Reducing Total Cost of Care and creating new Medicare billings for your provider Clinics is your ACO’s primary mission. But the high cost of doing business has not been met with adequate increases in reimbursement by CMS. And the increasing administrative burdens due to inappropriate MA plan practices have created an environment of financial uncertainty and lower or no shared savings distributions for member TINs.

The solution, the ACO Support platform can help you reduce Total Cost of Care, improve Quality Scores, provider utilization, the ability to act upon information immediately, and create accurate documentation that supports a patient’s diagnosis and satisfies potential Quality Care and CMS / MA audits. In addition, create new Medicare billings for your member clinics, increase billing encounters, reimbursement, and shared savings distributions that meet the expectations of your Member TINs.

How much money have you invested in the systems and processes (and people) that help to optimize your Shared Savings results? What is the annual ROI to your Member TINs? And what are you doing to create an increase in ROI?

Many ACO executives boast about their cost of care, Quality scores, robust risk adjustment, cost savings, abstract coding teams, QA audit teams, care coordination, and provider education. Unfortunately, they are still apathetic about action needed because up until now, fully meeting requirements has not amounted to any significant increase in revenue. This has now changed.

So, now executives need a new and significant value to show their Board and Member TINs. Our ACO Support platform is the answer.

The platform offers a comprehensive suite of services:

• Medicare CCM Program Optimization
• MACRA Optimization
• HIE Optimization
• RAF Compliance Optimization
• Patient Outreach Optimization
  

See below for the important details on each.

Most ACO are Not Optimized for CMS's Medicare CCM Program

CMS has a program that you might not think of as a core mission for your ACO. But what if activities you already perform could generate new Medicare Revenues, both for your ACO directly, and for your member TINs?

The Medicare CCM Program is Natural

The CMS Medicare CCM Program pay above and beyond office visit based chronic care.  ACO's who think outside the box should be able to easily extend care coordination activities to reimbursable monthly Chronic Care tele-health activity.

It sounds simple, and natural.  After all, everyone cares for chronic patients.  But most provider groups don't have the resources to take advantage of this important Medicare program that reduces costs, generates revenue, and improves patient care.

The Medicare CCM Program is Lucrative

How lucrative? We will do the math for you.

ACO-employed nursing staff can generate new revenue that range from $56 to $120 per patient per month, shareable between your Member TINs and ACO.

We will help figure out what your opportunity could be. We analyze your physician practices against a series of CPT Codes with reimbursement averaging around $80 per patient per month.  And we pair that with data on each TIN's top 3 Chronic Conditions by patient volume and project the gaps.

We will analyze this impact on you and your first 5 TINs at no cost to you.  We use CMS-Public data for this analysis, so there is no effort required by you or your TINs.

How We Help You Generate Medicare CCM Health Revenue

• Evaluate existing TIN-level CCM activity.
• Predict incremental physician-level CCM revenues.
• Create an ACO-level CCM program.
• Proprietary technology for high volume  CCM program efficiencies.
• Predict revenue for your ACO.
• Operational and strategic CCM program support.

The Entrepreneurial ACO

Your ACO can create a new business, as a virtual CCM vendor to your Member TINs and clinics.

CCM is a major new initiative for every ACO and their participating clinics that goes down the path.  In many ways, it is a lot like a business startup.  Your best chance of success is to align yourself with a team experienced in big initiatives.

Why Set Up as a Medicare CCM Program Vendor?

Your providers could (and some will) contract with outside organizations who sell CCM services.  We know this because we are one of those organizations ourselves.  They (we) charge a per-patient-per month fee in exchange for conducting tele-health Care Management visits with qualifying patients.

Those Care Management "calls" can overlap with your own care coordination mission and create confusion among patients.  Would it be better for your own staff to be making these calls? One big benefit is that under Medicare rules, you can get paid for it.  And with your close relationships with your clinics, you are in the position to do a better, more cost-effective job of it.

What Do You Need to Combine Care Management with Care Coordination?

IT is like any other business.  You will need a template for a contract / arrangement with your clinics to provide this service.  You will need software that manages Medicare compliance and supports high-volume tele-health scheduling.  And you will need a library of templates for care plans, patient education, and patient consent documentation.

Beyond that, you can leverage existing capabilities, in your nursing care coordination staff, and clinical data integration with TIN EHR / Billing systems.  The platforms provide all of this and more.  

