41. An Interview with David Storto: The Pros and Cons of Medicare Advantage

Summary

Leading Organizations That Matter - Episode 41: An Interview with David Storto on The Pros and Cons of Medicare Advantage

Release Date: October 29, 2024

In Episode 41 of "Leading Organizations That Matter," host Ray Spadoni engages in a comprehensive discussion with healthcare expert David Storto about the intricacies of Medicare Advantage. This episode marks a significant shift for the podcast, transitioning from short solo episodes to in-depth interviews with industry leaders, aiming to provide listeners with nuanced insights into crucial organizational and healthcare topics.

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Introduction to Medicare Advantage

The conversation begins with Ray introducing David Storto, highlighting his extensive 40-year career in healthcare leadership, including his roles at Spaulding Rehabilitation Hospital and Tufts Medicine. Ray sets the stage by emphasizing the importance of understanding Medicare Advantage, especially as it diverges from traditional Medicare.

Key Points:

• Medicare Advantage (Part C) is an alternative to traditional Medicare, managed by private insurers.
• Traditional Medicare consists of Part A (hospitalization) and Part B (outpatient services), with Part D covering medications.
• Enrollment in Medicare Advantage occurs during open enrollment, allowing beneficiaries to choose between traditional Medicare and Medicare Advantage plans.

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Government’s Intent and Cost Management

David explains the government's rationale behind introducing Medicare Advantage, primarily aimed at achieving cost savings through private insurers managing beneficiaries' care. Unlike traditional Medicare, Medicare Advantage allows insurers to coordinate care, potentially reducing overall expenses.

Notable Quote:

“Privatizing, which is effectively what Medicare Part C does, gives the insurer the opportunity to manage care in a way that could result in more profits for the insurer.”
— David Storto [06:56]

Key Points:

• Insurers receive a capitated rate per member per month, adjusted for risk and regional factors.
• Success for insurers hinges on managing care costs below the government’s capitated payments.
• Increased enrollment in Medicare Advantage suggests both popularity among beneficiaries and governmental endorsement, though the economic benefits remain contested.

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Benefits and Drawbacks for Beneficiaries

The discussion delves into the enticing benefits of Medicare Advantage, such as additional services (dental, vision) and lower out-of-pocket costs, which have driven over half of Medicare beneficiaries to opt into these plans.

Notable Quote:

“For beneficiaries, part of the reason why more than half have opted in is because there are additional services that are provided...”
— David Storto [08:59]

However, David underscores significant drawbacks, particularly for those requiring extensive care. Medicare Advantage often necessitates pre-authorizations, leading to delays and denials in necessary treatments, especially problematic for individuals with chronic conditions or disabilities.

Notable Quote:

“Medicare Advantage is notorious for denying claims and authorization for rehabilitation care for people. And it's very troublesome.”
— David Storto [13:52]

Key Points:

• Pros: Lower premiums, additional health benefits, streamlined coverage options.
• Cons: Strict authorization requirements, potential denials of necessary care, administrative burdens for beneficiaries and providers.

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The Appeals Process and Its Challenges

When Medicare Advantage denies a claim, beneficiaries can appeal the decision. David outlines the cumbersome nature of this process, which often requires navigating multiple levels of appeals, sometimes culminating in litigation. Despite high approval rates upon appeal, the initial denials create significant hurdles.

Notable Quote:

“There's a level of expertise that's been developed to appeal. And the interesting thing is for people that really go to the mats and follow through this appeal process, the vast majority of them end up being approved...”
— David Storto [14:03]

Key Points:

• Many beneficiaries lack the resources or knowledge to effectively navigate appeals.
• Automated algorithms increasingly determine appeal outcomes, reducing human oversight and potentially leading to unjust denials.
• The system often favors insurers, making access to necessary care a "Russian roulette" for beneficiaries.

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Impact on Healthcare Providers and Organizations

Medicare Advantage's stringent requirements have led to a shift in the healthcare provider landscape. Many organizations are withdrawing from Medicare Advantage due to the administrative burdens and financial strains caused by pre-authorizations and claim denials.

Notable Quote:

“It's actually the tide is turning a bit here. A lot of healthcare providers are dropping Medicare Advantage...”
— David Storto [24:30]

Key Points:

• Providers face increased costs and reduced reimbursement rates under Medicare Advantage.
• Continuity of care is disrupted as providers may refuse new Medicare Advantage patients, limiting patient access to preferred healthcare professionals.
• The reduction in participating providers undermines the network flexibility and accessibility promised by Medicare Advantage plans.

