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Leaving Money on the Table

Research shows care management reduces total cost of care for chronic disease patients while improving their overall health. Post-discharge care management has been proven to reduce costly readmissions. However, few providers offer formal care management programs because there was no payment available for the time, effort, and resources spent managing their patients’ care outside the four walls of the exam room.

Over the last three years, Medicare began paying physicians for transitional care management, chronic care management, and advance care planning. Commercial plans and state Medicaid programs are now jumping on the bandwagon and offering similar forms of payment for care management. Despite strong interest among providers, most have been slow to implement care management programs due to complex regulatory requirements and anticipated disruption in established office procedures.

In addition to passing up significant new practice revenue, providers are foregoing the opportunity to develop key competencies for future value-based payments. These new reimbursement programs give providers the opportunity, and financial resources, to develop experience managing the health of these often high-cost populations. As a result, participating providers are actively preparing for risk-based contracting – while still receiving fee-for-service payments.

New Revenue, New Skills

PYA is a nationally recognized leader in developing and deploying ambulatory care management programs. With a team that includes clinicians, regulatory experts, and physician practice specialists, PYA cuts through the complexity and delivers streamlined solutions.

PYA supports you each step of the way in establishing your care management program.

  • Financial projections and modeling
  • Strategy and design for a comprehensive care management program
  • Evaluation of technology solutions and outsourcing opportunities
  • Workflow enhancement and redesign
  • Step-by-step policies, procedures, and detailed forms to ensure compliance
  • Patient risk stratification
  • Staff training and reference materials