Navigating the complexities of Medicare Advantage continues to be a sticking point for organizations trying to scale their business. In an education session at the 2024 Axxess Growth, Innovation and Leadership Experience (AGILE), Brent Korte, CEO of Frontpoint Health, and Wendy Conlon, MSPT, Senior Vice President of Client Experience at Axxess, discussed the ways organizations can adapt to the changing reimbursement landscape and ensure their survival.
The Evolution of Care
Conlon and Korte began the session by examining how care is delivered under Medicare Advantage, highlighting the differences in care rates among beneficiaries. They emphasized the importance of organizations being aware of these variations in care.
“I think it’s important that we recognize our role as providers of the target population while also considering the various factors that influence the care we provide,” Conlon said.
Conlon also encouraged organizations to understand the margin of care they provide, highlighting that the care at home industry, and healthcare in general, continues to be an undervalued space.
Korte added that organizations should focus on what Medicare Advantage is looking for in terms of providing care, and set expectations for beneficiaries.
Strategies for Success
Conlon noted that organizations providing care for Medicare Advantage beneficiaries need to have a plan in place to see success in their business.
“It’s about strategy,” Conlon said. “It’s truly about disciplined commitment to excellence when caring for patients and a plan to do so appropriately with appropriate measures in place to get to that success and to watch those margins.”
Conlon stressed the importance of organizations finding operational efficiencies and strategizing their approach to patient care. She encouraged them to embrace the financial and administrative aspects of home care, treating it as a business to ensure sustainability and growth.
Conlon and Korte also encouraged organizations to look at their staffing models and clinician structures when strategizing their business.
“Do we have all of our clinicians seeing all of our patients, or have we strategized and almost stratified our clinicians to understand how to see different subsets of patients very specifically and understand those payer models behind them?” Conlon asked.
Korte advised leaders to continue to advocate for an episodic payment model for Medicare Advantage to improve the quality of care patients receive.
“That really, really matters because not only do we get paid more so we can provide better care and get to that 24.9% margin or maybe 14.9% margin, but it doesn’t disrupt our model of episodic care which is very much, ‘give the patient what they need,’” Korte said.
Leaders were also encouraged to use technology to help streamline operations and keep their organizations accountable and their records accurate.
“How nimble is the technology and intuitive for setting up those payers to allow us to make those changes that we need to make when we need to make them, but also to ensure that we’ve got accuracy?” Conlon asked.
The pair concluded the session by emphasizing the importance of not only examining and refining internal organizational processes but also looking outward. They advised leaders to leverage community resources and collaborate with payers.
“Externally, understanding our community and our community resources and then also understanding how we can speak to the payers and negotiate with the payers [is essential],” Conlon said. “We may think, when there’s a group of folks that are advocating for that, that tends to bring about a lot of positive change, but that doesn’t mean that one person [or] one organization cannot be the catalyst for that change to happen.”
With more than 350 attendees, more than 50 sponsors and countless connections made, AGILE was a massive success for everyone. Check out the recap video and mark your calendar for AGILE 2025, May 5-7, in Dallas.
