by Rowan Report | Feb 28, 2024 | Clinical
by The National Minority Health Association,
Embracing Change, Empowering Caregivers
In the ever-evolving world of homecare, recruitment and retention pose significant challenges, particularly in California. However, FACT – Family, Adult and Child Therapies, a southern California-based homecare agency, has emerged as a beacon of hope, leveraging the innovative Caring4Cal program to enhance its workforce and service quality.
FACT, dedicated to supporting individuals with developmental disabilities, has a rich history dating back to the 1980s. Originating& from a collaboration of dedicated professionals and parents, FACT has been at the forefront of providing exceptional care and support to a diverse clientele, including minors, adults, and families grappling with a spectrum of diagnoses.
Caring4Cal: A Game-Changer in Caregiver Recruitment and Training
Under the leadership of its Board of Directors and their executive team: Tina Castro (Director of Adult and Employment Services), Lethia Perry (Director of Operations and Human Resources) and Spencer Ludgate (Director of School-Based Services and Controller), FACT has fully embraced the Caring4Cal community health worker recruitment program. This initiative has seen remarkable participation, with 39 staff members taking advantage of the opportunities it offers.
Eligibility and Scope
To participate in Caring4Cal, caregivers must:
- Reside in California.
- Currently work in or aspire to join an eligible job role in home- and community-based settings.
- Eligible roles include a wide array of healthcare professionals like HHA, CNA, RN, LVN, and more.
Partnership and Funding
The National Minority Health Association (NMHA), a pivotal entity in reducing health disparities among minorities, received a substantial grant under the Caring4Cal initiative. Spearheaded by the California Department of Healthcare Access and Information (HCAI), this program is a concerted effort to reinforce the workforce in home- and community-based care. With a strategic collaboration with Nevvon, a leader in e-training solutions for healthcare, this initiative is set to revolutionize caregiver training and retention.
FACT: A Legacy of Excellence and Adaptability
FACT’s enduring commitment to providing holistic, affordable, and quality mental health care is well-aligned with the Caring4Cal program. Their person-centered care approach, accessible locations, and advocacy for independence resonate deeply with the program’s objectives. For over twenty years, FACT has not only adapted to societal changes but has also been a vanguard in accepting and appreciating diverse abilities.
The Future Outlook
With the Caring4Cal program, FACT is not only addressing the immediate need for skilled caregivers but is also shaping a future where comprehensive and compassionate care is accessible to all Californians. This initiative stands as a testament to FACT’s unwavering dedication to its mission and philosophy.
A Call to Action
The success of FACT with the Caring4Cal program is a clarion call to all agencies in the sector. With available funding and training opportunities, it is an opportune time for other agencies to participate and enhance their capabilities. The program not only offers financial incentives but also ensures that caregivers are equipped with state-of-the-art skills to meet the growing demands of the sector.
FACT, working with the NMHA and its successful integration of the Caring4Cal program, exemplifies how strategic partnerships and innovative training initiatives can effectively address the twin challenges of recruitment and retention in the homecare industry.
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About the NMHA: The National Minority Health Association is a 501c3 non-profit organization founded in 1988. The NMHA delivers on its mission of heath equity through innovative programs including Health is for EveryBODY™ (www.healthisforeverybody.org), Operation Healthy You™, Equityville™ and The Art Alliance, to name a few. The lack of health equity in underserved, marginalized and hard to reach communities translates into lost lives, adverse health outcomes, higher costs, diminished productivity and declines in quality of life and well-being for everyone. For more information visit www.thenmha.org
by Rowan Report | Feb 14, 2024 | Partner News
FOR IMMEDIATE RELEASE
Contact: Johnathan Eaves
(903) 445-6969
jeaves@axxess.com
Axxess Launches New Axxess Connect Solution to Accelerate Health Information Exchange
Secure Data Sharing Now Possible Across Any Network
DALLAS, January 18, 2024 – Axxess, the leading global technology innovator for healthcare at home, launched a new product called Axxess Connect, a groundbreaking interoperability solution. This new product will revolutionize the way Axxess users connect and share data with healthcare providers and specialists, further enhancing care coordination, improving patient outcomes and driving the future by enabling new care models and value-based care.