Provide Patient-Level Nursing Staff to Your Member TINs and Clinics

Sometimes the biggest obstacle is just getting started.  Who will do the initial stages, until your volume hits the level where full-time staff is profitable?

We provide nursing staff on a per-patient (or even on a per-call) basis.  The cost of these staffing arrangements come from clinic billings. However, there is a reasonable set-up fee.

How Your ACO Can Become a CCM Vendor

Software

Our Provider Partner will license (and even white-label) their proprietary CCM software suite to you.  Their software suite is built to create staffing efficiency.  They integrate with clinic EHR and pass billing data to clinic practice management systems.  And their tele-health tools schedule and make phone calls, while tracking nurse time and documentation that Medicare requires for billing.

Further, their software comes complete with configurable care management templates and patient education materials that your nurses will need.

They also offer a software-only option that could also be the perfect solution. Advanced CCM software tools help to scale your Medicare CCM Program upwards.  If your clinics  only have one Care Manager, and a small number of patients, their staff can manage the process manually.  But as patient volume grows, those manual processes create errors and bottlenecks that will constrain efficiency and the ability to reach all the patients who will benefit from the program.

Contracts

Sometimes the biggest speed bump is in drafting the contracts, proposals, and marketing materials that educate and commit clients.  The platform comes complete with the templates that you can use as-is or modify to fit your unique offering configuration.

Processes

There are two dimensions to the Medicare CCM Program.  One dimension (the obvious one) involves certified healthcare professionals interacting with consented patients according to a physician-approved care plan.  In this dimension, all activity is paid for under Medicare.

But there is a second dimension, that often gets overlooked and becomes a big obstacle to a rapid ramp-up.  That dimension involves analyzing your existing patient population and reaching out to them and is pre-funding.  Patients need to understand that they have the option to work with their own dedicated nurse every month, at no cost to themselves.  We support this need with outreach tools that help your team efficiently educate patients and get them enrolled into the "for-pay" component of your offering.

For your ACO's care coordination activity is a natural patient outreach, giving you a huge advantage in achieving high penetration into your chronic condition population.

Staffing

The platform contract will enable - but not require - you to tap into a knowledgeable and certified nursing staff.  We call it demand-based staffing that helps kick-start your operation.

Startup Strategy

Think of the platform as something of a "franchise" partner.  The platform has already developed the software, templates, and processes that get you a quick start.

 Why the Medicare CCM Program is Mission Critical for ACOs

• CMS estimates that the Medicare CCM Program reduces Medicare cost by $74 PMPM.
• CCM and ACO overlap in mission-critical areas.
• Chronic condition-based quality.

Where clinical Quality Measures reference chronic conditions, the presence of the Medicare CCM Program goes far in sustaining visibility into chronic patients.  And visibility is a first step in managing quality.

Chronic Condition-Based Cost

Cost measures are completely based on Medicare patients.  This makes the Medicare CCM Program particularly powerful in the ability to influence utilization of expensive services, by pre-empting the need with ongoing clinical care.

Care Coordination

Care coordination and care management involve both clinical staff interacting with active Medicare patients.  The goal of both is to prevent the need for expensive services. The difference is that you can get paid for CCM.

Physician / Clinic Relationship Management

Imagine a scenario where your activities generate new revenue for your physician population - daily.  In some cases, you enable those revenues in ways the physicians cannot.  Might that improve physician recruitment and retention?

Patient Recruitment (REACH-Model ACO)

REACH-Model ACOs are allowed to provide incentives to patients to be a member of the ACO.

What better incentive for a patient than having monthly access to their own nursing staff?

The payment adjustments under the Quality Payment Program’s (QPP) and Medicare Access and CHIP Reauthorization Act (MACRA) began in January 2024.  And its increase in the Medicare Fee Schedule to TINs is now at a level that can exceed most Shared Savings Distributions.

MACRA Facts

The QPP & MACRA went into full effect on January 1^st, 2022. But up until 2024, it was just a compliance checkbox issue and a nuisance. But now eligible ACO Member TINs, physicians, and clinicians receive a positive or negative payment adjustment of up to 9% more, or up to 9% less on their Medicare Part B claims submissions, based on your ACOs (or their own) Corresponding Performance Year Final MIPS Score (note* Critical Access Facilities & Federally Qualified Healthcare Clinics are exempt).

