Oct 17, 2019
In this health care podcast, I speak with John Gorman, who is a government-sponsored health programs guru. He’s also the founder of a newly minted organization called Nightingale that (spoiler alert) we discuss toward the end of our conversation. I just want to interject right here that I, for one—but I’m sure John would agree—do not believe that Medicare Advantage (MA) is, as is, perfectly terrific and devoid of problems.
There are, of course, well-known issues with coding, the whole exaggerated diagnoses for higher reimbursements thing … then there’s the whole potentially wasteful quotas payments and the restrictive networks of doctors cited issues. We don’t get into these during our conversation, focusing instead on comparing MA to FFS (fee-for-service) Medicare.
From there, we get into advice for independent physicians in rural hospitals and then we wind up at price gouging by nonprofit hospitals. John’s points are insightful as always, and I guarantee he will give you a lot to think about.
You can learn more and connect with John on LinkedIn.
John Gorman is the founder
and former executive chairman at Gorman Health Group (GHG). For 22
years he led the development of the industry’s leading consulting
practice and several entrepreneurial ventures in government health
programs. John’s work focuses on Medicare Advantage, Medicaid, and
Accountable Care Act strategy, governance, and social determinants
of health. John considers himself a defender and fixer of health
insurance coverage, especially Medicare, Medicaid, and subsidized
individuals served by health plans. He has strong opinions and
relies on evidence and sound policy. Prior to founding GHG in 1996,
he was appointed by President Clinton as the first assistant to the
director of the Health Care Financing Administration’s (now Centers
for Medicare and Medicaid Services) Office of Managed Care.
After leaving GHG in July 2018, John founded and currently serves as the CEO and chairman of Nightingale Partners, an organization dedicated to helping payers and providers make an impact on social influences that prevent patients from achieving healthy, happy lives. Nightingale Partners is a qualified Opportunity Zone investment firm focused on social determinants of health.
John continues to speak regularly at about two dozen industry conferences across the country each year and is regularly quoted in the trade press and national media. He serves on the board of directors of Henry Ford Health System’s Health Alliance Plan in his birthplace of Detroit and serves as a senior adviser on Medicare Advantage and Medicaid to Premier Inc., the hospital purchasing cooperative. John serves on the editorial advisory boards of several industry publications, including Bloomberg Government.
01:37 The quality measures being used to assess value.
04:00 “Half of the rating is attributable to the member
experience.”
04:29 Are the ways that FFS and Medicare Advantage value-based care
measures are weighted legitimate?
07:59 Insurance carrier profitability.
08:33 Medicare for all to Medicare Advantage for all—how John sees
this morphing into the future.
11:07 Is insurance profitability at the expense of the rest of the
country?
13:47 “A more rigorous antitrust approach to hospital mergers would
certainly help.”
15:10 “Get bigger and get more sophisticated in … the value you
bring to the table.”
16:49 “There’s always strength in numbers.”
20:35 EP202 with Frazer
Buntin.
23:28 “If you’re not adapting, you’re
dying in this environment if you’re a hospital.”
24:37 John’s advice to rural hospitals.
27:44 EP219 with Arshad
Rahim.
28:27 What Nightingale is and what they do.
You can learn more and connect with John on LinkedIn.
Check out our newest #healthcarepodcast with @JohnGorman18. #healthcare #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
The #quality #measures being used to assess value with @JohnGorman18. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
“Half of the rating is attributable to the member experience.” @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
Are the ways that #FFS and #MedicareAdvantage #valuebasedcare measures are weighted legitimate? @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
#Insurancecarrierprofitability. @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
How will #medicareforall morph into #medicareadvantage for all? @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
Is #insuranceprofitability at the expense of the rest of the country? @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
“A more rigorous antitrust approach to hospital mergers would certainly help.” @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
“Get bigger and get more sophisticated in … the value you bring to the table.” @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
“There’s always strength in numbers.” @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
“If you’re not adapting, you’re dying in this environment if you’re a hospital.” @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging
What Nightingale is and what they do? @JohnGorman18 discusses. #healthcare #healthcarepodcast #podcast #digitalhealth #medicare #qualitymeasures #medicareadvantage #pricegouging