“Axxess Connect is a new benchmark for interoperability in healthcare,” says Tim Ingram, Executive Vice President of Interoperability at Axxess. “By working with our partner Kno2 we can now connect our solutions to help accelerate the exchange of health information securely across any network. This means our clients will have easier access to a broader range of providers and specialists, making data sharing and referrals more efficient.”
By being Kno2 Connected™, Axxess Connect, enables the secure, effortless, and maximized exchange of patient information across patients, providers, payers and HIT vendors. The solution meets data security and compliance requirements in accordance with HITRUST and HIPAA regulation for privacy, data sharing and healthcare communication standards supported by national and regional frameworks including Direct Trust, Carequality and most recently, TEFCA. This ensures that patient data is interoperable, secured and protected when shared across systems.
“Our collaboration with Kno2 not only improves the overall experience for our users, but it also reduces the administrative load on healthcare providers,” said Ingram. “By minimizing time spent on administrative tasks, our clients can focus more on providing quality patient care.”
Added Theresa Bell, Co-founder, President and Chief Technology Officer of Kno2: “By seamlessly connecting Axxess users with healthcare providers and specialists, we are breaking down barriers and revolutionizing the way data is shared in every care setting. Axxess Connect represents the power of the partnership and the value of being Kno2 Connected. Together, we are revolutionizing care delivery and thoughtfully solving healthcare’s biggest problems.”
Axxess Connect will first be available to Axxess Palliative Care clients before eventually being rolled out to the entire Axxess suite of solutions for home health, hospice and home care.
To start using Axxess Connect, contact Axxess’ enterprise sales team via email at integrations@axxess.com.
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About Axxess
Axxess is the leading global technology innovator for healthcare at home, focused on solving the most complex industry challenges. Trusted by more than 9,000 organizations that serve more than 5 million patients worldwide, Axxess offers a complete suite of easy-to-use software solutions that empower home health, home care, hospice, and palliative providers to make healthcare in the home human again. Multiple independent certifications have confirmed that Axxess has the most secure and industry-compliant software available for providers. The company’s collaborative culture focused on innovation and excellence is recognized nationally as a “Best Place to Work.”
by Rowan Report | Feb 7, 2024 | Admin, Recruitment & Retention
by Jen Waldron,
Recruiting caregivers for your home care agency franchise can be challenging enough, but it’s even more frustrating when those same caregivers don’t bother to pick up the phone after applying for your jobs. You may have put in a significant amount of time, money, and energy into trying to find qualified caregiver applicants, only to be repeatedly met with radio silence, missed calls, or unanswered texts.
In my mission to help home care agencies recruit more efficiently, I have identified the top five reasons why caregivers do not pick up your calls and what you can do about it.
1. You are not offering competitive pay or benefits
In a comprehensive study Pew Research found that the number one reason people leave their job is, in fact, for more money. But the number two and three reasons are “no advancement opportunities” and “feeling disrespected at work.” If your compensation package — and your career advancement opportunities — are not competitive, caregivers may choose to ignore your calls and continue searching for better opportunities.
2. Your job ad looks like spam; your hiring process does not stand out from the crowd
Candidates do not read your job description, especially if it is wordy. All job posts look like spam to the applicant, they apply to too many jobs, as many as 16 or more at one time!, and, as a result, they never read job descriptions.
This confusion can lead to candidates feeling apprehensive about texts and phone calls from unknown numbers and explain why they often opt not to answer your phone calls. The screen shot below is an example of how caregiver applicants get too many messages about jobs. To stand out from the crowd, an agency HR team must find a different way to communicate with the applicant about the value and challenges of your jobs.
3. You are not demonstrating professionalism in your hiring process
Caregivers are professionals and they expect you to have a professional hiring process. Many agencies use hiring software built for other industries and, as a result, their hiring process is clunky. On many job boards, applicants “1-click” apply with a job seeker profile they may have made several years ago. When they are followed up with through some sort of automated text system (which they think looks spammy – see pic!), they are annoyed that they are being asked to “apply” again.
4. You have poor online reviews or ratings
Today, people trust online reviews and ratings as much as personal recommendations from friends or family. If your agency has too few positive or too many poor online reviews from clients and/or employees, caregivers may not have confidence in you as an employer. Even if the impression they glean from your reviews is inaccurate, they may choose a competitor whose reviews reflect the culture and work ethic more suitable to their own. Therefore, it is imperative that you invite positive feedback from satisfied clients and employees and respond quickly to negative online reviews. This is critically important to attracting caregivers interested in working for you.