MACRA requirements make up thousands of pages of regulations in the Federal Registry and are a very complicated beast and no small task to manage or optimize.

Though most ACOs did a good job meeting Quality Measures in the past, many are missing the opportunity to help Member TINs qualify for the maximum payment adjustment of up to 9%.

MACRA is Worth Money$$

The CPY is the 12-month period during which Quality, Promoting Interoperability, Improvement Activity, and Cost data is gathered, and after the close of the year, submitted to CMS. Around 6-months later, CMS calculates the payment adjustment (based on your ACO’s Final Adjusted Score and the population of the revenue neutral pool, which is capitalized from the physicians who are penalized).

The PAY is the 12-month period during which the CPY’s financial adjustment is applied.

Make sure your Member TINs don’t leave any money on the table. Help them qualify for up to the maximum payment adjustment in the next PAY.

Understanding the financial implications of the QPP & MACRA helps in making the decision on whether to invest in MACRA Optimization / Registry Services or stay the course with your ACOs current effort very easy.

The only thing worse than failing to maximize your Member TINs payment adjustment is not taking the simple steps to help them qualify for it.  And that’s exactly what most ACO decision makers are doing.

The MACRA Optimization Cycle

Optimization consists of a 9-step process that can only be achieved with an Active or On-Going Program that follows a regiment of extract, report, analyze, plan, and act for each quarter or month. And only by taking each step can your ACO earn an exceptional Category Weights and a Final MIPS score that will qualify your Member TINs for the maximum payment adjustment in the next PAY.

Technology That Provides More Than EHR

Who Needs It? (Epic, Cerner, Allscripts, eClinical Works) - Almost All EHR Users

EHR’s can't submit MACRA data directly to CMS.  In fact, it can be hard to even analyze MACRA data in meaningful ways.  That's why the platform subscribers get better reimbursements, with less manpower.

Physicians Buy EHR for Patient Care - Not for Fast-Moving Regulatory Compliance

Managing MACRA from a physician point of view should be a by-product.  We find that even the best EHRs only keep up with MACRA at the superficial level of creating numerator / denominator values, and honestly - those rules don't change much.

CMS Publishes Hundreds of Pages of New MACRA Rules Each Year 

The platform relies on EHR to do the numerator and denominator work, but does all the rest relating to those hundreds of pages.

EHR Plugin

The platform is a cloud-based tool that connects to EHR with no local software needed.  And with its enhanced reporting and sophisticated concierge team take it to the next level - beyond simple numerator / denominator content.

Whether EHR is sophisticated enough to create QRDA3 output, a simple spreadsheet, or just a PDF - connecting to the platform simplifies connecting to CMS.

Automated Data submission

With the platform there is no need to manually submit or upload data via EIDM.  It provides an automated streaming API directly to CMS, with automated response and tracking at the level of TIN, Provider, MIPS Category and Measure.

MACRA Financial Projections

The platform automatically queries CMS for Medicare billing and payment history for each provider.  Then it applies statutory minimum / maximum expectations based on each year's MACRA rules, adjusted for estimated CMS Scaling Factors.  It then sets budgets that tie together operational performance with financial performance.  Finally, as it accumulates PI, CQM, Cost, and CPIA data throughout the year, it displays actual financial results against these budgets.

Provider Dashboards and Scorecards

Our platform's excellent dashboard integrates financial performance with MACRA operational performance in uniquely powerful models.   It flags individuals, TINs, and customizable groupings against operational targets throughout the year. And it provides potent provider communication tools that clearly share the impact of performance.

Analysis of Alternatives

As the platform tracks actual performance data through the year, you will have instant visibility into which submission models (Group / Individual, EHR / Registry, ACO / Advanced APM / Standalone) earns the greatest MACRA reimbursement.

Physician Compare / Review and Correction Cycle Management

Submission is not the end of your MACA Season. CMS ultimately will echo back their understanding of submissions, and gives the chance to agree, or to submit data for further review.  The platform gives provider groups the tools to manage the overall process.

Complex TIN and Provider Organization Management

No one tracks complex organizations like the platform.  Its tools incorporate not only TIN dashboarding, but also identify the key workflow steps that keep track of progress across complex TIN structures.