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Future Trends and Policy Implications

Looking ahead, David anticipates that Medicare Advantage will face ongoing challenges as both insurers and providers reevaluate participation based on profitability and administrative feasibility. He suggests that regulatory reforms aimed at reducing denial rates and improving authorization processes are necessary for Medicare Advantage to remain viable.

Notable Quote:

“What is going to need to occur in order for Medicare Advantage to continue to flourish is various things that would mitigate the risk both for the insurer as well as the beneficiary who's signing up.”
— David Storto [30:25]

Key Points:

• Potential regulatory changes could enforce stricter timelines and oversight on insurers' authorization practices.
• The balance between preventing overutilization and ensuring access to necessary care remains a critical policy debate.
• Political perspectives on healthcare reform, such as Medicare for All, influence the trajectory of Medicare Advantage and traditional Medicare.

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Final Thoughts and Recommendations

David offers a cautious perspective for beneficiaries considering Medicare Advantage. He recommends traditional Medicare for most beneficiaries, citing the unpredictability and potential barriers within Medicare Advantage plans.

Notable Quote:

“I say go with traditional Medicare. It just really is, you know, it's roulette, like you said...”
— David Storto [18:27]

Key Points:

• Traditional Medicare provides more predictable access to a broader network of providers.
• Medicare Advantage may offer short-term financial benefits but poses long-term risks for those who require extensive medical care.
• Beneficiaries should thoroughly assess their health needs and understand the intricacies of both Medicare options before enrolling.

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Conclusion

Episode 41 of "Leading Organizations That Matter" offers a deep dive into Medicare Advantage, exploring its benefits and significant drawbacks from multiple perspectives. David Storto’s expertise sheds light on the complexities of Medicare Advantage, emphasizing the need for careful consideration by beneficiaries and ongoing policy scrutiny to ensure that the program serves its intended purpose without compromising access to essential healthcare services.

For more insights and resources, visit RedSailAdvisors.com.

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Contact Information:

For further information or to reach out to David Storto:

• Email: [e-mail]
• Phone: [phone]

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Music by Kevin MacLeod at incompetech.com.

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Note: This summary excludes introductory remarks, advertisements, and concluding statements to focus solely on the substantive content of the interview.

Transcript

[Ray Spadoni]

Foreign.

[David Stordo]

Welcome to Leading Organizations that Matter, a podcast about leadership, organizational culture and how we find meaning and purpose in our work. I'm your host, Ray Spadoni, former Healthcare CEO, current consultant, author and speaker. Today's topic is the Pros and Cons of Medicare Advantage. If you've seen the title of this episode, you'll recognize that this marks a bit of a pivot for us here on the podcast. Allow me to break the third wall for a moment and discuss the podcast itself. For the past 40 episodes it's just been me offering a brief thought or two on a topic of interest for those who lead mission driven organizations. Thank you to everyone who has been listening. It has been fun receiving your questions and feedback and to be honest, seeing the numbers of subscribers and downloads increase week by week has been great and frankly, pretty motivating. Today marks the beginning of the next chapter and introduces interviews with industry leaders and experts. There are a lot of interview podcasts out there that offer one or even two hour episodes. My goal here is to keep them shorter and more to the point, but.

[Ray Spadoni]

Of course they are going to run.

[David Stordo]

A little longer than the four to six minute versions I've released so far and the interviews themselves are going to be spaced apart, so you can expect to still receive the short dose episodes as well. Okay, so here goes. Today I'm delighted to interview David Stordo on the topic of Medicare Advantage. David's going to talk about what that is and then comment on it from the taxpayer, beneficiary and industry points of view. David has over 40 years of experience and many major achievements in healthcare. He served as the President and long term leader of the Spalding Rehabilitation Network and Continuing Care Division of Mass General Brigham, the system formerly known as Partners Healthcare. More recently, David served as the Executive Vice President and Chief Strategy Officer of Tufts Medicine. Among his many distinguished achievements, David secured the funding and presided over the planning, design and construction of the state of the art and world class Spaulding Rehabilitation Hospital in Boston, which opened in April 2023, just 12 days after the tragic Boston Marathon bombings. Under his leadership, Spaulding has consistently been listed by U.S. news & World Report as a top rehabilitation hospital, ranking as a top two or three hospital in the nation. For the past several years. Spaulding is the internationally recognized home of Harvard Medical School's Department of Physical Medicine and Rehabilitation and its residency program has been ranked as one of the best in the country. David is also a leader in the broader healthcare community and has served on a number of boards of directors and industry leadership groups. Trust me, his list of contributions and awards is a long one. Before moving to Boston, David was the Executive VP and COO of the Rehabilitation Institute of Chicago, the number one ranked rehabilitation hospital in the country since its inception of the U.S. news & World Report rankings. David received his Bachelor's degree from the University of Michigan, a Master's in Social Service Administration from the University of Chicago, and a Juris Doctor from the Loyola Institute of Chicago School of Law. Okay, let's jump into it now.

