Providers: Get Paid to Lower TCOC Costs

As the nation’s largest payer, CMS’ focus is to find the balance between effective patient care, improved health outcomes, and cost containment.

In chronic condition populations, especially those with Diabetes, Heart Failure, Obesity, Hypertension, and COPD the ROI and Provider Compensation for proactive intervention and ED/inpatient admission mitigation can be exceptional.

Driven by Prevention Quality Indicators (PQI) and Total Cost of Care (TCOC), CMS has turned to Providers with an economic incentive model that can generate $1,300 - $1,600 per patient per year in anticipated free cash flow.

How the model works:    

    1.  Providers identify patients with herat failure, non-controlled hypertension, diabetes, obesity and/or COPD.

    2.  Providers designate patients into Chronic Condition Management (CCM), Principal Care Management (PCM), CPC/CPC+, or MDPCP.

    3.  Providers (and/or their staff) complete the 1-page HealthLink enrollment form (per patient).

    4.  Providers monitor patient results, review alerts, and process according to CMS guidelines billing CPT Codes 99454, 99091, G2064 and as appropriate, G2065, 99457, 99458, and 99358.

Providers and their clinical teams elect the notification criteria that meets the threshold for actionable information - in turn, every alert is Insight meeting the conditions each recipient has established for that patient. 

Alerts are pushed to the provider and their team - so there is nothing to check.

Providers/stakeholders choose where to receive alerts (SMS, SMTP, Secure Message App) and when the messages are to be generated.

Included at No Extra Cost:  HealthLink Insight™ for professional colleagues, care providers, the patient and their selected family.   That's right, no extra cost.  Community-of-Care is a central part of HealthLink's mission- we believe that enabling access for the patient's community-of-care is a right.   As the PCP, you elect which colleagues to invite, Patients control which non-provider stakeholders to include.

For providers this means enabling in-house colleagues and specialists with whom the patient is shared to each have access, set their own criteria for alert, and be kept informed.  As one physician said, "Mr. Jones sees each of us in support of his health. To him, we are his providers.  To us , he is our patient."

And, if you serve populations that are part of FQHC or RHC programs, effective January 1, 2021, PCM service are expected to be available in support of those populations!

To learn more,  please reach out to us.  HealthLink, we're here to help.