Software + Concierge

Because the platform is independent of EHR and Registry offerings, it is in a unique position to identify, configure, and submit your very best MACRA options.  It often blends from multiple offerings, which really fine-tunes your result.

Tools and Consulting Combined

Not even the best tools stand alone.  And not even the best consultants can organize and optimize complex data.  We believe your needs include both consulting and software thoroughly integrated.

Your Concierge is always available, for help with any MACRA tasks.  The platform’s software integrates with any EHR and any Registry, to give you the best of both worlds.

MACRA is much more than a year-end submission exercise or a periodic measure calculation.

You can’t improve performance by looking at your metrics after the year is over.  And simply making numbers available a couple times a year only improves things a little.

At times your ACOs Category Weights and Final MIPS Score may not be complete and/or accurate. And while some solutions can be applied retroactively, many require that coders or physicians change the way they describe things, or even change physician behavior.

Many so-called MIPS or MACRA experts’ (vendors) give lip service to CMS quarterly or monthly requirement of integration and feedback. They get by with a dashboard that clients can look at any time. Such a passive approach is NOT reliable. The fact is – a dashboard is the least reliable of all.

What Else is Required

For your Member TINs with fewer than 100 physicians & clinicians, it should be enough to run reports from your EHR quarterly, post them to a standalone MACRA database for performance analysis, and discuss shortfalls against targets.  For complex multi-TIN organizations, MACRA Optimization steps need to be done monthly.

Sophisticated program analytics is required because raw MACRA data doesn’t mean a lot to ACO and TIN management, physicians, or clinicians.  By adding the financial impact, this creates a clear frame of reference. And once CMS publishes their Physician Compare content, the MACRA team should study the impact of public scores on the flow of new patients.

Many of your mid-to-large sized Member TINs may need at least one person with the expertise, time, and resources (including access to external expertise) to maintain or achieve the highest performance status.

If your ACO is already working with a MACRA or MIPS vendor or Registry, you still need an independent 3rd party review of their work to ensure they’re following up on all requirements. Because you can’t afford to find out if they’re not after the fact.

We will also help your ACO identify areas that need improvement for getting a patient scheduled for Chronic Care Management (CCM) conditions. So, if you’re looking to do more than check the compliance box, the platform will allow you to turn your compliance into higher revenue by developing services in line with CCM.

Payment Adjustment Remittance Verification

In PAY 2024, CMS reports that more than 21% of all MIPS eligible TINs, physicians, and clinicians will be penalized with a negative payment adjustment.

It is estimated that up to $3.6 billion will be redistributed to 2022 top MIPS performers in 2024.

Your Member TINs can find their payment adjustment in their QPP Detailed Final Report. But they need to verify the payment adjustment on each claim they submit because it will not be easy to identify and will require a bit of calculation to show if it is correct. It will show as a dollar amount on their remittance advices, but to determine if it is accurate they will need to convert it to a percentage and compare it to the expected percent for the submitting physician, which will not appear on their remittance advices. Our Payment Adjustment Remittance Verification pulls the expected percent from the CMS / QPP database and compares that value to the value calculated on your Member TINs Remittance Advices.

Your management team needs to contemplate the value of the payment adjustment in the Medicare Fee Schedule under the QPP & MACRA to those same TINs knowing that a single point (increase or decrease) in MIPS score will probably be worth up to $250k or more.

Some of our MACRA solutions will be oriented towards your ACO (i.e., calculation of eCQMs under optional / mandatory regulations, and real-time calculations of ACO-level MACRA (MIPS) scores throughout the Corresponding Performance year (CPY), and others towards your Member TINs (i.e., enabling a hierarchy of CQM, PI, IA, & Cost evaluation and submission and Patient Engagement options that can enhance the TINs Payment Adjustment Year (PAY) revenue and reimbursement beyond ACO-level results).

We will help your Member TINs earn that return and probably for considerably less than half the cost of a single new hire.

eCQM

As CMS incentivizes ACOs to integrate eCQM into their reporting repertoire, your Member TINs will look to your ACO for guidance. We provide the needed knowledge, tools, and people to support all required data collection, communication, and analytics to help. And quite probably do it for less than the cost of one employee.

Our formal process for optimizing MIPS (Category Weights Scores) proves that early corrections have big impact, and that year-end (submission-time) analysis has little or no impact on improvement.

