Some Medicare Plans are Shifting Financial Risks to Doctors

Of the almost 60 million Medicare beneficiaries in the entire United States, nearly one-third of those individuals are covered by a Medicare Advantage Plan, an alternative to Medicare insurance offered by private companies contracting with the government and offering all Part A and Part B benefits. Federal officials estimate that number is expected to grow as high as 41 percent nationally over the next ten years but some states already see enrollment rates that high.

 

In states like California and Florida, Medicare Advantage plans are employing something known as global risk or full risk to help curb the skyrocketing costs of health care while creating financial incentive for providers to take the very best care they can of their patients. In those states, about half of Medicare Advantage plan members get care under the global risk model, compared to an estimated 10 percent nationally.

 

Under total risk arrangements, the insurance plan give health care companies the bulk of their Medicare funding when they take on the mantle of being financially responsible for all patient care. For the physicians groups, the arrangement means they get paid a large amount of money upfront for patient care and do not have to worry about billing issues or waiting for insurers to pre-approve medical procedures and treatments. Patients benefit by being able to spend more time with their doctors to get all the care they need and can usually get same day or next day appointments.

 

Because these global risk insurance plans are designed to health care costs, the potential is that they may allow the physician companies to lower premiums and attract more customers, possibly gaining momentum to lowering overall health care costs. While past experiences with total risk insurance coverage were less than positive, modern plans appear to be run better, allowing insurers to set benefits, handle member complaints and review which doctors are allowed in its network.

 

Furthermore, health insurance companies utilizing global risk plans understand they can trust physicians groups to be good stewards of patient health, making sure they receive the proper care need to ensure they do not enter a revolving door of emergency room visits and discharges. Meanwhile, patients can rest easy knowing that they can see their doctor anytime without paying any more than their monthly premiums and sometime even receive free transportation to and from their physician’s office.