Statistics show that only between 10-13% of Medicare patients have had their Annual Wellness Visit. Why is that? Most practices do not have the staff or the time and the cost vs. benefit is simply not strong enough.
THE PROBLEM
Physicians are constantly struggling to keep up with growing demand in the face of shrinking reimbursements. In an effort to combat shrinking reimbursements, to stay ahead of shifting healthcare policy and ensure the survival of their practice, doctors are scratching their heads and crossing their fingers trying to solve this dilemma.
Medicare, long criticized for kicking in only once people got sick, in 2012, started paying primary care physicians to talk to their senior citizen patients once a year about staying healthy. This is the Annual Wellness Visit.
THE SOLUTION
Prevention Plus Professional (PPP) has created an innovative and comprehensive solution that both improves patient care and outcomes as well as providing practices with a significant increase in profit with only nominal costs. Our Prevention Plus program is anchored by the Annual Wellness Visit. However, the scope of the program goes well beyond the AWV and now provides the patient an extra layer of care. Why do we do that?
We are taking this specific approach to adhere to the CMS intent to develop, deliver and update a personalized help plan to prevent disease and disability. We want to identify AND address a patient’s current health and risk factors. We have brought together exceptional web based applications, advanced DNA technology, Chronic Care Management and a protocol to improve the health and quality of life of seniors. These efforts have resulted in the delivery of the most efficient, effective and profitable solution for the Medicare Annual Wellness Visit.
THE PROBLEM
Physicians are constantly struggling to keep up with growing demand in the face of shrinking reimbursements. In an effort to combat shrinking reimbursements, to stay ahead of shifting healthcare policy and ensure the survival of their practice, doctors are scratching their heads and crossing their fingers trying to solve this dilemma.
Medicare, long criticized for kicking in only once people got sick, in 2012, started paying primary care physicians to talk to their senior citizen patients once a year about staying healthy. This is the Annual Wellness Visit.
THE SOLUTION
Prevention Plus Professional (PPP) has created an innovative and comprehensive solution that both improves patient care and outcomes as well as providing practices with a significant increase in profit with only nominal costs. Our Prevention Plus program is anchored by the Annual Wellness Visit. However, the scope of the program goes well beyond the AWV and now provides the patient an extra layer of care. Why do we do that?
We are taking this specific approach to adhere to the CMS intent to develop, deliver and update a personalized help plan to prevent disease and disability. We want to identify AND address a patient’s current health and risk factors. We have brought together exceptional web based applications, advanced DNA technology, Chronic Care Management and a protocol to improve the health and quality of life of seniors. These efforts have resulted in the delivery of the most efficient, effective and profitable solution for the Medicare Annual Wellness Visit.
PROGRAM COMPONENTS
ANNUAL WELLNESS VISIT This program is designed by CMS as a preventative program that will identify patient health risks and then address those risks with needed screenings, tests and programs to improve overall healthcare. Only 10%-12% of Medicare Beneficiaries have received the AWV.
CHRONIC CARE MANAGEMENT Started1-1-2015, this program is focused on delivering another layer of care to Chronic Care patients. They will receive many additional services each month including medication adherence, reconciliation and transitional care. No provider time or office space is required.
MEDICATION ADHERENCE AND COMPLIANCE SPAC is both CMS and FDA certified to provide Chronic Care Management. The entire SPAC program meets all of the CMS scope of work and billing requirements including drug adherence and compliance. The SPAC/CCM cloud based software and network is certified for CCM delivery. It also features ONC HIT Portals certified for Meaningful Use 1 & 2.
"PULL-THROUGH" SCREENINGS These screenings are identified in the Health Risk Assessment and are to be administered to the beneficiary as preventative services that will keep the patient living a healthy, independent lifestyle.
ANNUAL WELLNESS VISIT This program is designed by CMS as a preventative program that will identify patient health risks and then address those risks with needed screenings, tests and programs to improve overall healthcare. Only 10%-12% of Medicare Beneficiaries have received the AWV.
CHRONIC CARE MANAGEMENT Started1-1-2015, this program is focused on delivering another layer of care to Chronic Care patients. They will receive many additional services each month including medication adherence, reconciliation and transitional care. No provider time or office space is required.
