Relentless Health Value

The biggest pay-for-value program in history is the Medicare Star ratings initiative. I heard on a Navigant podcast recently that for every star a Medicare plan gets, it earns 8% more revenue, between the financial rewards for improved performance and the increased enrollment. Then we have MIPS and APM. Today I speak with John Gorman, founder and executive chairman at Gorman Health Group (GHG). John has a reputation for telling it like it is. His expertise and candor is like a ray of sunshine into the shadowy interworking of health care business models.

Find out more information at gormanhealthgroup.com, or follow John Gorman on LinkedIn and Twitter.

John Gorman is founder and executive chairman at Gorman Health Group (GHG). In this role, he has led the development of the industry’s leading consulting practice and several entrepreneurial ventures in government health programs. John’s work focuses on Medicare, Medicaid, and Affordable Care Act strategy, governance, and turnaround of distressed health plans. Prior to founding the firm, John served as assistant to the director of Health Care Financing Administration’s Office of Managed Care where he provided day-to-day management and served as the external liaison for the Medicare and Medicaid managed care programs. During the 1993 debate on national health care reform, John was chief lobbyist on health care financing issues for the National Association of Community Health Centers, an organization of federally-funded primary care clinics for the medically underserved. John’s career in Washington began as press secretary and staff director for US Representative John Conyers, Jr (D-MI), then chairman of the Government Operations Committee.

01:22 The impact value-based payments have made.
01:50 The star-ratings program in Medicare Advantage.
04:00 How value-based payments has improved the quality of care.
09:23 How substandard care factors into star-ratings in Medicare Advantage.
10:40 Medicare Advantage as the most regulated program, but also the most enticing for insurance companies.
12:52 How Medicare Advantage plans are making more than commercial plans.
13:07 “There really was a tipping point a few years ago…”
13:54 What health care providers with a number of Medicare patients need to know.
15:54 “You ignore these trends and these demographics at your peril.”
17:42 Risk adjustment.
20:07 “The highest quality is provided by providers that share risk with their Medicare Advantage plans.”
21:08 Are fee-for-service plans able to achieve the quality that a Medicare Advantage plan is looking for?
22:41 “It’s only a matter of time for small practices, unless they band together…”
23:08 Proving high quality care vs the administrative burden.
24:44 MIPS vs APMs.
26:14 “APMs and bundles are going to be major drivers of payment in traditional fee-for-service in health care.”
27:00 Value-based payments – inexorable?
30:15 Find out more information at gormanhealthgroup.com, or follow John Gorman on LinkedIn and Twitter.