[Ray Spadoni]

Welcome, David. Thank you for joining me on the podcast. It's great to have you here.

[David Stordo]

Thank you, Ray, for having me. Great to be here.

[Ray Spadoni]

Good. Well, I'm looking forward to our topic today, Medicare Advantage. There's a lot that is said and written about the topic. It's been in the news and, you know, on paper. And at the highest level, it's an option for Medicare beneficiaries that makes a great deal of sense. What could possibly go wrong? So I think we're going to talk about the pros, the cons, how it influences our healthcare system, how it impacts subscribers. And so why don't we start with the very basics of what is Medicare Advantage? And you know, for someone as a, as an enrollee or someone who's concerned about the larger policy issues of the healthcare system, what do they need to know about it?

[David Stordo]

Sure. As you said, Ray, it is an option for beneficiaries to go with a Medicare Advantage plan that is administered and managed by private insurers, unlike traditional Medicare that is just managed by the government. And Medicare Advantage is referred to as Medicare Part C. Often Medicare parts A and B are the basic traditional Medicare coverage, A for hospitalization, B for all other outpatient services. And then there's Medicare Part D, that is for, for drugs, for medications. And beneficiaries have the option during open enrollment, by the way, which is just about to start, to participate in either a Part C Medicare Advantage plan or stick with Medicare, know traditional Medicare parts A, not Part B coverage, and then have to get a drug plan under Part D.

[Ray Spadoni]

So from the government's perspective and from a policy perspective, why do they introduce this and what are they hoping to achieve?

[David Stordo]

They're hoping to achieve cost savings by having insurers manage care as opposed to under traditional Medicare, there really is not a care coordination, care management function. There are criteria for different services to be reimbursed at different levels, but there really is no intervention by the government or any other third party to manage the care of a beneficiary. So privatizing which is effectively what Medicare Part C does, gives the insurer the opportunity to manage care in a way that could result in more profits for the insurer. So under Medicare Part C, the government pays a per member per month capitated rate, as it's frequently referred to, to the insurer to manage the total cost of care for that particular beneficiary. It's risk adjusted and it's, you know, you know, reimbursement levels depending upon the different parts of the country. There's a multifactorial kind of calculation that drives what, what's paid. But effectively, if the insurer is able to manage the care in, you know, an amount less than what they're being paid by the government, they win. If they end up, you know, costing more than what the government is paying them to provide care, they lose.

[Ray Spadoni]

Well, given the fact that the, the percentage of enrollees in Medicare Advantage has increased, is it safe to say that they have achieved their objective and that the federal government is completely backing this as an option?

[David Stordo]

Well, you're, you're, it's true the now more than half of beneficiaries have opted for, for Part C plans in terms of how effective it has been at reducing costs. You know, I've kind of, I've seen different kind of reports and studies on what the real economic impact has been and you know, quite frankly, you know, it's just not clear. I think for beneficiaries, you know, part of the reason why more than half have opted in is because there are additional services that are provided frequently dental, glass eyeglasses. There's lower CO pays for services. There may be no CO pays, depending upon a plan, lower premiums than if you stick with traditional Medicare under, you know, a Part B plan where you do pay for that. So it, it, it's got all of those enticements for beneficiaries and insurers spend a lot of money marketing these services. You probably have turned on a TV at some point in time and seen some celebrity that's been touting the advantage of Medicare Advantage and to call that 1-800-number, you know, to, to take advantage of it. So it's got those, those enticements, as I said, benefits that kind of go above and beyond traditional Medicare.

