Episode Summary
The traditional fee-for-service model in healthcare has created some problematic incentives for providers. When providers are paid for each test, procedure, or service performed, it incentivizes them to order more of these services - even unnecessary ones - to maximize their income. This fragmented system leads providers to focus on treating isolated conditions rather than proactively maintaining patient health. It has contributed to high healthcare costs and suboptimal health outcomes.
However, this is starting to change, especially within Medicare Advantage plans. A growing number of providers are shifting towards value-based care models, where they are paid based on patient health metrics rather than service volume. In these models, providers receive a fixed monthly payment for each patient under their care. This payment does not change based on how many tests or services they order.
This incentivizes providers to focus on preventative care and keeping patients as healthy as possible. Their patient panels are evaluated based on metrics like reduced hospitalizations, cancer screening rates, and appropriate coordination of care between specialists. Providers may receive bonuses for superior performance on these health outcome measures. This motivates them to take a more holistic, proactive view of patient wellbeing.
For Medicare Advantage members, this shift means better access to coordinated, preventative care focused on their overall health instead of isolated conditions. Providers are incentivized to monitor members closely, intervene early when risks are identified, and ensure care is properly integrated between all of a patient's specialists and facilities. They are rewarded based on health outcomes, not service volume.
As insurance agents, it is important to understand these changing provider incentives within Medicare Advantage. We can identify plans that utilize value-based provider networks to ensure our clients get access to superior preventative care and care coordination focused on their total well-being. This enables us to provide tremendous value as trusted advisors guiding clients to the plans that will best incentivize providers to deliver high-quality, integrated healthcare.
The shift to value-based care presents an exciting opportunity for agents to positively impact client health through the Medicare Advantage plans we recommend. I encourage all agents to learn about this trend so they can match clients with plans that will motivate providers to deliver the kind of coordinated, prevention-focused care that improves outcomes and quality of life.
Timestamps
(0:00:00) - Broker Link podcast discusses value-based care and how it could impact Medicare Advantage
(0:01:28) - CP: When an agent comes into the business, there are two aspects
(0:07:06) - David: Typically, people categorized Medicare as higher income
(0:07:56) - Doctors are being motivated and incentivized by these programs. Is that a good way of describing
(0:12:03) - Simply enroll is the broker's alternative to Medicare Gov. It's free and easy to use
(0:13:33) - I was tasked with trying to talk to everyone yesterday about sustainable growth
(0:15:13) - CP is expanding out of just Florida; you've got some other markets
(0:16:32) - CP: I'm happy to help any insurance agent, whether experienced or green
