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  #11  
Old 03-12-2018, 05:07 PM
kooky cookie kooky cookie is offline
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Originally Posted by George Frankly View Post
I’m feeling pretty trained up on the clinical side of things.

My (biased) view is there is some room for spillover here. As these value-based programs proliferate, one thing we are seeing is more and more risk pushed down to providers. You’d like to think that you could cram down clinical risk to physicians, and have the insurers continue holding the actuarial risks, but the break isn’t clean.

That said, I’ve been on the provider side of health for six years. Most of my job is more like ‘analytics’ and ‘reporting,’ I don’t spend a ton of time solving real actuarial problems. But when actuarial problems arise, and they do, guess who is uniquely qualified?
George - since you're on the provider side, do you have a view about the ever-increasing amounts of admin work that docs have to do, quality measures, EHR check boxes, etc?
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  #12  
Old 03-12-2018, 05:55 PM
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Carol Marler
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George - since you're on the provider side, do you have a view about the ever-increasing amounts of admin work that docs have to do, quality measures, EHR check boxes, etc?
Don't forget those worthless "customer satisfaction surveys" or is that just Medicare?
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  #13  
Old 03-12-2018, 07:27 PM
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George - since you're on the provider side, do you have a view about the ever-increasing amounts of admin work that docs have to do, quality measures, EHR check boxes, etc?
Basically, if you add one mouse click, physicians completely hate it. But there's not much we can do. Lots of my physicians are in the CMMI Oncology Care Model, which comes with a ton of reporting. It's an optional program and you get a PMPM payment... a bit of revenue helps them swallow the pill.

So much other mandatory stuff though. MIPS is coming whether you like it or not. A lot of commercial payers are demanding clinical & staging data, and NDCs for IV drugs.

I guess my take is that my physicians hate it. They either have to do more work or hire someone to help, but there's typically no payment to offset the extra work. And right now (in oncology at least) it's the wild west. So you have to do A,B, and C for one payer, and X, Y, and Z for another. But it's the way things are going, so for now we're dealing with it and pushing back where we can.
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  #14  
Old 03-12-2018, 07:28 PM
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Don't forget those worthless "customer satisfaction surveys" or is that just Medicare?
The sat survey for the Oncology Care Model is 84 questions I think. And yet, they are getting really good response rates. Perhaps Medicare pts have a bit of time on their hands???
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  #15  
Old 03-12-2018, 08:47 PM
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The sat survey for the Oncology Care Model is 84 questions I think. And yet, they are getting really good response rates. Perhaps Medicare pts have a bit of time on their hands???
oh my gosh, 84 questions!

I think I bailed out after no more than a dozen questions, and that was the longest I stuck to it. The thing that bothered me most was that the questions being asked did not seem to have any actionable result, not matter what I answered.

And I sure don't have that much time on MY hands.
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Originally Posted by Westley View Post
And def agree w/ JMO.
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This. And everything else JMO wrote.
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Yup, it is always someone else's fault.
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I feel like ERM is 90% buzzwords, and that the underlying agenda is to make sure at least one of your Corporate Officers is not dumb.
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  #16  
Old 03-12-2018, 08:58 PM
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By the way, am I just out of touch or what? This thread is my very first encounter with the phrase "triple aim."

I do remember a three-cornered stool, but that was for retirement policy. And seems to have been dropped by the wayside long ago.
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Carol Marler, "Just My Opinion"

Pluto is no longer a planet and I am no longer an actuary. Please take my opinions as non-actuarial.


My latest favorite quotes, updated Apr 5, 2018.

Spoiler:
I should keep these four permanently.
Quote:
Originally Posted by rekrap View Post
JMO is right
Quote:
Originally Posted by campbell View Post
I agree with JMO.
Quote:
Originally Posted by Westley View Post
And def agree w/ JMO.
Quote:
Originally Posted by MG View Post
This. And everything else JMO wrote.
And this all purpose permanent quote:
Quote:
Originally Posted by Dr T Non-Fan View Post
Yup, it is always someone else's fault.
MORE:
All purpose response for careers forum:
Quote:
Originally Posted by DoctorNo View Post
Depends upon the employer and the situation.
Quote:
Originally Posted by Sredni Vashtar View Post
I feel like ERM is 90% buzzwords, and that the underlying agenda is to make sure at least one of your Corporate Officers is not dumb.
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  #17  
Old 03-12-2018, 10:33 PM
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By the way, am I just out of touch or what? This thread is my very first encounter with the phrase "triple aim."

I do remember a three-cornered stool, but that was for retirement policy. And seems to have been dropped by the wayside long ago.
This is my very first encounter with the phrase “three-cornered stool”

Triple aim is thrown around mostly in public policy forums, afaik. So I wouldn’t consider you to be out of touch because you haven’t heard it before. Now, you may be out of touch for other reasons, of course, lol.
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  #18  
Old 03-12-2018, 10:57 PM
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This is my very first encounter with the phrase “three-cornered stool”

Triple aim is thrown around mostly in public policy forums, afaik. So I wouldn’t consider you to be out of touch because you haven’t heard it before. Now, you may be out of touch for other reasons, of course, lol.
Three legged stool has been thrown around with the ACA individual market to show how the mandates, subsidies, and guaranteed issue clause work together.
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  #19  
Old 03-12-2018, 11:51 PM
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Originally Posted by George Frankly View Post
Basically, if you add one mouse click, physicians completely hate it. But there's not much we can do. Lots of my physicians are in the CMMI Oncology Care Model, which comes with a ton of reporting. It's an optional program and you get a PMPM payment... a bit of revenue helps them swallow the pill.

So much other mandatory stuff though. MIPS is coming whether you like it or not. A lot of commercial payers are demanding clinical & staging data, and NDCs for IV drugs.

I guess my take is that my physicians hate it. They either have to do more work or hire someone to help, but there's typically no payment to offset the extra work. And right now (in oncology at least) it's the wild west. So you have to do A,B, and C for one payer, and X, Y, and Z for another. But it's the way things are going, so for now we're dealing with it and pushing back where we can.
I don't know how many alternative payment arrangements you're in but if you negotiate directly you can consider adding bonus payment (contingent or non-contingent) based on your providers' completion rates that affect plan revenues. I'm not sure whether or not it matters quite as much for oncologists as primary care docs, but if it is then I'd say try to get that one in there.
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  #20  
Old 03-13-2018, 12:20 AM
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wiki has something about it in another page:

Anywho, in my experience, there have been people with "great ideas" to implement in Cost Management and Utilization Manafgement, they have come to actuaries seeking the answers for, "How much will this save the company, could you include it in the forecast, and could you tell the priing actuaries to assume it when determining premium?"
yeah.

Back to the topic of why health care costs so damned much: the easy answer is that since some people get health care at a lower cost to them, everyone else has to pay more.

Also, no one seems to care all that much, until they themselves have to pay for it.
I missed this one earlier. The quoted section from wiki on the triple aim was nearly verbatim a notecard for a recent FSA exam. I can’t get it out of my head.
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