The Sands of Time and Your Value-Based Capabilities

Date: February 9, 2023 Lincoln Intelligence Group

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Reactions to the Intelligence Group’s “When to Walk Away from Medicare Advantage” session at Home Care 100 fell squarely into two camps:

  1. Thank you…but I am doubling down on attracting traditional Medicare referrals.
  2. Thank you…and this was reminder that we need to redouble our efforts to capture and convey value so that we can attract suitable health plan partners.

Whether you fall into camp one or camp two, placing an hourglass nearby on your desk should serve as a valuable reminder in the years ahead.

  • For camp one, the hourglass represents your margin volume from traditional Medicare, which is both finite and dwindling.
  • For camp two, the hourglass represents how quickly 2030’s value-based expectations will arrive and, with these expectations, the end of traditional Medicare reimbursement as we know it.

Doubling Down on Traditional Medicare

There is nothing inherently wrong with doubling down on traditional Medicare as a short-term strategy. Declining markets still entail opportunity, particularly ours which is guaranteed to sustain for some time. However, the price of opportunity is always its counter-weighted opportunity cost: Too much attention to the declining market means too little attention to innovating for new markets.

Our Baseline Strategy: Push, Then Partner

Our feeling: It’s OK to push back from the table with the Medicare Advantage plans who do not in the present, and will not in the future, value your services. It’s not OK to just walk away from MA altogether. As painful is it seems today, the right MA plans could turn out to be your best paying partners in the future.

Pushing back from the table in the short run could yield a positive benefit. Specifically, the plans who value home-based interventions could come back to you. However, staying away from the table for too long could jeopardize your long-term ability to convey yourself as a value-aligned partner.

Important networks – and their entailed access to timely care – are being established now. If you are on the sidelines with MA for any period of time, you should use that time to retool and reculture your organization for value.

Building Your Value-Based Capabilities Stack

Now is the right time to take a good hard look in the mirror and see if you have what it takes to compete in a value-based future. From talking to those who have setup their organizations for value, we know that instilling value-based capabilities requires the better part of decade. Why does it take so long? There are a total of seven critical layers to this stack of capabilities:

  • Interoperability and Integration
  • EHR and Administrative
  • Data and Analytics
  • Communication and Unification
  • Clinical Interventions
  • Population Management
  • People and Culture

The Intelligence Group’s March Think Tank will be about building the capabilities you need to embrace value and push back on the risk to our clinical revenue model. If you’d like to contribute your perspective to our research on this topic, please use this link to compare calendars and set a meeting.