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CMS has currently received approximately 5,700 applications for the new ACO REACH program. If you are considering any ACO REACH proposal, you need to know specifically what they offer, how much risk it means for you, and what new technology and responsibility it puts on you and your staff. Please take a few minutes and review our “Must Haves” report for any program that you wish to consider.
Precision Risk Share Cooperative (PRSC) contracts with several of the largest ACO REACH programs, that have access to better-paying Medicare Advantage and other contracts. These multibillion-dollar entities sponsor our programs through PRSC to offer providers effective models specific to individual risk tolerance and revenue goals. This provides the unique freedom to source the best match for you among all the resources available in this fragmented and confusing market.
What does this look like in the real world? We recently provided an analysis for a multispecialty group. Our data analytics platform identified the practice as missing $35,299,032 in mandated services. Their 17 PCPs are missing $15,639,103. Missed mandated services are failures to perform on medical necessities according to the CMS Standard of Care. With our four “Revenue Silos”, the PCPs should net $15,529,705 under full risk, $11,874,985 under half risk, and $8,220,265 with no risk.
Our four Revenue Silos are;
1. Missed mandated Medicare Fee for Service Encounters at 80% engagement - 60% compliance is required to avoid penalties. Most providers are less than 10%.
2. Capitation advance payment monthly on risk shared savings – depending on provider RAF score and other metrics, this can be up to $30 PMPM based on Traditional Medicare beneficiaries.
3. Risk Share Gains – Using our proprietary metrics we can expect $2,400 PMPY based on only a .25-point improvement in RAF score. Moving up to 1+ point is not uncommon by utilizing our services.
4. Shared volume discounts and other Provider Compliance Rewards when using certain contracted partners - paid quarterly.
Please click the links below for more information.
Thank you in advance for your time and interest!