Advanced APMs

Advanced APMs are exempt from MIPS. However, most if not all physicians will likely fall into “Partial QP” status due to the QP threshold increase from 50% to 70%.

The impact is that Partial QPs are optional MIPS submitters. But with your normal high performance, submissions should earn your member physicians more than their historical QP reimbursement of 5%.  (Note: by electing to not submit they receive zero).

Here is the best option going forward - First, as Partial QP’s, submission should be made by all TINs individually, and the ACO-level CQM submission does not apply.  In this approach, we fulfill the role of ACO support by interacting with each TIN throughout the year to optimize their own Category Weights Scores. For all but one TIN, this will involve generating CQM data from their Certified EHR. This approach will avoid any chance of penalties and maximize earning & efficiency for your Member TINs.

For your member TINs that utilize an Ambulatory Certified EHR, proactive steps must be taken to meet compliance requirements. CMS requirements for sharing, receipt, and use of digital data could have a serious impact reimbursement.

The platform is a vital and proactive solution for all MIPS eligible ACO Member TINs. It is particularly important for ACOs who score well on CQM, but more must be done to help members qualify for the maximum payment adjustment under the QPP & MACRA by improving their Promoting Interoperability (PI) Score, which is an integral part of the CMS MIPS score calculation.

Your member TINs PI Scores is a major component of your ACO’s Adjusted Final Score and measured by CMS through the calculation of:

1. Effective Use of Their EHR (Integration & Feedback with CMS)

You might think all EHR’s handle compliance requirements. EHR’s are only the start - not the finish.

Even the best EHRs only keep up with CMS requirements at the superficial level, and only Ambulatory certified EHRs can submit data directly to CMS. No Inpatient certified EHRs can submit.

PI Scores are EHR driven because all reportable metrics come from EHR systems. And your members EHR needs to define the relationship between eligible clinicians and TIN.

The platform will help your members optimize their EHR by coordinating with their IT team (and the EHR vendor) to have all CMS integration add-ons activated (this comprises up to 30% of their PI score). 

2. Coordination of Care Among Multiple Providers (Referral Network)

The most challenging part of meeting CMS compliance and achieving a high PI score lies in you and your members managing your Referral Network data. CMS prefers the use of a bi-directional HIE, but this option is not available in all areas.

There is an alternative for those without a viable HIE. It is possible to share relevant clinical data by incorporating information about their referral network into their EHR – and incorporating information about them into theirs.

The platform analyzes the options available in all areas. And if available, coordinate between an EHR vendor and HIE providers. If an area is not supported, we have a fallback process for managing Direct Messaging (in the event they need to take this step, there may be additional fees) or we can coach them through the process of doing this on their own.

We will help your members achieve the most effective referral pathways to exchange clinical data, which will help them meet requirements and dramatically improve their PI Score and the efficiency of their entire Referral Network (this comprises up to 40% of their overall PI score).Top of Form

3. Patient Care Coordination & Integration (Patient Outreach/Data Collection)

Increasing Quality of Care by directly assessing and highlighting gaps in care at the individual patient level is required by CMS. The platform’s engagement gathers risk-level data on your members entire patient population across all payors utilizing assessments that have been designed to gather the maximum relevant health information (this comprises up to 30% of their PI score).

A Must Know for Those MIPS Eligible

The PI Category Weight is worth 25% of your ACOs Adjusted Final Score and requires a minimum of any continuous 90-day reporting period during the calendar year. Under certain circumstances, CMS will reweight the PI Category to 0% and the 25% would be added to other MIPS Category Weights.

The last day for your members to start a minimum 90-day reporting period to attest to PI is October 1^st. So. they need to start optimization as early in the year as possible or risk failing on PI, and therefore fail to maximize their payment adjustment under the QPP & MACRA in next the PAY.

To learn more about Member TIN PI score improvement, see our HIE Optimization webpage.

Why RAF Compliance Optimization is important

• More than 50% of Medicare beneficiaries are now enrolled in MA plans.
• Since 2021, chronic conditions among Medicare beneficiaries have skyrocketed.
• Due to this rise in chronic conditions, beneficiaries are trapped in their MA plans. Going back to regular Medicare is not possible because they would not be able to afford their high-risk Medicare Part G Supplement insurance premiums. Without ACO’s and their member TINs taking action, this will be inevitable and cause a huge spike in lost reimbursement and write-offs.
• Providers need the best-in-class technology and support to ensure timely reimbursement and an increase in claims acceptance by MA plans.
• ACOs and their member TINs need help negotiating better capitated agreements terms with MA plans.

