Medicare Advantage
In Medicare Advantage, much of the work behind your quality scores happens between visits.
The discharge follow-up. The refill nobody picked up. The care gap nobody called about. That work needs a system, not one person holding it all in their head.
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It’s Thursday. The report just landed.
The plan’s monthly file arrives: hundreds of rows, every one a patient someone should call. The hospital has sent three discharge summaries since Monday. The adherence list says a dozen patients are late on a refill, and the only way to check is to open the plan’s portal and look them up one by one.
If you’re the one who handles this, you’re good at it. You’re also the only one who knows where everything is: a spreadsheet, three portal tabs and your head. When you’re out, it stops.
Then the quarter ends, the score moves, and nobody can say exactly why.
Four kinds of work. Each one with a name on it.
Each used to live in someone’s spreadsheet. Now each one is a list with an owner, a due date and a log of every call attempt.
Hospital follow-up
Seven days go fast
Today
A patient is discharged on a Friday. The papers arrive as a fax nobody has time to read, and by the time someone calls, the window has closed.
What changes
The details from the papers come already filled in for someone to check, and the 7-day window, calls, transport, equipment and medication checks are tracked until it’s closed.
Refills and adherence
The refill nobody picked up
Today
The adherence report lists who’s at risk. Confirming who picked up means opening the portal one patient at a time.
What changes
The report becomes call lists. Pickups are pulled in from the portal for the whole list at once, and patients who can’t afford a medication are held and followed, not lost.
Care gaps
The care gap that walked out the door
Today
A patient with an open gap comes in for something else and leaves with it still open, because nobody knew in time.
What changes
Call lists for open gaps, plus the patients coming in this week who still have one, so the gap is handled while they’re in the building.
Condition lists
The list that doesn’t match
Today
The plan’s list of conditions and your providers' lists drift apart.
What changes
Your providers' lists are checked against the plan’s before the visit, so each condition is addressed accurately in the room and supported by the chart.
Nobody retypes from the portal.
The plan’s monthly quality and adherence files go in as they are, with no retyping. Pickups are pulled in from the plan’s portal for the whole list at once, instead of someone opening each record by hand. When a document is read for you, like a discharge summary, a person on your team checks every detail before it counts. The work gets faster. The judgment stays with your team.
For the doctor who signed the contract
You signed a contract that pays for quality. You were never handed a way to run it.
Medicare Advantage pays for work that happens between visits. When that work slips, so does the money, and usually nobody can say exactly where. With this in place, you can see which follow-ups are open, where the quality work stands, and who is working each part of it.
We don’t chase scores. We make sure what’s addressed in the room is accurate and supported by the chart, and that the quality work your plans pay for gets done, and counts.
Other quality contracts work the same way.
Tell us which part of your quarter keeps catching fire.
Start with one. Nothing to prepare.
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