@@ahealthcarez Thank you for answering so quickly. Do you see a way to create an advanced specialty super group similar to these advanced primary care groups like ChenMed?
Sounds like if one is to work on a digital health telehealth primary care start-up, one strategy is to offer enterprise solutions for employers with an older workforce, like transport/ manufacturing rather than tech?
Is it possible that Amazon may focus on consumer vs enterprise and do so through Prime? I don’t see MA fitting well with the rest of their business - it’s simply not synergistic with the rest of AMZN in any way
Great question. Consumer healthcare is typically urgent care, plastic surgery, LASIK eye surgery. Generally primary care does not lend itself to direct to consumer.
If revenue is 12x for the MA population, wouldn't their expenses also be 8-9-10x of their commercial/concierge business due to taking on full risk? I think what needs to be assessed is the earnings per member
Here’s my question. I thought that Medicare advantage was potentially so lucrative due to their risk adjustment programs coupled with their more….Experieced… subscribers. But they don’t capture that any risk adjustment data for telehealth appointments, right? So how exactly does Medicare Advantage end up being an advantage for digital healthcare? As always, thank you for being a reliable source of insight and information.
Risk adjustment can be captured during office visits and home visits and the telemedicine visits can help manage chronic illnesses and keep members out of the hospital… in coordination with the in person visits. Appreciate you watching
Risk Adjustment codes can currently be captured in both telehealth and face-to-face visits. The key for the success of both remains adhering to compliant documentation standards in EMR, approved provider types for code attestation and submission, and, most importantly, care coordination by a multidisciplinary team to keep utilization & costs at the appropriate level for the patients' needs. Telehealth doesn't always allow for full visibility of nuance fluctuations in patient's health status which is where remote monitoring will increasingly come in to play.
This was so great and mirrors what we've seen in previous work on advanced primary care and employers (e.g. Boeing partnering with Iora but only allowing employees/dependents 40+ years old to sign up.) The video is focused on the advanced primary care provider perspective, but I'm curious what the talk would look like from an employer point of view. If these companies pivot to where the high cost patients are, where does this leave employers who want to help their employees get access to high quality primary care.
Great question… contract with an on-site/near site clinic company. Many starting to offer Virtual primary Care as well. ProactiveMD is a good one. I have no financial connection to them. Thank you for watching!
That is so dangerous.....
Thank you for watching and for your comment.
Hi Bricker: A Great video. Could you do an update on Amazon Health?
You explained this so well. I didn't even have to listen twice....but did anyway!
Ha! Thank you for watching… twice. 👍👍
Where do specialists (i.e, Podiatrists, Ophthalmologists, Vascular Physicians, etc) play a role in the MA capitated models?
Typically a Referral from a Primary Care Physician is required in order to see a specialist if it is a Medicare Advantage HMO.
@@ahealthcarez Thank you for answering so quickly. Do you see a way to create an advanced specialty super group similar to these advanced primary care groups like ChenMed?
Sounds like if one is to work on a digital health telehealth primary care start-up, one strategy is to offer enterprise solutions for employers with an older workforce, like transport/ manufacturing rather than tech?
Yes. I would agree.
Thank you for watching and for your comment.
I love you enthusiasm. I can hear you well ☺️. 👂
Thank you for watching and for your feedback.
Is it possible that Amazon may focus on consumer vs enterprise and do so through Prime? I don’t see MA fitting well with the rest of their business - it’s simply not synergistic with the rest of AMZN in any way
Great question. Consumer healthcare is typically urgent care, plastic surgery, LASIK eye surgery. Generally primary care does not lend itself to direct to consumer.
If revenue is 12x for the MA population, wouldn't their expenses also be 8-9-10x of their commercial/concierge business due to taking on full risk?
I think what needs to be assessed is the earnings per member
Their loss ratio was 85%, so on pace to keep $1,800 per beneficiary per year… typical for the industry.
Thank you for watching and for your question.
Funny how CVS just acquired Oak Street Health
Agreed. Thank you for watching.
What is the future of DPC in the employer space, under age 65?
It can carve out a healthy niche. Don’t try to boil the ocean. 😉
Excellent review Dr. Bricker with great insights into the MA per-member value versus the self-insured employer per-member value.
Thank you for watching and for your feedback.
I love your site
You are very kind. Thank you.
Here’s my question. I thought that Medicare advantage was potentially so lucrative due to their risk adjustment programs coupled with their more….Experieced… subscribers. But they don’t capture that any risk adjustment data for telehealth appointments, right? So how exactly does Medicare Advantage end up being an advantage for digital healthcare?
As always, thank you for being a reliable source of insight and information.
Risk adjustment can be captured during office visits and home visits and the telemedicine visits can help manage chronic illnesses and keep members out of the hospital… in coordination with the in person visits.
Appreciate you watching
Risk Adjustment codes can currently be captured in both telehealth and face-to-face visits. The key for the success of both remains adhering to compliant documentation standards in EMR, approved provider types for code attestation and submission, and, most importantly, care coordination by a multidisciplinary team to keep utilization & costs at the appropriate level for the patients' needs. Telehealth doesn't always allow for full visibility of nuance fluctuations in patient's health status which is where remote monitoring will increasingly come in to play.
I would recommend getting a lapel mic or something similar. Would really improve the ability to hear you. Thank you.
Thank you for your suggestion. Appreciate you watching.
This was so great and mirrors what we've seen in previous work on advanced primary care and employers (e.g. Boeing partnering with Iora but only allowing employees/dependents 40+ years old to sign up.) The video is focused on the advanced primary care provider perspective, but I'm curious what the talk would look like from an employer point of view. If these companies pivot to where the high cost patients are, where does this leave employers who want to help their employees get access to high quality primary care.
Great question… contract with an on-site/near site clinic company. Many starting to offer Virtual primary Care as well.
ProactiveMD is a good one. I have no financial connection to them.
Thank you for watching!
Thanks doc
You are welcome.
Wonder what your thoughts are on Babylon health
Great question. I don’t know. Need to look more.
You meant, PLANDEMIC