5. Your recruitment process takes too long; caregivers are moving on
The data shows that 57% of applicants today expect to hear back about the position they applied for within 1 week. With regard to retention after onboarding, one of the reasons caregivers leave is they are not given enough hours to make full time work. They say they want those hours to be in the right location and compatible with their scheduling needs and experience level.
You do not want to incur the cost of going through the whole interview, orientation, and hiring process if you do not have the right clients to match their needs and preferences at that time. Therefore, it is vital to streamline your recruitment process and to implement fast and efficient process with the best applicants.
In Summary
As a home care agency owner, it is essential to understand why caregivers may not answer your calls, even after applying for your jobs. Based on our five reasons applicants do not pick up your calls after they apply, there are steps you can take to improve your odds of attracting the best applicants:
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- Evaluate your recruitment process, compensation package, job description, communication methods, and online reputation.
- Ensure you demonstrate professionalism through your interactions, online and during interviews.
- Make your job description and requirements stand out amongst the spammy looking emails and texts out there today.
- Take steps to eliminate bottlenecks in your hiring process.
By doing so, you will attract the best caregivers who will choose to work with you, and your agency can grow and thrive.
# # #
Jen Waldron is one of the co-founders of Augusta Home Care Recruiting She started working in the senior care industry in 2009 as a professional caregiver in a memory care community. Since then, she has been an executive supporting thousands of home care agencies and other senior care businesses through software solutions. Augusta is an innovative software company designed entirely for home care. The platform gets caregivers to show up to interviews through inspiring confidence in the applicant, speed to hire and identifying top talent.
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
by Rowan Report | Dec 13, 2023 | CMS, Regulatory
From the NAHC Newsroom
Public comments due January 5, 2024
CMS Policy Changes to Medicare C & D. On November 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications.
Key provisions in the CMS policy changes that are of interest to home health and hospice providers are detailed below.
Behavior Health
CMS aims to improve access to behavioral health care by adding certain behavioral health provider specialties to the MA network adequacy standards as a new facility-specialty type. The new facility-specialty type, ‘‘Outpatient Behavioral Health,’’ can include Marriage and Family Therapists (MFTs), Mental Health Counselors (MHCs), Opioid Treatment Program (OTP) providers, Community Mental Health Centers or other behavioral health and addiction medicine specialists and facilities.
Special Supplemental Benefits for the Chronically Ill (SSBCI)
CMS is proposing regulatory changes that would help ensure that SSBCI items and services offered are appropriate and improve or maintain the health or overall function of chronically ill enrollees. The MA organization must be able to demonstrate through relevant acceptable evidence that an item or service offered as SSBCI has a reasonable expectation of improving or to maintain the health or overall function of a chronically ill. The MA plan must follow its written policies based on objective criteria for determining an enrollee’s eligibility for an SSBCI when making such eligibility determinations. CMS is proposing to require that the MA plan document its denials of SSBCI eligibility rather than its approvals.
CMS will also modify and strengthen the current requirements for the SSBCI disclaimer that MA organizations offering SSBCI must use whenever SSBCI are mentioned. Additionally, CMS proposes to require MA plans to notify enrollees mid-year of the unused supplemental benefits available to them. The notice would list any supplemental benefits not utilized by the beneficiary during the first 6 months of the year.
Guardrails for Agent and Broker Compensation
CMS is proposing to generally prohibit contract terms between MA organizations and agents, brokers or other third party marketing organizations (TPMOs) that may interfere with the agent’s or broker’s ability to objectively assess and recommend the plan that best fits a beneficiary’s health care needs, CMS proposes to set a single compensation rate for all plans; revise the scope of items and services included within agent and broker compensation; and eliminate the regulatory framework which currently allows for separate payment to agents and brokers for administrative services. CMS also intends to make similar changes to the Part D agent broker compensation rules.
Health Equity and Utilization Management (UM)
CMS proposes to require that a member of the UM committee have expertise in health equity and that t the UM committee conduct an annual health equity analysis of the use of prior authorization. The analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors (SRFs): receipt of the lowincome subsidy or being dually eligible for Medicare and Medicaid (LIS/DE); or having a disability.
