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.