MEDICATION ADHERENCE AND COMPLIANCE SPAC is both CMS and FDA certified to provide Chronic Care Management. The entire SPAC program meets all of the CMS scope of work and billing requirements including drug adherence and compliance. The SPAC/CCM cloud based software and network is certified for CCM delivery. It also features ONC HIT Portals certified for Meaningful Use 1 & 2.
"PULL-THROUGH" SCREENINGS These screenings are identified in the Health Risk Assessment and are to be administered to the beneficiary as preventative services that will keep the patient living a healthy, independent lifestyle.
We have selected these specific programs to maximize the Annual Wellness Visit and provide the opportunity to identify and reduce critical risk factors that will lead to prevention and care strategies for beneficiaries:
Health Risk Assessment
The Prevention Plus AWV begins, for the patient, with a comprehensive Health Risk Assessment (HRA). CMS requires the HRA to collect self-reported patient information. Our cloud based, HRA software is fully compliant with CMS guidelines.
The AWV must include Personal Preventative Plan Services and must contain the following bullet points, which are delivered in the Health Risk Assessment (CMS Bulletin 7079):
Cognitive/Depression Assessment
According to the Journal of American Geriatrics, as high as 76% of dementia and pre-dementia patients go undiagnosed in the primary care setting.
Medicare Chronic Care Management requires a care plan that includes a cognitive, psychosocial and functional status of the patient to be enrolled in this program.
Medication Management Program
Why have a Medication Management Program?
Hereditary DNA Cancer Screening
Rather than treat a disease, let’s prevent the disease.
Chronic Care Management
On January 1, 2015, CMS began paying MONTHLY reimbursement for patient care coordination services to eligible Medicare beneficiaries with 2 or more chronic conditions.
Research consistently shows that effective chronic care management reduces the cost of care for chronic disease patients while improving their overall health. Until now, providers have not been reimbursed for non-face-to-face chronic care management services.
Chronic disease patients are often left to manage between-visit care for themselves. This creates a break in communication, resulting in medication noncompliance, increased healthcare expenses and an increase in the likelihood of poor health outcomes.
While it is possible to tackle CCM alone, why would you?
We ensure that you benefit from this profit generating opportunity WITHOUT adding to your expenses, increasing your workload or making any changes to your current workflow.
Service, Support, Software and Program Management
We are a provider advocate for the practice.
Health Risk Assessment
The Prevention Plus AWV begins, for the patient, with a comprehensive Health Risk Assessment (HRA). CMS requires the HRA to collect self-reported patient information. Our cloud based, HRA software is fully compliant with CMS guidelines.
The AWV must include Personal Preventative Plan Services and must contain the following bullet points, which are delivered in the Health Risk Assessment (CMS Bulletin 7079):
- Establishment of a written screening for the beneficiary, such as a checklist for screenings and services for the next 5-10 years.
- Establishment of a list of risk factors and conditions for which interventions are recommended or underway including any mental health conditions or health risk factors identified in the HRA.
- Furnishing of personalized health advice to the beneficiary and referrals, as identified in the AWV, health education, preventative screenings or counseling services aimed at community-based lifestyle interventions, to reduce health risks and promote self-management and wellness, weight loss, physical activity, tobacco-use cessation, fall prevention, flu shots, blood tests, mammogram, bone density, nutrition counseling and more.
Cognitive/Depression Assessment
According to the Journal of American Geriatrics, as high as 76% of dementia and pre-dementia patients go undiagnosed in the primary care setting.
Medicare Chronic Care Management requires a care plan that includes a cognitive, psychosocial and functional status of the patient to be enrolled in this program.
- CMS reports, older adults have the highest risk of suicide of all age groups.
- These beneficiaries are important particularly in the primary care setting because 50% to 75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care.
- The Alzheimer’s Association says that assessment for cognitive impairment detection is essential as millions of Americans advance to an age when they are at greater risk for developing Alzheimer’s and other dementias.
- Patients indicated with cognitive/depression issues need to have these risks addressed.
- The test results are automatically scored for ease of review by the physician.
- In keeping with CMS objectives, our cognitive assessment will identify any deficits and lead to pro-active steps to help the patient maintain an independent lifestyle as long as possible.
Medication Management Program
Why have a Medication Management Program?
- Drugs work on some people and not on others. The Human Genome Project found that 50% of the population has inherited genetic variants in the liver which prevent proper metabolizing of drugs.
