Medicare Advantage Partnerships: Two Consultants’ Advice for PCPs

Medicare is confusing for patients and providers alike. Unfortunately, while there is an abundance of resources to assist Medicare beneficiaries in selecting their Medicare Advantage plans, there is significantly less information available to independent physicians who are interested in expanding their Medicare capabilities. If ever there were a time to make the leap, it is now. Medicare Advantage premiums are at a three-year low. In 2019, there will be 600 more Medicare Advantage plans available. Enrollment is projected to hit an all-time high of 22.6 million, 11.5 percent more than 2018.
Beyond the numbers, aligning with Medicare initiatives is a way of preparing and future-proofing your practice for healthcare’s shifts. Revised Medicare Advantage plans embrace forward-thinking population health initiatives such as paying for transportation, at-home aides, or grab bars, simple solutions that can keep beneficiaries out of the emergency department while also advancing toward value-based care.
Having invested time, energy, and care into building relationships with patients, you wouldn’t want to lose them simply because your practice cannot accommodate their Medicare Advantage plan. As Medicare Advantage’s financial risk shifts increasingly to providers, establishing the right partnership can help your independent practice navigate these changes while remaining competitive.
So what are you waiting for?

What value can a high-quality Medicare Advantage partnership add to your practice?

Amy Atkins, MBA – Medicare Advantage Consultant: “Education and support. When partnering with an MA program, many provide insights into the best practices for managing your panel. There are often centralized programs, such as year-round initiatives for education or assistance in completing screenings just to name a couple, that small offices can leverage to reduce the stress on their clinical staff.”
Kathleen Doerr – Medicare Advantage Clinical Associate: “Aside from the obvious financial benefits, the biggest perk is the one-on-one consulting. As a Medicare Advantage Clinical Associate (MACA), I dedicate time every week to each office in order to work with the staff members and physicians on developing workflow habits that meet their goals. For example, we will bring a medical adherence report and work with the Medicare advisor on dialogue tips to better communicate with a pharmacy technician to determine what obstacles may be preventing a patient from picking up their medication. This kind of personal touch brings the smaller offices up to a more efficient and profitable level.”

What are the most common problems independent practices have with MA programs?

AA: “The most difficult step for independent practices is figuring out how to do it all. MA programs provide education and resources to the practice to help them streamline processes and create efficient workflows. Often the programs are able to provide data on the members, but providers can get buried in the paperwork. We try to provide our offices with streamlined data so that it is usable and they don’t get burnt out trying to make sense of it. Our mission is to set the offices up with the action items they need to reach their goals.”  
KD: “I believe one of the biggest challenges for the smaller offices is not seeing the bigger picture, or not understanding the benefits to the patients that result from the extra work is required of the staff. Let’s face it: It does take a team to run every aspect of an MA program. Really investing time and energy into the staff and physicians with education and lots of encouragement are key. The reports that we bring to them weekly are strategically calculated to move the measures and guide the staff in changing some of the workflow areas that need some help. Another common problem is the concept of retraining the patients for the additional preventive care that is needed. For MACAs, one challenge is reshaping the views of the staff and physicians to educate the patients that these additional tests are necessary, not because the insurance requires it, but rather that it is what’s best for the patient. This takes time and lots of patience with the staff.”

What can PCPs do to prevent those problems?

AA: “The best thing a provider can do is get involved. They can attend available training, go to physician meetings, and meet with their program representatives. Make sure that the provider — as well as the staff — knows the ‘why’ behind the program. MA programs are designed to provide additional preventive care and services for the patients. They aim to keep seniors healthier and extend their lives. The ultimate goal is to provide great care to their patients, and that’s a noble cause that gets right down to the core of medicine.”
KD: “Educate, educate, encourage, and educate again! I tell the physicians that the secret to his or her practice’s success starts with them. If they are talking to the patients in the exam room about getting a mammogram, the patient will be much more apt to follow the directive of the Medicare advisor to get it accomplished than if the MA alone is encouraging them to get the mammogram. Supporting the staff also greatly reduces many of the common problems that arise. As providers learn more about the MA program, they should be talking to their staff about the new changes. It is crucial that the providers attend PCP divisional or associate meetings in order to stay up with the fast-paced, ever-changing medical world.”

Key Takeaways

• Smaller practices can lighten the load on their clinical staff through centralized programs
• Retraining and revising workflows are often easier for independent practices because of their size and autonomy
• Streamlining data is one effective way to avoid burnout and remain in the MA program long enough to see returns

Want to learn more about how Medicare Advantage for independent practices? Click here to read a piece by James Harvey, MD!