innovative approach as it explores a path to a more\npredictable healthcare cost; however, we are doubtful that this new Primary\nCare First program will work. Our assessment\ncomes from nearly 30 years of experience working with providers. The providers just do not have the financial\nbacking and experience to qualify, nor do they manage the risk for what\nMedicare wants. Furthermore, they do not\nhave the resources to invest in technology, systems and training to handle the\nresponsibility. Technologies like\ntelemedicine, IoT and integrated or universal EHRs are required for this type\nof program to work \u2013 particularly if we want them to be profitable, scalable\nand predictable. <\/p>\n","protected":false},"excerpt":{"rendered":"
As we move forward with Part 6 of our blog series, Healthcare 2030, we hope that we\u2019ve been able to detail why we advocate healthcare as a dominant business segment of the United States. It is about to get crazier as we are just passing the midpoint of the Baby Boomer generation entering the Medicare program and their high healthcare cost consumption years. Medicare has seen this unavoidable wave for decades. It has tried to push and incentivize Medicare beneficiaries into more predictable managed care or Medicare Advantage (MA) programs, […]<\/p>\n","protected":false},"author":6,"featured_media":4089,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4088","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/pwer.com\/wp-content\/uploads\/2019\/12\/AdobeStock_91136467-scaled.jpeg","_links":{"self":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4088","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4088"}],"version-history":[{"count":1,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4088\/revisions"}],"predecessor-version":[{"id":4090,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4088\/revisions\/4090"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/media\/4089"}],"wp:attachment":[{"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4088"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4088"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4088"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}