PROVIDERS OF MEDICARE SHARED SAVINGS

 PROGRAM: 

 OUR MENU OF SERVICES FOR PROVIDERS OF MEDICARE SHARED SAVINGS

 PROGRAM (MSSP) MASTERY

• We will help you to establish your own participation in an established ACO/MSSP with the complete support of our proven success team.
• We provide an underwriter for your risk guarantee if you can’t provide or secure your own financial reserves. The Program has nine - $1+ billion who support Our partnering sponsor MSSP programs.
• Our data analytics will validate how CMS scores your providers and then automatically maps out and executes the care plans that the CMS Standard of Care requires.
• We will separate and isolate the risks within your provider roster so poor performers don’t drag down the risk share revenue of the stronger performers.
• We will partner with you, manage the entity for you, and/or provide the technology and the care coordination with Our electronic patient engagement and VSN.
• We share in a percentage of only the revenue lift that we provide in your risk share over last year, leaving the lion’s share of revenue to you.
• We provide all of these services for a small Per Member Per Month (PMPM).
• We will provide Coding support, chart preparation support, and a hotline for your staff to ask questions about either program.

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.