decisionhealth Newsletters, Part B News - 2017 Issue 10 (October)
5 ways to find if there’s a place for you in the Medicare Advantage boom
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Article Overview
This article examines the expanding Medicare Advantage market and what it may mean for physician practices considering participation or expansion. It is aimed at practice leaders, physicians, and administrators who want a broad overview of the operational, financial, and strategic factors associated with Medicare Advantage plans, including risk adjustment, administrative demands, patient mix, contracting considerations, and plan quality assessment.
Why This Topic Matters
Medicare Advantage enrollment growth can affect patient access, payer mix, and practice operations. Understanding the broad considerations around participation can help practices assess alignment with their clinical, financial, and administrative goals.
Article Sections
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Medicare Advantage growth and practice opportunity
Introduces recent Medicare Advantage enrollment trends and explains why some practices may be reconsidering participation. Covers the broad market context and potential impact on patient volume.
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New patient opportunities with MA
Discusses the types of opportunities Medicare Advantage plans may create for practices and patients. Focuses on general market and care delivery considerations.
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Risks with MA plans
Reviews broad operational and administrative concerns practices may encounter when working with Medicare Advantage plans. Includes topics such as coding-related demands, audits, and authorization processes.
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5 tips when engaging MA plans
Summarizes practical business and organizational factors practices may want to evaluate before participating in Medicare Advantage. Covers capacity, leadership, costs, negotiation, and plan quality at a high level.
What You Will Learn
- How Medicare Advantage growth may affect practice strategy
- What broad opportunities and challenges can come with Medicare Advantage participation
- Which operational and financial factors practices commonly evaluate before contracting
- Why plan quality and administrative requirements matter to physician organizations
Who Should Read This
- Physicians
- Practice administrators
- Revenue cycle and billing staff
- Physician group leaders
- Healthcare consultants
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