[Ray Spadoni]

Well, the advertisements are compelling. Yeah, they're very easy to be drawn into it. And so if you are Medicare eligible or if you're planning for your own eligibility at some point in time or you're advising a friend or, or maybe you're trying to Help your own parents as they are evaluating the possibility of going the traditional Medicare route versus the Medicare Advantage route. What would you advise, folks? And let's look at this from the beneficiary perspective is what really are the pros? Are the ads correct or are there any cons?

[David Stordo]

Oh, yeah, there are consistent. And the cons basically fall into one major bucket, which is under Medicare Advantage plans, care needs to be pre authorized by the insurer and there are frequently long delays in granting those authorizations for care and there are frequently denials for provision of reimbursement for the services. So for the beneficiary that's basically healthy, doesn't need a lot of care other than, you know, kind of preventive kind of care, and can take advantage of all those enticements that I talked about, it's, it's great. They pay less and they get more. Yeah. Now they get sick, they have a chronic condition, they have a physical disability as a result of a traumatic event or an illness, a stroke, and they need a wide range of services over the course of the rest of their life. Then Medicare Advantages cons really surface in ways that are very, very problematic. And so problematic obviously for the beneficiary and their family, but also problematic for providers, for hospitals, for doctors that, you know, have this care of the person that they can't, can't get authorization to go forward with because they go forward without the authorization, they don't get paid. So that's the biggest, biggest disadvantage and there's a lot more attention being paid to that issue. Now Stat News has really kind of taken this on as one of their, you know, their, their poster kind of issues and, and has written a lot about it. It's, you know, for me, coming out of a career that included a long commitment to rehabilitation medicine, it's particularly problematic because Medicare Advantage is notorious for denying claims and authorization for rehabilitation care for people. And it's very troublesome.

[Ray Spadoni]

What's the recourse if you're a beneficiary who needs, for example, rehabilitative care and they deny me, Am I stuck?

[David Stordo]

There's an appeal process. They vary somewhat from plan to plan, and there's different levels that you can escalate to. The final level is, well, I guess the final level is actually to sue, which has happened in some cases. But before you get to that level, you know, having a, a, a discussion from provider to provider, physician to physician to review the need for the care with the beneficiaries, physician advocating for why they need it to A physician who represents the insurer and ultimately decides, okay, are we going to overturn the initial decision based on this appeal or are we going to stick with that decision? The problem with the appeals process and the process is challenging, cumbersome for, for people that really know what they're doing. And because of the problem that's been created with the pre ops, there is a level of expertise that's been developed to appeal. And the interesting thing is for people that really go to the mats and follow through this appeal process, the vast majority of them end up being approved, which begs the question about why should they have ever been denied in the beginning? And there's, there's plenty of press about it. So any of the listeners here who are interested can, you know, just go on Google and find all kinds of reports. But there's a, a lot now just about how algorithms are being used so that through multiple stages of the appeal process, you're not even really dealing with a human being, you're just dealing with an algorithm. And so, and there's reports of certain insurers that have really, really created pressure for their employees to abide by the algorithms, even when from a clinician's point of view, they feel it inappropriate. And that has created, you know, a lot of controversy in the field.

[Ray Spadoni]

Well, that's fascinating. So if, if ultimately many of the appeals are, are approved and the initial decisions overturned, it feels as though it's a system that has been built to create friction so that, you know, the, the care will be covered but you got to work for it. Is that too oversimplified a way of looking?

[David Stordo]

No, no, I think that, I think that's a nice pithy, you know, characterization. And you know, unfortunately there are plenty of folks and plenty of providers who just either don't have, you know, the, the expertise or even if they have, it have so many other issues that they don't, they don't go to bad. And so that person that might really, the person who's a 68 year old stroke survivor that could really, that was otherwise basically healthy and could benefit from an intensive rehab, you know, intervention might wind up in a, in a nursing home getting less intensive kinds of care and perhaps develop all kinds of other complications. And so it, it, you know, it, it, the, the, the, the denial process actually works because not everybody does appeal.

[Ray Spadoni]

Right. Is there a way? Let's say I'm approaching Medicare eligibility and I say to myself, you know, I've been in an HMO now for 30 years, I'm used the way HMOs, work and, and, and, and I now have an opportunity to pretty much stick with what I know. I'm pretty healthy. But, you know, when that time comes that I get sick, I'm going to surf the wave over and pivot into traditional Medicare so I don't have to deal with all this.

[David Stordo]

Yeah, yeah, yeah.

