
Quality comes first.

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.
About Lincoln Health
PRIMARY GOALS OF ACO REACH PROGRAM

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

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

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?

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

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

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

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


WHAT ABOUT OTHER MEDICARE PROGRAMS?

VALUE-BASED SUCCESS THROUGH PARTNERSHIP



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.



OUR TEAM

Peter Hamilton
Managing Member
Behavioral Health Options, Founder & CEO
Freedom From Addiction, Founder & CEO
Merchant Pay, Founder & CEO

Dr. David Priscal
Managing Member
Ilumed, Chief Medical Officer
Humana, Chief Medical Officer
Family Physicians Group, Chief Medical Officer

Robert Cardenas
Managing Member
Behavioral Health Options, CFO
SoBe Well Institute, CFO & COO
Fox Pan American Sports, CFO

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

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