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THCB Reader -- April 24, 2021

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THCB Reader

April 24 · Issue #110 · View online

Everything you always wanted to know about the health care system. But were afraid to ask.


This week on THCB Reader, Kim Bellard critiques Biden’s infrastructure plan and argues that we need to reinvent the long-term care system and Hans Duvefelt reflects on the almost-daily influx of paperwork fraudulently trying to obtain physician signatures. 
We have two WTF Health interviews where Jess DaMassa gets the inside scoop on Cano Health’s SPAC IPO and Crossover Health’s next move after their recent $168 million Series D. 
Meanwhile, on Thursday’s episode of THCB Gang, I was joined by regulars: futurists Ian Morrison (@seccurve) & Jeff Goldsmith; privacy expert and now entrepreneur Deven McGraw @HealthPrivacy; and digital health guru Fard Johnmar (@fardj). Click here to see it.
And of course to listen any time you can subscribe to #THCBGang and #Healthin2Point00 podcasts with an easy click on Apple or Spotify.

In health care tidbits this week, I’m focusing on the RAF. In case my British friends are confused, this does not concern military aviation but it’s about how Medicare Advantage (MA) plans get paid. Basically the higher the RAF (risk adjustment factor) the sicker the patient is and the more the plan gets paid. This week HHS’ Office of Inspector General reported that back in 2015 Humana had made a mistake of $200m when it reported the health status & RAF of its members. You’ll be shocked, shocked to discover that this error was not in the taxpayer’s favor. Futurist Jeff Goldsmith who (I am thrilled!) is a regular on the #THCBGang is a Humana MA member, and also is a cancer survivor. He told us this week that about every 3 months Humana calls asking to send a nurse to his house to “just assess how he’s doing.” He surmises that what’s really going on is that Humana is looking for factors that would allow them to upcode his RAF, and that every MA plan has a systematic effort going on to do that. Given that in recent years the OIG has accused Anthem, Cigna and United of RAF upcoding, it’s hard to argue that it’s not going on. In fact the OIG thinks that about $2.8bn each year is paid out to insurers because of inappropriate RAF upcoding, of which 80% results from assessments given during home visits–such as the one Jeff keeps being offered. Given the hay being made by the big MA plans at the moment, it’s not hard to imagine that the sun may at some point stop shining.
Follow me on Twitter @boltyboy and THCB at @thcbstaff for more similar insights/nonsense (and even the occasional sensible idea)! Enjoy! – Matthew Holt
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April 20, Kim Bellard
The biggest part of Biden’s infrastructure plan is home and community services, but Kim thinks despite these laudable goals, they aren’t nearly enough, and are not spent on the right things. We may miss a generational opportunity to fundamentally rethink the infrastructure for long-term care. Let’s not just throw more money at home and community care workers; let’s reinvent the long-term care system in which they work. 
April 23, Hans Duvefelt 
One of the many dirty little secrets in medicine is that doctors get so many papers to sign that there is actually no way we could read them all before scribbling our signature if we still want to see patients, meet clinic revenue projections and match our own productivity quotas. But scammers take advantage of that, sending suspicious faxes to collect physician signatures.
One Drop is reimagining chronic condition care. Learn more at getonedrop.com
One Drop is reimagining chronic condition care. Learn more at getonedrop.com
Inside Cano Health's SPAC IPO & Tailoring Medicare Advantage Primary Care for the Latino Market
Crossover Health’s CEO on Next Move: Private? Public? With a Payer??
Hope you enjoyed the newsletter. As ever let me know if you have any comments or want to sponsor/advertise–this newsletter doesn’t write itself but about 17,000 people get it and 80-100K visit the blog every month!
Matthew Holt
Matthew Holt
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