CMS’s National Quality Strategy (NQS) requirements have begun. These have and will continue to create lower earning and a significantly higher risk of an audit if not handled properly.

Our Patient Outreach Optimization platform is a vital and proactive solution for all TINs, physicians, and clinicians from all payor classes. In addition, IPAs, ACOs and Advanced APMs.

Though most TINs did a good job with patient engagement compliance in the past, due to complexity and the failure of vendors to provide the proper expertise, tools, and/or training, most are NOT meeting CMS requirement benchmarks and targets.

Administrators even boast about their EHR, cost of care, robust QA audit teams, and provider education. Unfortunately, too many are still apathetic about actions needed because up until now the requirements have not amounted to any significant increase in revenue. This has now changed.

So, now when ownership, boards, and/or stakeholders ask why your TIN’s reimbursement has been reduced and no one can explain why or do anything about it, ignorance or apathy will not be an accepted excuse. Don’t let this to happen to you!

Increasing Quality of Care starts by directly assessing and highlighting gaps in care at the individual patient level. You are required to gather specific standardized and health risk assessments on up to 60% of your entire patient population and integrate this data into your EHR system.

Under the NQS, Value-Based Care, 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 you’re doing Annual Wellness Visits (AWVs) and Health Risk Assessments (HRAs) for every patient, you 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 TINs, physicians, and clinicians swing & miss on identifying many services that can generate hundreds of thousands of dollars in additional annual revenue with Value-Based Care and CMS’s Medicare CCM Program. In addition, it is the cornerstone for increasing reimbursement via improved MIPS and/or patient RAF Scores.

To learn more, see our Medicare CCM Program Optimization, MACRA Optimization, and RAF Compliance Optimization webpages.

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

Specific types of assessments are sent to your 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 also 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.

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 your billing encounters.

You will receive a monthly report showing the detailed encounters information. This includes patient demographics and a unique encounter ID.

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

You might think your EHR handles your outreach requirements. Your EHR is only the start - not the finish.

Even the best EHRs only create numerator/denominator values. None can address the hundreds of individual patient medical necessities and “next step” requirements, nor can they maintain compliance standards because they’re a forensic tool, tracking only what has been done or what is left to do off a taskmaster list. Without assistance, none one can identify individual medical necessities, nor can they directly engage each patient to begin the next steps electronically. Assessments and their resulting medical necessities extend far beyond the capabilities of any EHR.

All EHR platforms generate raw assessments but cannot expose new medical necessities or guide the CMS Standard of Care plan. So, even if you’re do an assessment on 100% of your patient population, you can still be penalized with a lower score for failing to act on new medical necessities found within the results.

Based on the individual risk level, patients can receive an email or phone call based on their needs and your 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 decide how you want each category handled.

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 you and achieves enrollment attribution for your patients.

The information contained in the assessments can be used prior to the in-office visit while also allowing the patient to update their information including email and cell phone. The data is helpful at identifying patients to come into the office prior to the next scheduled visit, thus potentially helping minimize hospital admissions, Urgent Care or ER visits.

Managing the Increase in Patient Visits

The first step is to put the right patients in front of your 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 your staff/personnel if needed.  And this can be white labeled as your TIN.

Relying upon an ACO REACH 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 exceed those from an ACO REACH and provide a significant boost in risk shared revenue while lowering overall costs.

The transient nature of working with physicians and clinicians and managing the evolving regulatory compliance standards related to Value-Based Care, and standing out from the competition as an ancillary service provider can be very challenging.

We can help you successfully overcome obstacles while adding significant value to your core business. The platform bridges compliance gaps and drive new business from your current Medicare provider clients, as well as make it easier to attract new providers.

The Three Problems You Face

1. Medicare Physicians don’t order.
2. Medicare Physicians drop the ball.
3. Medicare Physicians don’t pay for lack of medical necessity.

The platform solves these problems at NO cost to you. It facilitates billable events by identifying medical necessities (where applicable) for your service offering from your referring Medicare provider’s entire patient population.

This is accomplished by Specialty Assessments that provide your referring Medicare providers with the required third-party validation of medical necessity. In addition, enrollment of their patients and submits pre-populated orders for your service. The result is an increase in compliance and revenue.

All Ancillary Service Providers Can Benefit

Any type of ancillary service, such as RPM, Sleep, Allergy, ANS, etc., will be enhanced by the platform by identifying medical necessities, engaging patients to enroll, and improving compliance.

Our Patient Outreach Optimization platform is the cornerstone for obtaining data that is both invaluable and actionable. It will ensure you meet requirements, increase revenue and reimbursement, and improve outcomes and patient satisfaction.

Understanding the financial implications of Patient Outreach helps in making the decision on whether to invest in optimization services or stay the course with your ACO, vendor, or your own efforts very easy.

Take a few moments to download our supporting materials.

• HEDIS Measure Subset Impacted Patient Engagement (pdf).
• NQS 2024 (pdf).AHA 2024

Our Provider Partner is the leading firm specializing in the processes of Patient Engagement Healthcare Technology for financial ROI.

They support thousands of independent and hospital-based physicians & clinicians, multi-TIN organizations, ACO members, and Medicare Advantage plan providers. They 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 simple enrollment process. The execution of a BAA is required.

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: Patient Outreach Optimiztion).