CMS Final Rules

CMS’s Final Rules dictate that ACO's must meet Risk Adjustment Factor (RAF) compliance requirement benchmarks and targets to qualify for higher reimbursement.

CMS’s Risk Adjustment Data Validation (RADV) and Transaction Coding of Diagnoses Final Rules, and the National Quality Strategy (NQS) are in effect. These have and will continue to create lower reimbursement and a significantly higher risk of an audit.  In addition, The Transactional Coding of Diagnoses to support billing in a fee-for-service environment is NOT adequate to meet VBC program care requirements.

What ACOs Need

ACOs and their member TINs require a tool that empowers you / them with instant access to the information and data needed to manage and code each patient’s specific diagnoses – as well as create the documentation that supports the coding.

Members need a professional service that delivers results which achieve improved compliance, patient RAF Scores, patient attribution, Quality Scores, increased billing encounters and reimbursement, enhanced clinical support, outcomes, patient satisfaction, and cost reduction.

ACOs are paid based on patient RAF Scores. It’s a fact that physicians struggle with having enough time to complete ACO requirements related to the redocumentation of diagnoses. This can negatively impact the accuracy of patient RAF Scores.

To drive higher reimbursement, ACO’s often seek to identify diagnoses which will result in higher patient RAF Scores. This requires focus on the coding of a patient’s diagnoses, and not necessarily on how well each condition is being managed. In other words, VBC models have created an overemphasis on coding, instead of on caring.

ACO’s use a variety of methods to increase patient RAF Scores. One approach is to review a patient’s medical record, typically after the patient encounter, to identify opportunities for “upcoding” a diagnosis to raise scores. For example, if a diabetes diagnosis can be coded as having neurological manifestations, the risk score will be higher, as will the reimbursement.

Just a quarter-point increase in a patient RAF Score translates into an extra $3,000 per patient per year to your ACO and higher shared savings for your members.

There are a lot of software products coming to and on the market claiming to help identify opportunities to optimize or manage risk, but in reality, they are just a veiled way of upcoding. They do NOT provide the tools at the point of care for the patient; that is, properly manage, evaluate, assess, and treat a patient’s various conditions in accordance with the original intent of VBC: Improved Outcomes Through Better Management of Patient Health.

We will make efficient management of patient care as easy as 1-2-3. And it will Reflect the health status of a patient population accurately and compliantly, which makes it a vital tool for ACO’s and their member TINs.

RAF Compliance Technology

The platform technology provides the top-tier support you and your member TINs need on VBC reporting and outcomes management. Through EHR forensics, it allows them to view provider level risk scores from the prior and current years as well as the overall average risk score. You will be able to drill down to the usage of unspecified and unsubmitted coding and all patients associated with a provider. This will show the dates of a patients last physical exams, next appointment, number of ER visits, number of diagnoses codes, the number of unspecified as well as unsubmitted coding, and the patients risk score.

Being able to view this information allows you and your member TINs to identify areas that need further improvement or education and is vital for getting a patient scheduled for Chronic Care Management (CCM) conditions that need to be maintained and documented for improvement of the patient’s accurate risk score.

Under the NQS, VBC, and Standards of Care Guidelines where a medical necessity is found, action must be taken, unless the patient declines the service. Failing to do so can result in the reduction of Quality Scores and/or the penalty of lower reimbursement. Even if your ACO and / or member TINs are doing Annual Wellness Visits (AWVs) and Health Risk Assessments (HRAs) for every patient, you and / or your member TINs must act on any medical necessities found within those results. And each time a patient encounter is completed, new medical necessity “next steps” must be immediately identified.

Most ACO’s swing & miss on identifying many services that can generate hundreds of thousands of dollars in additional annual revenue with VBC such as Chronic Care Management.

The platform provides electronic beneficiary engagement and completion of the assessments.

Specific types of assessments are sent to an entire patient population throughout the year for completion including Health Risk Assessments, Social Determinants of Health Assessments, and others. They are delivered electronically via email and/or text / SMS and designed to gather relevant health information and engage patients in between visits, as well as obtain updated contact information as part of the process. Then patients can be engaged based on their low, moderate, or elevated risk.

