Learning Hub

September 20, 2018

Thinking about entering Medicare Advantage contracts? Here are four things to know.

Medicare Advantage (MA) plans are on the rise, and as a health care organization, taking on a different type of contract can mean changes to how your organization operates. For many health care providers looking to enter into an MA contract, this means taking on added risk. These plans are gaining traction and popularity, especially as your current patients age into Medicare and begin to rely on it for their health needs. This means that healthcare organizations may lose patients if they aren’t prepared to accept these risk-based contracts.

Furthermore, the Centers for Medicare and Medicaid Services (CMS) requires that organizations who take Medicare Advantage plans must have systems in place to accurately report data, market services and manage reporting. Here are four important factors to take into account when entering a Medicare Advantage contract.

  1. Get provider buy-in

To take on full-risk contracts, an organization must invest in tools and adequate provider support and training. Your organization needs its providers and administrative staff equipped and knowledgeable about the data required to show successful measurements have been taken to receive reimbursements. The focus needs to be on care management and using data to eliminate unnecessary costs. Provider buy-in is possible, but don’t be afraid to seek help from experts who know how to implement these types of systems, like Boncura.

  1. Standardize systems


One way to close gaps is to work on standardization. Having standardized forms and systems helps providers know more easily the information they need to request and track. Proper documentation is key to having success in risk-based contracts. Providers need support to ensure they collect enough quality information. 

  1. Manage data collection

A fully-integrated system to track and manage data can make reporting and identification of areas for improvement much easier. Health care organizations need to be able to process and interpret that data across all levels, not just simply collect it. Integrated analytics and reporting are necessary to help determine if you are getting the most bang for your buck as well as determining a benchmark for how your healthcare organization is performing. Have you been able to analyze revenue projections? Do you have metrics for trends and prevalence in diseases amongst your healthcare population? These gaps in member analytics, revenue projections and financial management must be filled to receive the most benefit from a risk-based contract.

  1. Focus on prospective and retrospective services

Looking at care beyond the “point of care” and including services provided before and after the patient encounter is part of your comprehensive data. This includes noticing where gaps in service may be. For example, do you have all the necessary information on medication adherence? What’s your strategy for reaching out to at-risk patients or those you haven’t seen in a while? Case management is key to collect important information directly from high-risk patients to ensure they are managing care. Similarly, retrospective programs must be in place. While chart review has always been a necessity, you must be able to take it to the next level with coding, data submission and reporting to get the best benefit from MA contracts.

If there is one thing to take away on how to implement a Medicare Advantage contract, it is the necessity for clear, streamlined systems to collect and manage data. This requires a strong administrative backbone and lots of reporting and analytics. Let us help you and your organization operate smoothly, regardless of what your challenge may be. To find out more about our services, visit Boncura.com or contact us.   

About Boncura Health Solutions
Since 2011, Boncura Health Solutions has remained a dynamic organization aimed at improving patient outcomes, efficiently managing at-risk populations to reduce unnecessary healthcare costs, delivering services in a cost-effective manner, and providing unique and convenient ways for patients, providers, and clients to access key support services. Founded by physicians, Boncura’s expertise allows hospitals and health systems, independent physician groups, and accountable care organizations to provide value-based care through efficient and intelligent administrative and clinical services. Today, Boncura serves more than 7,000 physician providers and partners, managing upwards of 450,000 lives, and processing more than eight million claims annually.