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Cover Story: Medicare Advantage: The Future Model of Care

Continued from page 1 accomplish. For example, the government VC implications
The new budget bill, signed on Feb. 9, Medicare Advantage is prohibited from negotiating drug prices, Historically, VC-backed startups that
2018, after a several-hour government plans can now include but a private insurer is not. make tools needed to improve care qual-
shutdown, includes new policies that fur- We can imagine a world where, over ity have sold their products to self-
ther support Medicare Advantage plans: social support or non- time, the private sector is charged with insured employers or directly to com-
1. Medicare Advantage plans can now medical services in their lowering care costs—with Medicare mercial insurers. The traditional
include social support or non-medical Advantage being a key way of doing so. Medicare patient population has
services in their benefits packages, such as benefits packages, such remained largely untapped.
home-delivered meals or transportation to as home-delivered meals Impact for hospitals Now, though, Medicare Advantage
the doctor’s office. As the Medicare Advantage patient pop- presents tremendous opportunity for
2. The new budget includes the or transportation to the ulation grows, hospitals will face lower VC-backed startups that have the tools to
Chronic Care Act, which allows doctor’s office. reimbursements if they’re unable to predict when people need care and what
Medicare Advantage plans to tailor their demonstrate the value of their care. They’ll type of care, before they even show
coverage for patients and expand tele- have to emphasize clinical quality to symptoms. As the government pushes
health services. more transparency into their care and has remain financially viable. more people to Medicare Advantage,
pushed insurers to improve the quality of Hospitals will remain under pressure to health-tech startups that can offer the
Why the growing support for their services to compete. redesign delivery and invest in innovation tools needed to provide more effective
Medicare Advantage? CMS has already shown support for MA and digital technology with value-based care will be extremely valuable both to
Ultimately, the government’s move to plans by offering insurers under the plans payment. Despite incorporating value- insurers and providers.
expand the purview of Medicare flexibility. Insurers like Anthem, Humana based payment models over time, tradi- Medicare Advantage is the way for-
Advantage is driven by the three founda- and WellCare have shown plans to expand tional Medicare for the most part contin- ward, and health-tech startups—and
tional shifts that have taken place under their MA businesses through M&A activi- ues to reimburse hospitals for each service their investors—can lead that way.
the new administration: ty—most recently, Humana through its the patient has (fee for service model). If a We previewed this in the inaugural
1. Movement from an insurer market- deal with Walmart. patient goes to the ER and incurs a $1,500 edition of BDO’s Healthcare Rx
place governed by mandates to a system Now that the government has put this bill, Medicare will likely just pay it. The Newsletter. Read those insights at
centered on choice kind of support behind MA plans, we’re more services a patient undergoes, the https://www.bdo.com/blogs/healthcare/a
2. Movement from a marketplace char- only going to see activity increase in vol- more money Medicare will reimburse. pril-2018/future-of-healthcare-lies-in-
acterized by regulation to a marketplace ume. However, if a patient in Medicare the-data.
guided by competition when it comes to Advantage receives treatment at a hospital,
coverage and pricing The future of healthcare the insurer first determines the service was BDO South Florida healthcare leaders are
3. Movement from payments provided In 2016, Medicare spending alone was clinically appropriate or medically neces- ready to address your complex and unique
through subsidies to greater actuarial 15 percent of the total federal budget. sary, and, if so, that it was priced appropri- needs:
soundness. Moving more heavily to the Medicare ately. Alfredo Cepero, Managing Partner
Medicare Advantage plans have set a Advantage model is the fastest way the The new Medicare Advantage world will (305) 420-8006/ acepero@bdo.com
good example for the healthcare industry government can reduce this large portion indeed accelerate the move to value-based Angelo Pirozzi, Partner
by providing greater transparency and of federal spending. If more of the control care. (646) 520-2870 / apirozzi@bdo.com
accountability—and moving toward out- over Medicare patient care is shifted to the
comes-based payments. The star-ratings private sector, costs can be condensed in
system for plans has given consumers ways that the public sector currently can’t

Cover Story: Pompano Beach Native Serves

with the U.S. Navy Half a World Away

Continued from page 1
“I think being forward deployed is very beneficial because it supports the mission
of the overall Navy,” said Williams.
Williams is also proud of receiving the Junior Sailor of the Quarter award and Sailor
in the Spotlight for the hospital.
As a member of one of the U.S. Navy’s most relied-upon assets, Williams and other
sailors know they are part of a legacy that will last beyond their lifetimes providing
the Navy the nation needs.
"Serving in the Navy has presented me with opportunity to be more humble and
more accepting of different people and personalities,” said Williams. “Serving in the
Navy allows me to give back and help a bigger population, in turn providing more
assistance to not only myself, but to my country. It’s not just a job, it’s more of a serv-
ice of dedication.”

16 May 2018 southfloridahospitalnews.com South Florida Hospital News