The assessments reflect the health status of patients accurately and compliantly and are helpful at identifying elevated health risks and prompt the patient to come into the office prior to next scheduled visit. Thus, potentially helping to minimize hospital admissions and Urgent Care or ER visits. The patient is also asked to confirm and consent to the provider's review of the assessment results, which will result in a billable E-visit.

They are designed to gather the maximum relevant health information, whether the treatment standard is MIPS, HEDIS, STAR or Quality Care Measures, the platform pivots to those measures.

Patients with High Risk Factors are asked to schedule an appointment with their PCP within the next 7, 30 or 90 days, based on approved protocol. Follow-up actions from here are additional electronic engagement, virtual care, or in-office visits. And this creates immediate revenue for and achieves enrollment attribution for patients.

The patient communications are a combination of compliance statements and rewards that creates a 45-65% response rate, while the response rate of all other patient engagement methods is in the low to mid-single digits. The best part, in as little as 30-45 days the platform can significantly improve billing encounters.

Most services are provided at zero up-front cost and are only reimbursed when paid for patient services rendered.

Based on the individual risk level, patients can receive an email or phone call based on their needs and a staff’s direction to facilitate additional electronic services, a virtual appointment, or in-office visit. This could be a scheduling phone line, an email address, or even a link to book their own virtual or live appointment. You and your members decide how you want each category handled.

Managing the Increase in Patient Visits

The first step is to put the right patients in front of appropriate staff / personnel. Physicians are surprised to learn that over 50% of patients can appropriately be handled by another staff / personnel member.

The platform has a national network of PAs, NPs, MAs, etc., that are at your disposal who can help further triage moderate-risk patients into action or support staff / personnel if needed.  And this can be white labeled.

ACO Reach

You and your members will achieve improved patient diagnostics, attribution, reimbursement, and / or meaningful shared savings distributions. Trying to accomplish this under an ACO REACH model is less effective because you can’t drive the metrics needed to identify patient complexity, and thus assure a risk-sharing lift, without top performing Patient Outreach data. The performance metrics gathered from the platform will provide a significant boost in risk shared revenue while lowering overall costs.

 

The ACO Support platform is the empowering solution that will ensure your ACO and member TINs meet all requirements, improve Quality Scores and patient outcomes, reimbursement, reduce Total Cost of Care, and unlock Medicare CCM Program revenue streams. A reasonable analysis and / or set-up fee may apply.

It provides the support you need. All services are tailored to your ACO’s specific needs, which can change from one year to the next. They require very little workload and no additional staffing requirements.

Unlocking Financial Rewards starts with an analysis.  Because to determine the best course of action, we must first find out exactly where your ACO and member TINs are hitting and where you are missing.

Take a few moments to download our supporting materials.

• Live Well A.P.S. Inc., ACO Support Brochure (pdf).
• CMS MLN CCM Booklet (pdf).
• Medicare Chronic Care Management for Seniors article (link).
• CMS Outreach and Education on CCM report (pdf).
• Mathematica 2017 report on CCM (pdf). (This is an important study, but a bit long.  See page 64 for the Bottom Line)
• 2024 CMS MIPS & PFS Final Rule Changes (zip).
• Qualified Registry - A Pathway to Success within MACRA (pdf).
• 2024 CMS RADV Final Rule Changes (pdf).
• CMS Proposes Major Changes to Medicare Advantage HCC Codes in 2024 (pdf).
• Diagnostically Connecting Data and Diagnoses (pdf).
• HEDIS Measure Subset Impacted Patient Engagement (pdf).

Our Provider Partners are the leading professional service providers and consulting firms that specialize in the processes of the Medicare CCM Program, the QPP & MACRA, HIE, RAF Compliance, and Patient Outreach Optimization for financial ROI.

They support thousands of independent and hospital-based physicians & clinicians, multi-TIN organizations, IPAs, ACOs and APMs and their Member TINs.

They are specialists that possess knowledgeable teams of people that handle all necessary tasks, provide frequent reporting, and useful analysis.

In a 30-60-minute Zoom call, we will talk more about the required analysis and how we can help your ACO meet its mission goals and provide you with something you will be proud to show your Board and members.

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: ACO Support).