Aneesh Chopra (these days at Arcadia) and Matthew Holt got into a discussion of how Medicare Advantage is doing. Working with APG (America’s Physician Groups), his company Arcadia found that Medicare Advantage companies who paid capitation got better outcomes than those who were paying FFS for different patients to the SAME doctors. We got into what is really saving money (Humana says there is little cost differential), what this means for the policy, what is really happening with risk adjustment–Aneesh thinks we should put those home visits in the medical record to benchmark VBC based payments.
And he tells us why what we have done so far in Medicare Advantage and explains that it doesn’t work because we haven’t got the clinical data easily available via API. (Those in the know knew he was going to say that!). He also thinks that commercial payers may yet be the saviors of ACOs and Medicare Advantage by buying bundled care from providers and making it necessary for them to access the data across the board, and then change overall behavior. And Aneesh is quite optimistic about the new Admin and its MAHA stance. Matthew Holt
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