Right To Appeal an MA Plan’s Decision To Terminate Coverage for Non-Hospital Provider Services
Beneficiaries enrolled in Traditional Medicare and MA plans have the right to a fast-track appeal by an Independent Review Entity (IRE) when their covered skilled nursing facility (SNF), home health, or comprehensive outpatient rehabilitation facility (CORF) services are being terminated. Currently, Quality Improvement Organizations (QIO) act as the IRE and conduct these reviews. Under current regulations, MA enrollees do not have the same access to QIO review of a fast-track appeal as Traditional Medicare beneficiaries. CMS proposes to (1) require the QIO, instead of the MA plan, to review untimely fast-track appeals of an MA plan’s decision to terminate services in an HHA, CORF, or SNF; and (2) fully eliminate a provision that requires the forfeiture of an enrollee’s right to appeal a termination of services decision when they leave the facility. These proposals would bring MA regulations in line with the parallel reviews available to beneficiaries in Traditional Medicare and expand the rights of MA beneficiaries to access the fast-track appeals process.
- Dual eligible Special Needs Plans (D-SNP)
- CMS proposes to increase the percentage of dually eligible managed care enrollees who receive Medicare and Medicaid services from the same organization.
- CMS is also proposing to limit out-of-network cost sharing for D–SNP preferred provider organizations (PPOs) for specific services.
Further, CMS is proposing to lower the D–SNP look-alike threshold from 80 percent to 70 percent for plan year 2025 and 60 percent for plan year 2026. This proposal would help address the continued proliferation of MA plans that are serving high percentages of dually eligible individuals without meeting the requirements to be a D–SNP.
The National Association for Home Care and Hospice will continue to analyze the proposed rule, but supports CMS’ aim to protect Medicare beneficiaries by modifying policies and procedures that will improve programs under Part C and Part D.
Public comments are due January 5, 2024.
This article originally appeared at https://nahc.org/cms-proposes-policy-changes-to-medicare-part-c-and-part-d/. All rights reserved.
by Rowan Report | Dec 6, 2023 | Admin, Marketing
By Mary E. Maloney
What can you learn about brands and branding from an iconic company like the Mayo Clinic?
We daresay a lot
In this blog, we are going to first explore the “Mayo magic”—some key ideas about why Mayo Clinic has been named, again in 2023 as it has been so many times before, “among the best of the best” hospitals by U.S. News and World Report and listed as one of the “most trusted healthcare brands” by Beckers Hospital Review.
Then we will discuss the benefits of having a solid corporate brand like Mayo’s.
Finally, we will relate the branding principles established by this iconic corporate brand to why it is worthwhile to have a solid personal brand.
Successful Brands Are Built on Trust
Perhaps the most important lesson to take away from Mayo Clinic is that the best brands are built on trust.
A February 2023 Business Insider article titled, Mayo Clinic CEO: Here’s Why We’ve Been The Leading Brand in Medicine for 100 Years, asks Mayo CEO Dr. John Noseworthy how the clinic built its reputation and manages to stay at the top.’
“I think it all comes down to our core value, which is that the needs of the patient come first,”; Noseworthy says in the piece, “I know that might sound kind of trite in today’s world, but our staff is extraordinarily committed. If you spent a day here, and you grab(bed) anybody at the Mayo Clinic and ask(ed) them, ‘what’s the purpose of your work?’; they would say, ‘to meet the needs of our patients.'”
In other words, patients come to Mayo because they can—and do—trust their needs will be served.
The Best Brands Are Consistent
Based on the Mayo example, the best brands are consistent. In the Business Insider article, Noseworthy explains how the Mayo brand is expressed the same way across the organization.
“In my role, what I hear every day from patients and family members is that the minute they step onto a Mayo campus, whether it’s in Rochester, Minnesota; Scottsdale, Arizona; Florida; or in our large integrated health system, they immediately sense that there’s something different,” he says. “They feel it right from the first person they speak with, and it’s the physicians, it’s the science, it’s the engineers and technologists. It’s that patient focus and a relentless focus on quality. This goes all the way from the heart surgeons down to the cleaning staff.
Iconic Brands Stand for Something Significant
A few years back, a woman I know took her young daughter to Mayo Clinic’s Rochester, Minnesota, location for treatment for epilepsy. Ask her what words came to mind when she thinks about Mayo today, and she’ll say: “research, specialists, world-renowned.”
