Value-Based Care Success Community
@VBCSuccess
Transform your healthcare practice with expert guidance in Value-Based Care (VBC) - the payment model reshaping US healthcare by 2030.
The pivot to value-based care isn’t coming—it’s already reshaping the rules. If you’re still betting on fee-for-service, you’re standing on a burning platform. tomdavisconsulting.com
Hopefully this is tongue in cheek The reality will be exactly opposite, readjusted funding to severely curtail specialty slots while greatly expanding more streamlined general practice programs Rationing through access, were the only country that doesn’t do it
Should we concede that we have lost the war on developing primary care doctors and spend a huge proportion of our medical school and residency spots on specialists. This is not a knock on pcps. This is an admission that we can never produce enough drs to do this.
Should we concede that we have lost the war on developing primary care doctors and spend a huge proportion of our medical school and residency spots on specialists. This is not a knock on pcps. This is an admission that we can never produce enough drs to do this.
In value-based care, what you scale is just as important as how you scale. tomdavisconsulting.com
Outreach clinics might look good on paper, but under Medicaid VBC, they can quietly drain your resources. tomdavisconsulting.com
For those who didn't see the visual capitalist today. CON laws result in statistically significant higher insurance premiums as a percentage of median income. Who would of thought that the less competition, the higher the price perplexity.ai/search/1a3e950…
Clearly a cost-control barrier. These are going away as VBC becomes universal That's because it's the provider who will bear the cost, forcing them to balance efficacy, resource management, and ethics.
Received this delightful 7 page PA for testosterone therapy... after filling out the initial online PA which included submitting the labs supporting the diagnosis there, too. Almost like they want me to give up and just pay for the compounded test. out of pocket to save time.
Taking Medicaid VBC? Great. Just don’t silo your patients. tomdavisconsulting.com
Patients do, in fact, set healthcare prices. It's just that until recently, the volume of third-party payments has offset the value of higher prices to be had outside the system. 15 years ago, that became untrue for primary care. 7 years ago with telemedicine, you didn't even…
Thank you for this important post. “We are not seeing any new Medicare patients” is the answer an increasing number of Medicare “beneficiaries” will be hearing due to the price controls inflicted on the industry in the early 1990’s. GKS
Medicare can claw back revenue up to five years after it's booked It can extrapolate from audit samples to establish the amount. 5% error rate can = clawback of 5% of total revenue. Failure to remit 61 days after demand letter=felony, even if amount later found to be wrong.
The insurers can also "claw back" payments that they have made YEARS after they make them.
its not the specialty, its the system, specifically the payment model Pay based on outcome and things will rapidly change. Perfect? of course not. Better? possibly. at least the system will be forced to pay for its own mistakes
"Orthopedics Is By Far The Most Corrupt Form Of Medicine & The 2nd Most Corrupt Is Oncology." Gardiner Harris "Orthopedic Surgeons Will Choose Devices Based On Their Payouts & Bonuses...Not Patient Outcomes." "You Must Have An Advocate With You At The Hospital At All Times..."…
"Orthopedics Is By Far The Most Corrupt Form Of Medicine & The 2nd Most Corrupt Is Oncology." Gardiner Harris "Orthopedic Surgeons Will Choose Devices Based On Their Payouts & Bonuses...Not Patient Outcomes." "You Must Have An Advocate With You At The Hospital At All Times..."…
Want to grow your Medicaid VBC panel? Make sure you’ve built a system that can deliver real results—before you scale.
It's funny because it's true
Hi, ER Doc here. I don’t know who needs to hear this but do NOT even think about it.
Value-based care won’t just disrupt the system—it’ll flip it on its head. When the tide turns, private practices that perform will rise while bloated systems scramble to survive. tomdavisconsulting.com
can confirm🤣🤣🤣🤣🤣
“Engineers like to solve problems. If there are no problems handily available, they will create their own problems.” - Scott Adams
Don’t lead with Medicaid—let your performance make them come to you. When they’re desperate, you set the terms. tomdavisconsulting.com
Don’t lead with Medicaid VBC—it’s not designed to be your first move. tomdavisconsulting.com
Medicaid value-based care can pay off, but only if you see the market as it is—limited dollars, hidden corruption, and all. tomdavisconsulting.com
Do things compliantly and there’s no risk FSM is the tool for you
At the RISE Medicare Advantage Summit, #HHS OIG’s Ann Maxwell outlined key compliance risks facing #MedicareAdvantage plans. Learn how plans can stay ahead. foreseemed.com/blog/oigs-medi…