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 an independent PCP, 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.

There is a solution, you can increase your MA pmpm without seeing more patients. How? Our MA Optimization platform supports you in using MA to your advantage.

• There is NO 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 accomplishes this by:

• Negotiating better pmpm 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.

The platform helps independent PCPs achieve a consistent and predictable income from month to month. 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, the platform will smooth your glidepath during any transition.

(Platform is available to all independent and small PCPs and medical groups in the states of Alabama, Arizona, Colorado, Florida, Georgia, Hawaii, Illinois, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia)

The platform negotiates capitated agreements for physicians at rates they do not have the leverage to quality for on their own. It has been able to help small clinics double their MA pmpm within six months through negotiated rates with numerous 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.

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 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 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.

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.

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 because the platform has the ability and willingness to accept risk in the 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 PCP performs.

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 will also help support the credentialing process for getting you set up as a provider in MA plans).

Participating plans include (but are not limited to):

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

You can exit the agreement anytime with only 60 days advance notice if you should ever become dissatisfied with the relationship.

Using MA to your advantage will 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 does not compromise your independence.

All evidence points to VBC as the future of healthcare in the U.S. The 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.

Unlocking MA Financial Rewards starts with a Data Analysis.

To determine the best course of action, we must first find out exactly where you contractually stand with your MA plans. We will utilize data you supply us from your MA Plan(s), Electronic Medical Records (EHR) system, Practice Management System, and/or other manual sources.

Additionally, we will identify ways for getting patients scheduled for Chronic Care conditions and higher revenue for you by developing services in line with the CMS Medicare CCM Program.

To learn more, see our Medicare CCM Program Optimization webpage.

Our MA Optimization platform is the empowering solution that brings MA contracts that can double your MA pmpm revenue from one month to the next. In fact, it can continue to increase over time.

The platform’s ability to negotiate capitated agreements at rates most PCPs do not have the leverage to obtain on their own is the key. And PCPs supported by the platform are consistently earning higher pmpm 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 otherwise go to hospital stays and specialist visits.

Our Provider Partners are experts that specialize in the processes of MA and Medicare CCM Program Optimization for financial ROI.

They support hundreds of independent PCPs and possess knowledgeable teams 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 MA revenue 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).