[Ray Spadoni]

Can I do that?

[David Stordo]

Well, good question. And the answer is yes and no. And when it's yes, you can only do it during open enrollment. So if you are unfortunate enough to have, you know, a traumatic event or a sickness, you know, early in the year after you've been on a Medicare Advantage plan, you're stuck until open enrollment. And then in certain states, if you have been on a Medicare Advantage plan and then you develop chronic illness or condition in certain states, it's possible for all insurers who offer Medicare Advantage plans to deny your eligibility. It's a handful of states. And I, I don't want to mislead by, I think I, I definitely know a couple of them. Massachusetts is not one, by the way, but, but that's a real, real problem for that person that thinks, oh, I'm healthy today and I'll, I'll swap when I, when I really need the traditional Medicare. And then they find out, oh, my God, I don't really have that option anymore.

[Ray Spadoni]

Wow. So it's, it's a bit of a, it's a bit of a Russian roulette situation based on timing and your own health status.

[David Stordo]

David and I, you asked me earlier what I recommend to people and, you know, again, I, I, I will admit my bias. I, I think I've articulated what, you know, some of these benefits are of being on a Medicare Advantage plan. But when even healthy beneficiaries ask me for advice, I say go with traditional Medicare. I just, it really is, you know, it's, it's roulette, like you said. And, you know, you just have to kind of make your own choice based on your tolerance for the possibility that you're going to become ill and not be able to get the care that you need, or you may get it, but it's going to be, you know, major hassle for you, your family and your health care providers to get it.

[Ray Spadoni]

Do you have a sense at all, David, of what's the financial incentive to me as a beneficiary to play in the Russian roulette game? Because, you know, presumably I'm going to look at a Medicare Advantage option and see a lot of benefits to it and save some money versus Traditional benefit, traditional Medicare with some kind of supplemental, you know, plan bolted onto the side of it. Is it, you know, might someone look at this and say, yeah, I'll play, I'll play, I'll play the slots here and see what comes up because I'm saving a ton of money. Do people save a ton of money?

[David Stordo]

They say, I mean, I don't know how much a ton money would be, you know, and, and it's obviously all relative depending upon what one's, you know, financial situation is. But you know, if you are at paying the highest amounts per month under traditional Medicare for, for part B, it's 500 some bucks a month. So, and then you're paying separately for a Medicare Part E plan for your, for your drugs, which can be substantial if you're on high cost drugs as compared to what you're paying in a Medicare Part C plan. Some of those plans also offer the drug benefit, by the way, which would be substantially less than that, might be, you know, a couple hundred dollars a month. So you know, if, if you're a person who's in a position where, you know, you've making these tough choices about, you know, how much food you can put on the table versus, you know, you pay for your health care costs. Yeah, it's, it's a, it's a very, very challenging, challenging situation for people. I, I think the other issue though is that most people don't really understand. I've talked to so many people know my career that didn't even know they were on a Medicare part. They just, you know, they saw the advertisement, they say, hey, yeah, it looks good. I'm signing up for this because I get dental coverage too, you know, and I got bad teeth, so I want to get that dental coverage. So it, it, you know, I, I don't have, you know, an empirical study to support this, but my hunch would be the vast majority of people sign on to Medicare Part C without understanding what you and I have been talking about here, about the pros and cons. They see only the pros and they go for it.

[Ray Spadoni]

There is seeming simplicity to this, but there is complexity lurking just below the surface. You know, David, you and I have spent our careers working in an industry and I'd like to just switch over now to the, to the industry perspective. If you are a healthcare provider, and that's really for this podcast, leading organizations that matter. This concept of some organizations take the long view. They're very principled, they care for their, you know, members of their community. What has Medicare Advantage done to those kinds of providers.

[David Stordo]

Interesting. It's actually the tide is turning a bit here. A lot of healthcare providers are dropping Medicare Advantage for a couple reasons, meaning.

[Ray Spadoni]

They won't even take a subscriber who has Medicare Advantage, they won't have a.