Top brands know what they stand for—and then they deliver on it. For Mayo, this is serving people first, and especially people experiencing special health concerns.
“Founded more than a century ago by two brothers in the rural Midwest, the Mayo Clinic has built a world-renowned reputation as an exemplary network of clinics and hospitals that has become the preferred destination of patients with difficult-to-treat conditions,” reads the intro to a 2018 Q&A article published in Knowledge at Wharton, a business journal from the Wharton School of the University of Pennsylvania.
“As people live longer and have multiple different chronic diseases, the need for … advanced services will be ever greater,” says Larry Jameson, EVP of the University of Pennsylvania Health System, in the article.
The Benefits of a Strong Niche Brand
Being as famous and respected as Mayo would certainly be nice for any brand. But what are the deeper business benefits of having a strong brand in the home health/home care industry?
Qualtrics suggests that strong brands can capture greater market share, accelerate new patient acquisition through online rates and word-of-mouth marketing, and increase loyalty amongst a highly competitive set.
Here are some specific examples:
- Having a strong brand can help an organization appeal to underserved or growing segments.
- Having a strong brand that truly resonates with consumers can translate to patients promoting your organization through online reviews and social media mentions.
- Having a strong brand can boost communication and help to create moments that matter with those the organization serves.
- Having a strong brand creates “stickiness” and can mitigate employee turnover and improve retention rates. When employees feel like they are connected to an organization that is on-purpose, they are more likely to stay and to influence a healthy work culture.
Applying the Key Principles of Iconic Brands to Personal Branding
So how do these ideas we’ve garnered from an iconic brand translate into your personal brand?
As we have seen, consistently delivering on a brand promise helps people decide to do business with a brand. They trust that brand to deliver for them. At the end of the day, people do business with people if they have a choice.
Personal branding can help you excavate your very own brand manifesto and develop ways to tell others about it consistently and authentically. Being mindful of personal branding will help you answer mission-critical questions as: “What is my brand promise?” and “How consistently am I delivering on it?”‘
Personal branding can not only help you as a leader clarify what you stand for but also affirm it until you feel it with conviction. And it can help you to effectively deliver the same message about it in any situation—whether that’s the proverbial elevator, in an all-staff meeting, or in the field.
Imagine what your business would be like when everyone, whether it’s in the first 90 days or tenured staff, “owns” what they stand for and it aligns fully with your company core values.
You as a leader can
Knowing your “why” will also give you peace of mind to pursue your next act if you are in transition (on deck). Having a brand manifesto as your true north guide will enable you to more rapidly achieve your next career milestone and build your best exit strategy.
Once you get clarity, conviction and the ability to talk about your personal brand, maybe you’ll find yourself ranking on the Home Care Pulse 2023 Best of Home Care Awards or as part of the Modern Healthcare Hall of Fame.
Finally, a heartfelt thanks to all the healthcare leaders out there who are leading with purpose, no matter how tough it gets. It speaks volumes about your personal brand. You inspire us.
# # #
An executive advisor, educator, speaker and author, Mary E. Maloney is the founder of Revealing Genius and the expert that accomplished leaders trust for positioning, messaging and brand strategy. A former CEO and CMO, Maloney guides healthcare C-suite leaders, founders and physicians to powerfully and strategically message their expertise and “why” so they lead with conviction and achieve their most coveted career goals.
©2023 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only.
editor@homecaretechreport.com
by Rowan Report | Oct 11, 2023 | CMS, Medicare Advantage, Regulatory
NOW AVAILABLE IN iQIES – Preview Reports and Star Rating Preview Reports for the January 2024 Refresh
CMS just published updated measure for Home Health Outcome Information Set (Oasis) and all HH QRP claims-based measures. These updated measures are no based on the standard number of quarter.
For additional information, please see the HH Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage.
©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This article originally appeared in Home Care Technology: The Rowan Report. Click here to subscribe. It may be freely reproduced provided this copyright statement remains intact. editor@homecaretechreport.com
by Rowan Report | Oct 4, 2023 | Admin, M&A
by Greg Schriber
In the dynamic landscapes of home health, home care, and hospice services, these industries are experiencing transformative trends, marked by evolving market changes and a surge in demand. Understanding these trends and strategically positioning one’s business for a lucrative sale is paramount. This article provides a detailed guide on understanding the current market landscape and optimizing business value for a successful sale.
