Medicare is transforming into a value-based program that offers physicians and health systems three distinct reimbursement options:
- Medicare Advantage (MA) with reimbursement via agreed terms
- Medicare fee-for-service (FFS) through an accountable care organization (ACO)
- Medicare FFS coupled with the Merit-Based Incentive Payment System
However, these three payment arrangements present different opportunities and risks for providers. The challenge for providers is to determine which program presents the best financial results while affording patients the most flexible benefit options and beneficial cost-sharing arrangements. MA often presents the most favorable opportunity for providers and patients because of the following features:
To take advantage of the MA opportunity, providers would like to raise patient awareness of MA plan options, including their own sponsored MA plan, as the best option given their medical condition, but are challenged in how to make the introduction in an organized fashion and in scale. A provider-initiated communication and engagement program is the answer.
Published June 5, 2020
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