Relentless Health Value

If I had a nickel for every guest on this show who went on to achieve wild success … TJ Parker from PillPack three years before they were bought by Amazon. Anyway, let me introduce this show with a clip from the recent podcast (EP325) with Dr. Mai Pham. We were talking about the rampant and very open secret of excessive upcoding in Medicare Advantage (MA) that is costing American taxpayers a fortune and is very not correlated with actual spend. Here we go with Dr. Mai Pham:  Stacey: Do you have any thoughts relative to how you ensure that these MA plans that are becoming vast are still accountable to not game the system? How do you plug loopholes in a way that doesn’t invite additional and more nefarious gaming? Dr. Pham: My fantasy has always been that CMS can develop, or somebody can develop, a black box machine learning–driven, risk-adjustment algorithm that no one can see into—not even the payer. It would very much level the playing field, assuming that it was developed correctly, appropriately, and you u