Transformative Trends
The industry is witnessing a substantial increase in demand for home-based care services, primarily driven by an aging population and a growing preference for aging in place. This trend has been further propelled by the COVID-19 pandemic, as more families are opting for home care to mitigate the exposure risks associated with institutional settings. Additionally, the advent of technological advancements such as telehealth and health informatics is revolutionizing the way services are delivered, enhancing patient outcomes and operational efficiency. Embracing these innovative solutions is imperative to maintain competitiveness and address the changing needs of clients. The industry is also navigating through shifts in regulatory frameworks, emphasizing quality of care through value-based care models and patient satisfaction. Adherence to new regulations and standards is crucial to sustain the business and avoid penalties. Furthermore, the market is undergoing consolidation, with larger entities acquiring smaller providers to diversify their service offerings and extend their geographic reach. This trend poses both challenges and opportunities for business owners contemplating a sale.
Strategic Positioning for Sale
To position a business attractively for sale, optimizing operational efficiency is crucial. Streamlining operations and minimizing overhead costs not only enhance profitability but also make the business more appealing to potential buyers. Implementing industry best practices and leveraging technology can significantly elevate operational efficiency and service quality. Diversifying service offerings is another strategic move, as it can expand the customer base and open up new revenue streams. Providing a range of specialized and complementary services positions the business as a comprehensive solution, attracting acquirers. Building and maintaining a strong brand reputation through exemplary services, customer satisfaction, and community engagement is also vital. A reputable brand can draw in strategic buyers seeking market leadership. Investing in workforce development is equally important, as a skilled and stable workforce is a valuable asset that can influence business valuation positively. Maintaining financial health and accurate financial records is critical, as it demonstrates the business’s viability and can facilitate the due diligence process during the sale.
Managing the Sale Process
Seeking professional advice from industry experts, financial advisors, and legal counsel can offer invaluable insights and guidance throughout the sale process, aiding in accurate business valuation, negotiation of favorable terms, and navigation of legal intricacies. Negotiations require a strategic approach – understanding the buyer’s motivations, being transparent about expectations, and being willing to compromise can lead to a mutually beneficial agreement. Identifying a buyer whose vision aligns with that of the seller is essential to ensuring the continuity and growth of the business post-sale. Whether the buyer is a strategic entity looking to expand or a financial entity seeking investment opportunities, finding the right fit is crucial. Additionally, being well-prepared for the due diligence process can expedite the sale and reduce the risk of deal fallout. This includes organizing all necessary documents and addressing any potential issues beforehand. Developing a clear transition plan that involves open communication and support is essential to ensuring a successful handover and employee retention post-sale.
Positioning a healthcare business for sale is a multifaceted endeavor, involving operational optimization, brand enhancement, and meticulous strategic planning. By staying abreast of market trends, adopting best practices, and effectively navigating the sale process, business owners can maximize their business value and achieve a successful exit in this rapidly evolving industry. The journey extends beyond the sale; it’s about creating a legacy and ensuring the continued growth and service to the community under new ownership. By being proactive, strategic, and thoughtful, business owners can significantly impact the future of home-based care and improve countless lives.
Greg Schriber is the M&A Senior Advisor for American Healthcare Capital. To learn more about Transformative Trends, Greg can be reached at greg@ahcteam.com
©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
by Rowan Report | Feb 1, 2023 | Admin
by Wendell Potter
Medicare Advantage is a money-making scam. I should know. I helped to sell it.
Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.
But here is the truth: Medicare Advantage is neither Medicare nor an advantage.
And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.
During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare — real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits — at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.
Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems… Congress should work to lower the cost of health care.
Apology and Accusation
I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.
The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72 percent of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.
Members of Congress on both sides of the political aisle – and both sides of the Capitol – are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. As Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”
I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.
Medicare Advantage is a money-making scam. I should know. I helped to sell it. And I am going to continue working alongside patients, caregivers, and elected officials to address the problems.
Wendell Potter is the former vice president for corporate communications at Cigna. He is now president of “Business for Medicare for All” and author of bestselling books Deadly Spin and Nation on the Take.
commondreams.org/author/wendell-potter
©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Common Dreams.org. Reprinted by permission in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
