| The timeline issue
To promote competition in the marketplace, consumers are offered the chance to change Medicare Advantage programs each year. But short-term commitments from customers make it much harder for medical providers to plan to serve them – annual churn rates have increased to 20 percent or more per year, with half of all customers changing plans at least once every five years. High customer turnover increases pressure on medical providers to focus on short-term financial gains. One result is that news coverage of Medicare Advantage lately has been full of stories about billing abuses and aggressive upcoding to inflate reimbursements. Despite these systemic failures, the core philosophy of Medicare Advantage is worth saving. The problem isn’t the intent – it’s the timeline. A five-year contract
In the current landscape, insurance companies and providers are trapped in a revolving door. Because seniors can change their plans every year during open enrollment, the entire system is incentivized toward short-term thinking. A five-year contract would change the math of the doctor-consumer relationship. It takes at least a year just to build trust with a frail senior and understand what actually happened in their last decade in the acute care system. It takes time to de-prescribe unnecessary medications, clean up fragmented care plans, and determine a patient’s actual life goals. By locking in a five-year commitment, providers would have a runway to spend money upfront on proactive care. In a five-year model, an insurer or a provider group can afford to spend more in years one and two to stabilize a senior’s social and medical environment, knowing they will produce a healthier, lower-cost senior in years four and five. Currently, if a provider does that heavy lifting in year one, a competitor can move in and take the savings in year two. That is a recipe for rewarding poor performance and punishing innovation. True choice for seniors
It’s true that some unscrupulous providers could view a five-year commitment as a license to take for granted their locked-in customers. That’s why it makes sense to grant early opt-outs to consumers who experience truly bad service. The overall point, though, is to build an expectation for both providers and consumers to invest in a trusting relationship. Less money and time spent on annual marketing to retain existing customers means more resources can be devoted to actual medical care. True choice for a senior isn’t the ability to swap insurance cards every December. It’s the choice to have a consistent team that knows them as a person, not as a collection of ailments. — By MedCity Influencer Joel Theisen |
No comments