[David Stordo]

Contract and so they therefore will not provide care to, you know, Jane and John Doe who you know, were with the Medicare Advantage plan that the health care provider has discontinued. So and why, why are, is that happening? Well, one of the big reasons is what I would discussed earlier is just the pre auth issues, the denials and the administrative burden and cost associated with dealing with that longer lengths of stay that are, you know, that result in an acute care hospital while a person is, you know, awaiting discharge to, you know, a post acute provider, a rehab, a snf, a home care organization where they can't get the authorization timely. So it, it's, it's imposing a lot of cost and burden on providers. There's also issues and this is also getting a lot of attention, you know, where the government is challenging some of the coding of, of some of these providers, typically referred to as upcoding and alleging upcoding in many instances that you know, has an indirect, you know, economic impact to the provider. So it's, it's interesting that where it was at one point in time, just the cat's meow if you will, particularly for health systems that really kind of really bought into the idea of value based care and managing care effectively to now many providers dropping out.

[Ray Spadoni]

Well, you know, going back for a minute to the, to the enrollee, to the subscriber perspective, further restrictions to the network that's available to you of care and if you have a, a relationship with a provider just by virtue of going into Medicare Advantage, unbeknownst to you at, you know, as you're watching the advertisements and making your choices that you are going to have much more of a restricted network of care that you can access. Yeah. And it's, it's almost impossible to know that at the point when you're signing up.

[David Stordo]

That's right, that's right. And even as you know, you may wind up having a network that works for you, that could change on a dime. And I, I, how many people have you talked to recently? I said geez, I've had like four PCPs in five years. And you know, and that, and that's another issue, just the challenge of primary care and the, you know, the you know, challenges with access to primary care. So when you take that fundamental issue and couple it then with the reimbursement insurance complexity. It's really, really a sorry situation for many people are getting bounced around from plan to plan, physician to physician, network to network in ways that certainly fly in the face of the whole notion of continuity of care.

Well, speaking of continuity of care, and.

[Ray Spadoni]

You know, an area I'm familiar with, and I know you are as well, but in traditional Medicare for home care based services, individuals are given 30 days of care, say they're coming off of a surgery or something and they need home based care and there's 30 days of care. And now in a Medicare Advantage plan, they'll be approved for two or four visits. Not only does that significantly impact the reimbursement to that home care provider, but it changes their identity, it changes the nature of who they are. Because in 30 days of care, you, you're going to case manage, you're going to offer what you believe that patient needs most of all, which could include bringing in an occupational therapist or a home health aide or whatever you think that patient needs in order to meet the care plan goals and to have them move forward and to advance. Now you have four visits. And so for that home care agency, they're getting a lot less money to care for you. It's changing the identity of who they are, but also to go into the home and then to have a nurse say to someone who clearly needs a lot more care, this is my last visit. I have to leave. You're leaving a lot of frustrated patients rather behind who don't necessarily understand that it's not that home care agency's decision to never come back to the home. It's based on what they've been approved for. And so I suspect there are, there are corollaries in other aspects of the industry. But you know, the question really then becomes for the industry, what becomes of this going forward? You mentioned that the tide is turning a little bit. As you see that happening and you look up ahead the road, what are the trends you see coming for Medicare Advantage, if any?

[David Stordo]

Well, I think as they face the number of, you know, in many cases major health systems opting out of Medicare Advantage, you know, and as insurers themselves in certain markets decide they don't want to play either, just because a risk adjustment from their standpoint might not be sufficient. And they kind of, you know, they evaluate whether they think they can make this work profitably. So it's, it's, it's very tricky. I guess I would say that what is going to need to occur in order for Medicare Advantage to continue to flourish is various things that would mitigate the risk both for the insurer as well as the beneficiary who's signing up. You know, so that the, and there is, you know, there's, there's new regulations that came into effect this year that would curb some of what might be characterized as an abuse around authorizations, you know, making, you know, certain time frames in which they have to make decisions which I think are still pretty, they're not restrictive enough. But I think more of that kind of thing will need to occur. And, but then, you know, it's going to also then wind up costing the program, you know, as much, if not more, because if they're, you know, if the providers, if the insurers are, you know, taking a piece of the action, so to speak, you know, that that's costing overall, you know, more for the Medicare program. So that's what I guess I see now. I don't, you know, whether this will ever, you know, the political debate, you know, on the left with the Bernie Sanders kind of approach of Medicare for all versus, you know, strong opinions, you know, on more to the right about keep the government out of my life and every respect and damn, I'm not going to give them, you know, control of my health care care, which is kind of facetious because to some grant, they already do. But, but, you know, I don't know how that's going to play out. I don't know how that political thing is going to play out. It's, it's not been you know, a political advantage to people like Bernie Sanders to have that perspective.

