AEGIS COST CONTAINMENT SOLUTIONS
The Mission of Aegis Cost Containment Solutions Inc. is to assist Health Plans and employees in achieving real Value/Evidenced Based Quality Care by specific diagnoses. maximizing Health plan savings, and getting healthier employees.
We work with:
Health systems, Health Plans ,Self-Funded Plans,Taft-Hartley Plans, Payers, Third Party Administrators, Referral/medical/case/population/Disease Management Companies, Network Management Companies, ACOs, VBP/P4P programs, HIEs, Brokers and Reinsurers.
In short, our partner own's the very technology used to grade, rank, and penalize providers for failure to meet value-based scoring metrics and medical necessities identified for each individual patient. Within the results of each new encounter, our platform identifies new medical necessities and automatically generates care plans in seven categories. This gives us a Risk Stratification as well as the exact cost to care for any patient population at any given moment.
The Health Model is a model that can provide solutions for various stakeholders attempting to navigate the complex environment seen in digital health care and remote service delivery. It is built on the concept of leading with technology while supporting with people in order to deliver the right care, at the right time and in the right place. This requires a system that is scalable, customizable, and sustainable in the setting of a comprehensive health care delivery system with complex regulatory, compliance, and reimbursement challenges for all.
Health care choices made by patients are deeply personal. Similarly, stakeholders within the health care industry require various resources, levels of support and technology solutions. The bottom line is that there is no “one size fits all” approach for either of these groups and there is no single, universal solution to manage all the complexities and nuances of the health system.
The Team takes this significant reality into account and has designed programs to leverage tools and the management strategies described below. These can be used in whole, in part or delivered in a customized package to create a multifaceted, but simple to use, system tailored to the unique needs of various stakeholders. The resulting net effect is a system that meets these varied needs, while simple enough to use to ensure meaningful engagement and, ultimately achieve success as clients define it.
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Health Systems/ACOs – Improve quality scores to mitigate CMS quality penalties, increase bonus payments/shared savings from value-based purchasing arrangements/pay for performance programs and make risk-based reimbursement profitable using our program for referral optimization.
On the Medicare Advantage or ACO side, we unlock the key to creating the highest compliant revenue shares. No more great scores and no distributions. Our system puts the focus on remote engagement to triage who needs to be brought into the office. No labor costs are involved in this process. Then we focus on improving risk scores and individual patient complexity risks. The results are phenomenal. We can also engage your commercial or WC patient populations in support of any program initiatives you choose.
Please click on the links below for a brief summary of each market segment. Thank you for your interest and we sincerely look forward to working with you.
Case Study – How Our Referral Optimization Solution Increases Profitability and Funds Shared Savings Programs Under Risk Reimbursement/ACOs While Mitigating CMS Quality Penalties
A major health system decided to become an insurer/ACO and asked a critically important question “How does a health system generate profits under risk reimbursement?”
Answer; Just like any other business, by reducing costs of production within the revenue parameters while improving quality. Historically, health care systems looked to optimize revenues not costs. However, with the growth of bundled payments and other risk reimbursement models, optimizing costs will be necessary in order to be profitable. Furthermore, with increasingly severe financial penalties for quality deficiencies, minimizing that risk will also be required. So, optimizing cost and quality within revenue limitations is necessary.
The question then is how do we reduce cost without major organizational disruption?
Answer; Referral Optimization – identify which providers have demonstrated superior performance in longitudinal price efficiency and quality for specific diagnoses and then fund a shared savings program to incentivize providers to change referral patterns.
What are the benefits of Referral Optimization?
Schedule a call www.calendly.com/sc-a3
So how was this executed?
1. Our program scored and ranked physician/facility combinations on a diagnosis-specific basis on both longitudinal price efficiency and quality.
2. Our program quantified differences in physician/facility on a longitudinal diagnosis-specific basis as shown in Exhibit 2 A and 2 B in the link below.
3. Then the amount of profit contribution was estimated that would fund the shared savings. This required assumptions such as what percent of patients would be referred to high performing providers and the average savings per year per diagnosis was calculated.
4. Rules for bonus payments from the shared savings fund are customized so providers have a financial incentive to change referral patterns.
A process is established to document and publish “best practices” by diagnosis.
OUR MENU OF SERVICES FOR MEDICARE SHARED SAVINGS
PROGRAM (MSSP) MASTERY
Our technology operates in the background away from your office and staff workflow for a very small Per Member Per Month (PMPM) fee.
