Mandelbaum Barrett PC’s Post

Check out this insightful article discussing health insurance payer megamergers – a must-read for healthcare executives! Here are my top 5 key takeaways: 1) Ensure mergers don't compromise the quality of care or limit consumer options. 2) Opt for diversification over heavy consolidation in specific markets. 3) Avoid significant competition reduction in business segments like the Medicare Advantage market. 4) Stay mindful of provider consolidation impact on the overall network; focus on the right mix of providers for synergy. 5) Strive to enhance care coordination without disrupting the delivery of care. #HealthcareInsights #Insurance #HealthcareLeadership #HealthInsurance #PayerMergers #DigitalHealth #Healthcare #ReimagineTheFuture #TimeIsNow https://lnkd.in/gUUXvsxy

A great video from Eric Bricker, MD explaining Medicare Advantage “risk adjustment” payments are created. Personally, I’ll die on the hill that it isn’t risk if you are getting paid extra for something. The basic definition of risk is the probably of something bad happening. To the plan, the risk is they will have to pay more for that person. But, with additional revenue and utilization management techniques that reduce access to care… I’m baffled why we continue to discuss “risk” for these payments.

As always Dr. Bricker provides explanation and insight to an industry that appears to not care about businness ethics. think about it Tim

#MedicareAdvantage beneficiaries are older, sicker, and often have more than one HCC or comorbidities. Medicare Advantage business makes more money the sicker their beneficiaries are. Proactively addressing patient health through preventative care has historically lacked sufficient incentives. It's difficult to quantify the value of preventing conditions that aren't immediately life-threatening or debilitating #PreventiveCare represents a paradigm shift and a moral responsibility for providers, emphasizing proactive health management and the well-being of our patients There is a glimmer of hope: #ValueBasedCare. Health systems are increasingly willing to incentivize #ValueBasedPayments by ensuring patients are treated holistically without gaps in care. This means that one patient, even if they need multiple types of care, can find rehabilitation or cure efficiently and effectively without waste. #PayForPerformance ensures that providers focus on quality and #outcomes, aligning incentives with what truly matters: patient health and well-being. By embracing value-based care, we can shift the focus from treating illness to maintaining health, while healthcare systems find ways to create new #revenue streams.

#feeforservice is broken #valuebasedhealthcare is the solution Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill. https://lnkd.in/gJgvaZxC Aetna, a CVS Health Company , Cigna Healthcare , UnitedHealthcare , MultiPlan ..."The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much so-called out-of-network medical providers should be paid. It promises to help contain medical costs using fair and independent analysis. But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee...."

Cigna-Humana merger portends the end game for healthcare, patients and physicians in America. Insurers want to institute the Israeli 3-HMO for-all mandate here in America. The American version of the Israeli 3-HMO’s for all model will be Medicare Advantage Managed Care for All. MA for All in the USA will have 3-5 fully  integrated Health Insurance conglomerates acting as care rationing highly profitable subsidized pass-through banks with capitated or fixed labor (physicians) costs and zero medical or fiscal risk for the insurers. Watch for this conversion of American health insurers to risk-free care-rationing pass-through banks or clearing houses via MA for all in the next year or two. The quid pro quo lobbying in Washington for medicare Advantage managed care for-all with capitated labor is almost completed as per Niki Haley’s pronouncements on MA for All. Wendell Potter Jesse Ehrenfeld MD MPH PNHP - NY Metro https://lnkd.in/ewxmjcG2

Curious about the differences between government healthcare spending and private insurance? Check out this informative article that contrasts dynamics of these two essential sources of healthcare financing. https://lnkd.in/e4kkuh8g #HealthcareSpending #GovernmentVsPrivate

"It is incredibly hard to do anything constructive as a fully insured plan. When an employer is self-funded, they are able to access more detail on their claims data. They can see on a per-member or on a per-service basis what amount was paid by their plan." https://lnkd.in/eGf-seXz #fullyinsured #selffunded #insurance #employeebenefits #medical #medicalinsurance #healthcare

Lots of initialisms here! To simplify, the US healthcare revenue cycle can have anywhere from 10 to 16 steps. Doctors and primary care physicians (PCPs) hand over their revenue cycle management (RCM) to business process outsourcing companies (BPOs) like MacCare so that they can focus on examining patients instead of dealing with administrative tasks. MacCare’s admin experts zip through the RCM process much more efficiently, speeding up health insurance reimbursement payments and making the lives of doctors and PCPs so much easier. #MacCare #RCM #RevenueCycleManagement

🩺 What is an HMO? 🩺 Health Maintenance Organization (HMO) plans are a popular type of health insurance. Here’s what you need to know: 1. **Primary Care Physician**: With an HMO, you choose a primary care physician (PCP) who coordinates your care. 2. **Referrals Needed**: To see a specialist, you’ll need a referral from your PCP. 3. **In-Network Care**: HMO plans require you to use in-network doctors and hospitals for the best rates. HMOs can be a great choice if you prefer a coordinated care approach and lower out-of-pocket costs. Have questions about HMO plans? Drop them in the comments, give us a call at (864) 397-8866, email us at info@fikainsurance.com, or visit our website www.fikainsurance.com We're here to help! Don’t forget to like, follow, and share our page to stay informed with Fika! #HealthInsuranceAwareness #FikaInsuranceGroup #HMO #Healthcare #InsuranceEducation