- 125,000 people die a year from ADRs. More than deaths from guns and car accidents combined.
- Insurance companies spend $177B a year to care for patients with ADRs.
- Some drugs have such a narrow therapeutic range that the FDA recommends genetic testing for patients taking them, including Plavix, Warfarin, Tramadol, Fluvoxamine, Amitriptyline, Thioridazine, Coreg, Celebrex and others.
- This once in a lifetime test provides the physician with a virtual map of how the patient’s liver is metabolizing medications.
- This is the only way to know if a patient is receiving optimal efficacy from their specific medications.
- Genotyping the patient reduces hospital readmissions.
- Improves medication compliance and reduces ineffective drug therapy.
- Individualized patient prescribing provides the right drug, the right dose the first time.
- Reimbursed by Medicare.
- Supported by AMA, FDA, American College of Cardiology
- Centers of Excellence include Mayo Clinic , Cleveland Clinic, Duke University, Stanford University, University of Florida, Ohio State University, Vanderbilt University and many others.
Hereditary DNA Cancer Screening
Rather than treat a disease, let’s prevent the disease.
- Next Generation Sequencing from CLIA and CAP lab.
- Looks at DNA chain 500 times to identify variants.
- Looks at 31 genetic variants that can lead to multiple types of cancers.
- Can indicate for 8 solid tumor cancers: Colorectal Cancer, Breast, Ovarian, Endometrial, Skin, Prostate, Pancreas and Stomach.
- Patient must have specific personal or family history to be indicated for the screening.
- Covered 100% by Medicare for qualified beneficiaries.
- Greatly improves survival rate when these cancers are caught in Stage 1.
Chronic Care Management
On January 1, 2015, CMS began paying MONTHLY reimbursement for patient care coordination services to eligible Medicare beneficiaries with 2 or more chronic conditions.
Research consistently shows that effective chronic care management reduces the cost of care for chronic disease patients while improving their overall health. Until now, providers have not been reimbursed for non-face-to-face chronic care management services.
Chronic disease patients are often left to manage between-visit care for themselves. This creates a break in communication, resulting in medication noncompliance, increased healthcare expenses and an increase in the likelihood of poor health outcomes.
While it is possible to tackle CCM alone, why would you?
We ensure that you benefit from this profit generating opportunity WITHOUT adding to your expenses, increasing your workload or making any changes to your current workflow.
Service, Support, Software and Program Management
We are a provider advocate for the practice.
- Delivery and Training for a compliant Health Risk Assessment and Annual Wellness Visit
- Guidance on the implementation of an Annual Wellness Visit protocol.
- Support and training of AWV and Cognitive Assessment Results for the provider.
- We identify a Wellness Coordinator for the practice to interview if needed.
- We train the Wellness Coordinator and provide ongoing technical support.
- We find and train any replacement Wellness Coordinator.
- We provide implementation and configuration of computer and printer hardware and software.
- Provide guidance with the implementation of the Episode of Care, patient and engagement to help maximize revenue.
- Providing training on software updates to coincide with changes in the AWV from CMS.
- Provide additional products and programs that generate revenue for the practice.
- We provide complete management and support of the Wellness Program and work to maximize revenue for the practice with the AWV program. bone density, nutrition counseling and more. (CMS Bulletin 7079)
- We have researched the market for over a year to bring together a best in class family of products and services that offer compliance, quality and value allowing practices to maximize untapped revenue with the Annual Wellness Visit.
- Provision of select programs that also provide direct ancillary revenue and profit with minimal or zero costs.
- Our experience with the AWV program tells us it is most successful with a Wellness Coordinator dedicated to managing the Annual Wellness Program. This is preferred over giving a Medicare patient an Ipad to fill out the AWV on their own while in the waiting room. This leads to incomplete information.
- Use of a compliant, turnkey, automated AWV program to deliver a compliant Health Risk Assessment. It should also be noted that CMS is launching audits through Recovery Audit Contractors to discover improper or incomplete provision of the AWV. Many practices are simply billing for the AWV without providing a detailed and personalized plan at the time of the visit.
- Personal attention and service with an eye on detail and improved compliance.
- Identification of health risks and follow up with specific programs and screenings to mitigate those risks and improve overall patient health.
- All program support, training and management is provided by Rowlinson & Associates freeing up office staff and management to focus on daily patient activities.