Lincoln Health Logo

Quality comes first.

Lincoln Health Logo

Quality comes first.

Lincoln Health is a Managed Services Organization (MSO) supporting providers and their patients through access to value-based payment models, leading population health technology, and care coordination.

Utilizing the ACO REACH program, Lincoln Health assists providers in creating value while delivering first-class patient care.

PRIMARY GOALS OF ACO REACH PROGRAM

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Transform Risk Sharing Arrangements

flexible cash flows, predictable spending targets, payments that recognize the challenges of caring for complex chronically ill populations

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Empower & Engage Beneficiaries

enhanced voluntary alignment, benefit enhancements / patient engagement incentives transitioning Medicare FFS Beneficiaries into a Value Based Care delivery model

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Reduce Provider
Burden

manageable set of core quality measures, waivers to facilitate care delivery, opportunities for organizations new to Medicare FFS to participate

RECEIVE AN INCREASED FEE FOR SERVICE RATE OR CAPITATION RATE

FFS Rate

  • Receive an increased Fee For Service for providing quality healthcare

OR

CAP Rate

  • Receive a capitation rate per beneficiary for providing quality healthcare

QIP Bonus

  • Quality Incentive Bonus Earnings
  • Get rewarded for delivering high quality patient care and high quality healthcare
  • Simplified claims-based measures – no eCQMs

Shared Surplus

  • Against national risk-adjusted benchmarks
  • Benefit from the savings you generated by delivering better patient outcomes and overall quality healthcare

will there be billing changes?

Bill as Normal - Lincoln Health

Continue sending clean claims for all services to CMS as you normally would.

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Covered services will receive either a 110% increased FFS payment, or a 100% claims reduction with a PBPM capitated rate.

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Non-covered services, typically non-PCP services, will continue to be paid FFS per the CMS allowable.

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Upon completion of the performance period, receive shared surplus from savings compared to CMS risk-adjusted benchmark.

FULL SUITE OF DIFFERENTIATED POP HEALTH CAPABILITIES

TO MANAGE TOTAL COST OF CARE

Right care for the right patient at the right time

Apply targeted strategies and interactions with high-risk patients

Interactive
patient and provide profiles and scorecards

Increased focus on social determinants of health

Detailed gaps
in quality care
reports

High-risk patient trend analysis
and utilization optimization

FACTORS FOR SUCCESS

1

Primary Care

Be proactive with an
average of 4+ patient visits
per year.

2

Quality Visit

Address and document all
chronic conditions.

3

Gaps in Care

Close HEDIS quality care
gaps through preventative screenings.

4

Appropriate Referrals

Better control chronic conditions with appropriate specialist referrals.

5

Case Management

Ensure frequent touch points with highest risk patients.

6

Bonus Demographics

Collect additional demographic information for bonus quality points.

BETTER MANAGE YOUR HIGHEST RISK PATIENTS

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WHAT ABOUT OTHER MEDICARE PROGRAMS?

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VALUE-BASED SUCCESS THROUGH PARTNERSHIP

ilumed Logo
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desert rose recovery logo

Through its partnership with Ilumed, Lincoln Health provides access to value-based care solutions for providers and their patients nationally via the Direct Contracting / ACO REACH model.

Transforming healthcare

Proprietary technology and a network of leading providers with a mission of streamlining and modernizing healthcare.


Early adopter success

Accepted into the 2020 implementation period, Ilumed was one of the first participants in the DC model.


Scalable infrastructure

Utilizing both claims data and EMR sources, we provide risk stratification, gap identification, streamlined best-practices, management reports, and more.


Experienced team

Deep experience in clinical operations, risk contracts, administration, managed care, and practice turnaround.


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OUR TEAM

Peter H

Peter Hamilton

Managing Member

Behavioral Health Options, Founder & CEO
Freedom From Addiction, Founder & CEO
Merchant Pay, Founder & CEO

Dr. David Priscal

Dr. David Priscal

Managing Member

Ilumed, Chief Medical Officer
Humana, Chief Medical Officer
Family Physicians Group, Chief Medical Officer

Robert Cardenas

Robert Cardenas

Managing Member

Behavioral Health Options, CFO
SoBe Well Institute, CFO & COO
Fox Pan American Sports, CFO

James Hale

James Hale

Advisor

DignifiHealth, COO
Artivest, Head of Platform
Raymond James, Director
-Alternative Investments Group

Richard Queen

Richard Queen

Advisor

DignifiHealth, Co-Founder &
CEO
Ultimate Health Services, CFO
Memorial Health Systems,
Director of Data Solutions

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