DEFINE THAT
Also known as "Traditional Medicare," covers hospitalizations, available at age 65, or < age 65 with a disability, or ESRD.
What is Medicare Part A
A VBC Model for the high needs, chronically ill, sickest of the sick patients we serve.
What is the ACO REACH Program
HarmonyCares will engage with Maggie and accept ____% of the _____ for all her healthcare outcomes.
What is 100% of the RISK
VBC = ____ing Costs and ____ Value for our patients.
What is LOWERING and INCREASING
Federal program, administered by the states that provides health coverage for specific populations such as low-income individuals, children and pregnant women.
What is Medicaid
In VBC, payment is based on _________ ; delivering high quality, lower cost care, that improves the patient experience. When the patients do better, we do better!
Whare are Outcomes!
This group works together to play their part in assuming 100% risk for Maggie's care, they conduct in-home visits, collaborate with her PCP, create a plan of care, meet benchmarks for cost of care, and address Maggie's SDOH's.
Who are Maggie's PROVIDERS and CARE TEAM.
(MDs, PAs, NPs, CPs, NCMs, PHCs, Schedulers, SWs, Pharmacy, Pod Leaders)
Eligibility for this Program includes; Enrolled in Medicare Parts A&B, NOT in a Medicare Advantage program, Reside in an ACO Service Area, Have at least one high needs population criteria.
What is Eligibility for the REACH Program
Provided by private health insurance companies; often referred to as "Part C," must offer all the benefits of Parts A & B, and usually offers additional benefits.
What is Medicare Advantage (MA)
Groups of doctors, hospitals, and other health care professionals that work together to provide coordinated health care, improve outcomes, and manage costs.
What is an ACO (Accountable Care Organization)
Results of this include Maggie's costs per month lowered, decreased hospital utilization, diabetes well controlled, better outcomes, improved patient experience!
What is the IMPACT of ENGAGEMENT
One model incentivizes unnecessary services and lacks provider accountability while the other model improves care coordination, reduces utilization, and increases quality of care.
What is Fee for Service vs. Value Based Care
(FFS vs. VBC)
Reimbursement is based on the service provided, not tied to outcomes, "traditional" payment method, care can be fragmented.
What is Fee for Service
In VBC, we work to close these, by taking a holistic approach to patient-centered care, identifying their needs, barriers to healthcare, SDoH's, and achieve improved outcomes.
What are GAPS in care
HC's all encompassing FREE services for Maggie that provide holistic care, extend the reach of her PCP into the home, fill gaps, close quality measures, manage chronic conditions and provide access to social services.
What is WRAP AROUND Care
A type of VBC model where providers will receive FFS and SHARE in annual savings or losses based on outcomes. Requires an Anchor visit with MD and not based on Dx.
What is the MSSP Program
(Medicare Shared Savings Plan)