The underlying foundation of Value-Based Care (VBC) is not based on limiting care or quality. It’s about aligning optimal patient care with financial benefit – for the patient, for the doctor, and for the unsustainable cost of healthcare to our overall economy.

As a primary care physician (PCP) in independent practice, you can increase your Medicare Advantage (MA) revenue without seeing more patients while maintaining your independence and control of the way you practice.

How is this possible? Our MA Optimization Platform will support you in using MA to your advantage while you remain in the driver’s seat in the way you take care of your patients.

• No additional cost.
• You Choose your level of risk-reward.
  (ranging from zero risk to a percentage of risk/savings you determine).
• You remain in control of the way you practice.

The platform offers primary care physicians the tools for optimizing their MA revenue at no cost and total physician choice of the level of financial risk and reward (including no risk). It supports primary care physicians through:

• Negotiating better payment for your Medicare patient population.
• Coding and billing management for your MA patients.
• Care coordination and related documentation support.
• Marketing your MA plans to your Medicare patients during the annual Medicare open enrollment period.

Our platform is available to all independent and small PCPs and medical groups on the states of Alabama, Arizona, Colorado, Florida, Georgia, Hawaii, Illinois, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

Our platform works with and is dedicated to helping PCPs remain independent and in control. They negotiate capitated agreements for physicians at rates they don’t have the leverage to quality for on their own. It has been able to help small clinics double their MA reimbursement within six months through negotiated rates with a number of MA plans.

In addition, it can help you choose and participate in the right plans and set up your support system, so your office is successful in increasing your revenue without disrupting your current operations. In addition, help you optimize your participation with MA Plans while seamlessly integrating protocols that will streamline your entire office.

What the Platform Brings to the Table

• Better contracts – The best terms on MA contracts (with regular re-negotiations). Negotiated PCP cap rates from $60 to $325 over the last 6 years (all based on performance). But they start around $60 - $80 pmpm. Upside-only 50% share in the savings / surplus (without any financial risk). Then it switches to an 80/20 savings / surplus split (in favor of the PCP) after 3 years of stable performance. At any point, you can cancel the contract with a 60-day out (no questions asked).
• Better support – The platform also provides the following services to support performance:
• Marketing - to grow patient count (through network of independent brokers who set up events to attract patients to your practice).
• Clinical Documentation Support - from licensed auditors to ensure compliance (and discover undocumented diagnoses).
• Care Management services - for patients on behalf of the practice (to reduce the risk of unnecessary utilization).
• Better software – The platform's proprietary software delivers value-based insights directly to the clinician during each encounter on top of your EHR (integrates with any EHR)
• Pricing – All services are available at no cost to the PCP.

The platform can also take on the management of claims filing for MA patients, removing the burden from your billing staff so you can continue focusing on billing for your fee-for-service patients.

The platform also makes it easy for you to provide the documentation associated with the proactive care you provide to your MA patients by doing the heavy lifting so you can focus on your patient care.

During the annual open enrollment period (October 15-December 7), the platform has the relationships and clout with MA plans to arrange for plan representatives to be in your office at various times during open enrollment to answer your patients’ questions about MA as well as the specific MA plan in which you participate.

As an independent PCP in fee-for-service contract arrangements for your Medicare patient population, you are running ever faster (and never catching up) on an unending treadmill, needing to constantly see more patients and file more claims to offset the decreasing reimbursement levels that insurers know they can force on the smaller, independent primary care practices.

This is a losing arrangement, as evidenced by the exodus of independent primary care physicians. The platform helps independent PCPs like you achieve a consistent, predictable income from month to month and helps you create an environment where you have more time to focus on providing the optimal level of attention and care for your patients.

What’s more, you don’t have to transition overnight from primarily or entirely fee-for-service to entirely VBC. No matter where you are in this continuum, it can help smooth your glidepath during this transition.

In addition to their ability to negotiate capitated agreements for affiliated providers at rates they don’t have the leverage to negotiate on their own, the platform structures agreements to allow you to choose your desired level of risk-reward — from zero risk to your chosen level of shared risk and shared reward from surplus savings.

If you choose to accept some level of shared risk in exchange for the opportunity to share in the savings, you – and only you – determine the level of risk you want to share and that matches the percentage share you receive of any savings.

There is no cost to you in this arrangement because the platform has the ability and willingness to accept risk in these agreements in exchange for the potential to earn a share of any savings.

How the Platform Gets Paid 

The platform is paid by the participating health plans to ensure each PCP is performing on Value-Based agreements. Compensation is strictly determined by how well your PCPs perform.

Performance in the VBC world is a function of count of membership and sum of savings generated. The more the better.

You collect the monthly capitated payments for each MA patient in those plans for which you are a credentialed provider (the platform also helps support the credentialing process for getting you set up as a provider in MA plans).

Participating plans include (but are not limited to):

• Wellcare
• Bright Health
• Devoted Health
• Ultimate Health Plans
• Clear Spring
• And more

In addition, you can exit the agreement anytime with only 60 days advance notice if you should ever become dissatisfied with your relationship.

Using MA to your advantage can also help you retain control and stay independent rather than facing a future with no option other than retiring (if you can afford to) or working as an employed physician in a larger organization, which is the unfortunate circumstance of too many primary care physicians today. Or if you do decide to sell your practice, you can do so on your own terms and command the best price.

Primary care physicians like you still have an option to take control of your revenue cycle and your life, whether you go it alone or participate in an ACO, IPA or other affiliations in a way that doesn’t compromise your independence.

All evidence points to VBC as the future of healthcare in the U.S. Our platform supports independent primary care physicians in learning how to get ahead of inevitable change trends instead of futilely trying to keep up playing the old game by the old rules and falling further behind – if not out of the race entirely.

Independent physicians like you know that the system has been set up to accelerate your exhaustion and discourage you to the point that you give up. Let us teach you how to use the system to stay independent or sell on your own terms.

Our MA Optimization Platform is the empowering solution that brings MA contracts that double a PCP’s Medicare revenue rate from one month to the next. And it continues to increase over time.

Top performing PCPs supported by our platform are consistently earning well over $400 per Medicare patient per month from their MA contracts.

The additional revenue comes from dollars CMS is saving; an inevitable result of keeping patients happy and healthy. These dollars would have otherwise gone to hospital stays and specialist visits.

Unlocking MA Financial Rewards starts with an analysis. To determine the best course of action, we must first find out exactly where you contractually stand with your MA plans.

Our Provider Partner is a VBC company and an MA expert that specializes in the processes of MA Optimization for financial ROI.

They support hundreds of independent PCPs and possess a knowledgeable team of people that handle all necessary tasks and provide frequent reporting and useful analysis.

In a 30-minute Zoom call, we will talk about the required analysis and how much more revenue and reimbursement we can help you capture.

Take a moment to download our NCND. Complete and email it to: support@livewellaps.com. Then reserve your Zoom call with us.

1. Click Here to download our Mutual NCND (pdf). We are NOT data miners. Your info will be kept strictly confidential. We will also be sharing proprietary and confidential information with you on the Zoom call.
2. Click Here to go to our Calendly page to reserve your Zoom call (complete the required fields and when asked “purpose of call,” click: MA Optimization).