[Ray Spadoni]

Well, you know, we, you know, venturing into the political waters here. I mean, there are so many policy questions and, you know, for, for all of the time that I've been working in the healthcare industry, there's always been challenges, there's always been change. But it feels to me as though over the past several years, and granted we had a gigantic pandemic in the middle of that, but staffing shortages, you mentioned earlier, the primary care shortages, the fact that it has become a very diffic profession for many clinicians who want out. And a lot of it has to do with the aggravation that's presented to them by the fact that there are all these, you know, insurance programs and Medicare Advantage only adds to that because everyone's got their own requirements, their patients are asking them to help with their appeals processes, and they're spending less and less time dealing with the issues that they were trained to deal with, which is the health and well being of their patients. So we're adding complexity and to the Bernie Sanders point, this notion of Medicare for all. And then you alluded to the fact that Medicare is being privatized to the tune of half of are now part of the insurance company. I'm not sure what Medicare for all is going to mean in the future if that's a trend that continues. You know, it's, there's a lot of.

[David Stordo]

Policy questions here in many respects. I mean, I think it boils down to you want to find ways to prevent overutilization of care based on, you know, the old fee for service models where, you know, the more you did, the more you got paid. And then you, the same time you want to prevent, you know, underutilization and withholding of care because provider insurers economically incented to withhold care. How you strike that balance and then, you know, to some extent, if you think of it in context of the legal system, you know, are you, are you prepared to let, you know, nine guilty people go free to ensure that the one innocent person will not, you know, be incarcerated and prevented from going free? I guess if you're talking to David Stordo, I, I, while I certainly would not promote overutilization, I guess if I had to choose between the risks associated with that versus underutilization, I think the government can just pay a few extra bucks for the overutilization because all the infrastructure and apparatus that's put into preventing that is costing a boatload of money too.

[Ray Spadoni]

Well, as is often the case, it usually depends on from which perch you're observing all of this from. And if you are an extremely healthy person and you're doing fine with Medicare Advantage, you know, you might think one way about it, but if you're part of this significant wave of, you know, aged aging population and you are going to be experiencing health challenges in your life, Russian roulette is no, there's no game to be playing. When you need care, you need good care, you need access to it. You don't want to get, you know, aggravation and delays dealing with appeals processes. You know, costs a little bit more to go Medicare traditional. But I'm hearing from you, and I'm certainly sensing myself that folks need to pause and really think about this carefully and recognize that, you know, there's no free lunches. You may save some money on Medicare Advantage, but, you know, sometimes you get what you pay for.

[David Stordo]

Yes, sir. Absolutely. Right.

[Ray Spadoni]

Awesome. It's been, this has been a great Conversation. David, I appreciate it. This is the first of the interview series I've been sort of going with short form, you know, sort of one or two points per podcast. Been doing it now for a little over half a year and I'm now great.

[David Stordo]

They're great, by the way. As you know, I listen to all of them.

[Ray Spadoni]

Well, thank you. That's. I, I appreciate that very much. It's been, I will tell you, it's, it's a little addicting watching the subscribers go up and the, the downloads go up. It's been fun, but I'm, but I'm very much looking forward to taking it to the next phase. And so I, I can't think of a better inaugural episode on a, on, on a very, very important topic. So thank you very much for your willingness to be the crash test dummy on this podcast when it comes to the interviews. I know you're still very actively engaged in, in the industry. If folks are interested in learning more about you and the kinds of work that you're doing, how can, how can people get in touch with you?

[David Stordo]

Email is my last name Storto S T O R T O 907gmail.com and my cell number is 617-759-7724. That's how to reach me.

[Ray Spadoni]

And thank you for that. You're, you know, being accessible, you're a, you're an expert in this field and you're certainly an expert, given your long history leading significant organizations in healthcare, makes you a very valuable person. So thanks for being so accessible. I'll put that contact information for those of you who are driving and can't write it down. I'll make sure that's all in the episode notes and drive safely and, and thank you. Thank you all for listening. And again, David, thank you so much.

[David Stordo]

Thanks, Ray. Take care. Have a great day.

[Ray Spadoni]

You too.

[David Stordo]

Thanks for listening. I hope you'll consider leaving a five star review on Apple Podcasts or your platform of choice that will help others find us here. My mission is to help empower organizations that matter by supporting those who lead them. Feel free to learn more about me and my [e-mail].