These are services that providers are now required to perform but are largely not paying for via the standard platform offerings and the results and notes are readily available to you
To provide a telemedicine visit for a moderate risk patient, either your staff performs that work or Our technology will perform the service on your behalf for $20 per encounter.
On services such as AWV that you may choose to the bill, we will deliver everything needed to your Electronic Health Record (EHR) completed by our PAs/NPs for
$65. Your bill for the services and you keep the rest. You only pay for what you need.
Consider the program your “Compliance Assurance”!
For more information, connect with us and do a walk through for your specific needs. Leading with technology while supporting with labor, only where needed, is the only way that any value-based or fully capitated program can increase performance. To bill or not to bill for services is your choice and can vary based on your protocols.
MASTERING COMPLIANCE AND RISK SHARE REVENUE IN THE MSSP MARKET
Utilizing Our ACO REACH Compliance Assurance Program.
Our Virtual Urgent Care with our Comprehensive Patient Wellness Portal is the answer
By using the Our technology to determine what services are required based on each individual patient’s medical necessities, through our Virtual Support Network (VSN) will then begin the process of engaging patients remotely. This is the “Box Checking” portion of the requirements for acting where medical necessities are found.
From within the results of the initial assessments, the risk levels for action are identified. A patient with no significant risk level will repeat the same assessments in 90 days.
A patient with moderate risk should be followed up with a billable telemedicine call to determine the next steps.
The provider’s staff can try do this, or we can ensure this is for you.
A patient with elevated risk is automatically scheduled for an office visit and pre-registered in our software.
In some borderline cases, or if staffing is a challenge, providers may engage with Our licensed staff to perform these services remotely in the background away from the office and staff workflow.
Our national network of Physician Assistants (PAs), Nurse Practitioners (NPs),
Medical Assistants (Mas), Health Coaches, etc. is able to effectively perform these services on the providers behalf.
Here is the “Triage” aspect of what WE DO; We will perform by scheduling 20% of the patients that are in present need of your services for you and will continue to monitor the other 80% remotely, all without the direct cost to the provider for each encounter. Leading with technology allows us to be very high touch when labor is a challenge.
So far, all of this box-checking and triage work has been performed by our Coordination Technology, and not one penny has been expended on your staff labor.
In the ACO REACH or other MSSPs, you are required to perform these services and submit a claim to get HEDIS credit as well as drive the metrics needed to drive risk share revenue. You merely address the patients with moderate or elevated risk via telemedicine or an office visit as you deem appropriate.
If your MSSP does not have a carve-out for these services, they will return a zero claim. If they do, then you will be reimbursed the full amount yet pay us only a fraction for the technology engagement.
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Medical Assistants (Mas), Health Coaches, etc. is able to effectively perform these services on the providers behalf.
EHR data analytics, are essentially historical forensic data that identifies what was completed for the patient and does not necessarily identify the hundreds of items that were missed. Further, these systems do not provide a care coordination workflow to solve the gaps in care
expected, much less engage the patient on the provider’s behalf.
Our exclusive and proprietary technology knows the individual medical necessities of each and every patient. With each new encounter, the technology documents and updates the patient’s record with new medical necessities and care plans in seven specific areas expected and mandated by the CMS standards of care.
Whether the measuring standard is MACRA/MIPS/STAR/ HEDIS/QCM, The program can pivot its system by payer to enable these metrics while at the same time weaving in the CMS Standard of Care to provide the necessary value-based metrics.
With this road map to success, we assists providers in the delivery of appropriate care to patients with several best-fit options.
Currently, THE PROGRAMS Virtual Support Network (VSN) can provide over 150,000 virtual patient encounters per week.
This is a national network of Physician Assistants (PAs), Nurse Practitioners (NPs), Medical Assistants (MAs), Health Coaches, etc. Our VSN team will perform the services as a natural extension of the provider’s staff in the background away from the provider’s normal workflow.
The information related to the services performed is then dragged and dropped into the provider’s EHR without the need for full systems integration.
On the MFFS side, there is never an upfront cost, and nothing is owed until after the provider is paid. The providers’ profit margin for engaging Us to perform these services is 2-3 times what the typical margin would be for work performed by their own staff in their own clinics, yet our system requires no software to learn and requires no additional staffing.
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Sat | Closed | |
Sun | Closed |
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