The underlying foundation of value-based care 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.

Our Patient Outreach Optimization Platform is a vital and proactive solution for all payor classes (Medicare, Medicare Advantage, Medicare Shared Savings Plans (MSSP), Medicaid, Commercial – Insured and Employer Self-Funded Plans, and other Risk Based Reimbursement Plans).

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 National Quality Strategy (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.

Compliance is Now Incentivized

Though most TINs did an okay job with patient engagement compliance in the past, due to complexity and the failure of vendors and EHRs, 98% are NOT meeting the new requirement benchmarks and targets.

Administrators even boast about their EHR, 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!

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 gathered information is also 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.

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.

The Bottom Line

You need a professional service that will deliver results that achieve improved NQS compliance, RAF Score, patient attribution, Quality Scores, increased billing encounters and reimbursement, enhanced clinical support, outcomes, patient satisfaction, and cost reduction. And for ACO members and MA plan providers, not only do you need fee-for-service revenue, you must also drive the metrics necessary to identify patient complexity, and assure a risk-sharing lift.

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.

Patient Assessments that Reflect the Health Status of Patients Accurately and Compliantly Are the Cornerstone for Increasing MIPS and Patient RAF Scores, Billing Encounters, and Reimbursement. In addition, Bridging Compliance Gaps and Vulnerabilities.

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.

Our 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.

Promoting an Ancillary Service

We can also help you grow your in-house ancillary programs. If you have one that you want to grow, such as CCM, RPM, Sleep, Allergy, ANS, etc., we can grow those for you.

This can be accomplished with Specialty Assessments that provide the required third-party validation of medical necessity. In addition, enroll the patient and submit pre-populated orders for your services. The result will be an increase in compliance and revenue.

To learn more about offering CCM, or how to build-up your ancillary service offering(s), please see our Ancillary Service Optimization webpage.

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’ll talk about how our platform will help you meet NQS requirements and data that is both invaluable and actionable.

Take a few moments to download our Patient Outreach Optimization flyer, the NQS, and our NCND. Complete and email it to: support@livewellaps.com. Then reserve a Zoom call with us.

1. Click Here to download the NQS 2024 (pdf).
2. Click Here to download our Mutual NCND (pdf).
3. Click Here to go to our Calendly page to reserve a Zoom call (complete the required fields and when asked “purpose of call,” click: Patient Outreach).