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.
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
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
- Receive an increased Fee For Service for providing quality healthcare
- Receive a capitation rate per beneficiary for providing quality healthcare
- Quality Incentive Bonus Earnings
- Get rewarded for delivering high quality patient care and high quality healthcare
- Simplified claims-based measures – no eCQMs
- 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
patient and provide profiles and scorecards
Increased focus on social determinants of health
in quality care
High-risk patient trend analysis
and utilization optimization
FACTORS FOR SUCCESS
Be proactive with an
average of 4+ patient visits
Address and document all
Gaps in Care
Close HEDIS quality care
gaps through preventative screenings.
Better control chronic conditions with appropriate specialist referrals.
Ensure frequent touch points with highest risk patients.
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.
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.
Utilizing both claims data and EMR sources, we provide risk stratification, gap identification, streamlined best-practices, management reports, and more.
Deep experience in clinical operations, risk contracts, administration, managed care, and practice turnaround.
Behavioral Health Options, Founder & CEO
Freedom From Addiction, Founder & CEO
Merchant Pay, Founder & CEO
Dr. David Priscal
Ilumed, Chief Medical Officer
Humana, Chief Medical Officer
Family Physicians Group, Chief Medical Officer
Behavioral Health Options, CFO
SoBe Well Institute, CFO & COO
Fox Pan American Sports, CFO