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How to Insource Medicare’s Preventive Health Services

August 5th, 2021 | 7 min. read



Content Team

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Healthcare providers often outsource management of Medicare’s preventive programs. 

In some cases, this approach makes total sense. 

Third-party companies accommodate high patient enrollment, and they supply plentiful resources. Contracting such a service removes the onus from your practice and staff.

That said, upon utilizing these services, some providers question the outsourced approach. 

They see downsides to a hands-off solution, and they’re curious about what’s required for an in-house operation.

So, they approach ThoroughCare for information on managing their own programs.  

In regards to this, we’re commonly asked one question: 

  • How can my practice manage its own care coordination programs?

We’ve helped more than 600 clinics and physician practices across the United States establish their own management systems. Our care coordination software makes insourcing possible.  

Based on this experience, we’ve prepared the following article for your benefit. 

We review the potential benefits of self-management, as well as the steps to take to switch from a full-service solution. 

We also cover how care coordination software can help you manage your Medicare programs. 

With this information, you’ll have a better understanding of how to transition your Medicare preventive programs in-house. 

Why Manage Medicare’s Preventive Services In-House?

In our discussions with standing and prospective clients, we hear all types of feedback and pain points. 

Below, we outline the four common reasons medical providers consider managing their own Medicare preventive programs. 

1. Patients May Prefer Your Practice To a Third-Party Company

An outside solution can be a point of efficiency for your medical practice, but not necessarily for your patients.

For instance, staff turnover can be high at a third-party company. 

This can cause issues in care continuation, or disrupt patient relationships.  

This matters greatly to the people you treat. Especially when building trust.

Your patients are far more likely to trust you and your staff

They’ve spent more time with you. And their relationships have developed through face-to-face interaction and shared history. 

This bond promotes open communication, which is crucial when providing care services.

Without strong patient engagement, enrollment in the preventive programs you offer may slip. Or, patients may half-heartedly participate, skewing results.  

Managing your own programs may help avoid such circumstances. 

2. More Control of Your Programs 

By insourcing care coordination, you’ll maintain control over the entire administrative process — from hiring and/or training staff, to billing and reports.

Insourcing also allows you to more easily adjust your programs as needed. 

Whether you need to provide training, handle service issues, or simply communicate with your care managers, you’ll be able to readily respond to change.

3. Potential for Increased Reimbursements and Greater Revenue

On average, you’ll likely pay more to work with a full-service company.  

You could pay more than half the national average reimbursement for Chronic Care Management (at $62 per month per patient). Or, you may pay a notable percentage of the average reimbursements for Remote Patient Monitoring, Behavioral Health Integration, and Annual Wellness Visits. 

Depending on your situation and patient volume, that cost may make sense. You are paying for full-service, hands-off care coordination, after all, and that saves time.

That said, by utilizing your existing staff, as well as a designated care manager, you may find opportunity with an in-house approach. 

As well, care coordination software will aid your staff by simplifying the process. And while it comes as a cost, care coordination software is significantly cheaper.

4. Greater Staff Engagement

By administering your Medicare preventive programs in-house, you’ll foster staff engagement. 

Your staff will claim ownership of the process, while nurturing patient relationships. 

This may promote productivity and improve morale. As well, greater engagement and provider buy-in may enable certain staff to develop additional skills or expertise. 

This development may reflect highly on your practice, most likely through improved patient outcomes. 

This could help increase your practice’s Merit-based Incentive Payment System (MIPS) score, resulting in higher Medicare reimbursements. 

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How to Transition Your Preventive Services In-House 

In-house management may make sense for your practice. 

If so, here’s what you should consider prior to making the switch. 

Already Using a Full-Service Company?
Understand Your Agreement and Transition Options.

Make sure your contract allows for an exit, and under what circumstances. 

Your practice may need to honor the full agreement until the contract expires. 

As well, make note of whether your practice retains rights to your patients’ data. 

If so, make a plan to effectively capture this information from your third-party provider. 

Prepare Your Practice

Give yourself ample time to devise a strategy for success. To do so, you’ll want to follow three steps

1. Learn About Medicare’s Preventive Health Programs    

Familiarize yourself with what is required to successfully offer and bill for the services you wish to provide. 

Medicare’s programs come with all kinds of rules and regulations. 

While care management software will help you navigate these items, your own understanding is crucial. 

Our Learning Center makes this easy. We consistently create content to answer your questions about Medicare’s value-based offerings. 

These include:

2. Hire a Care Manager

Guided and monitored by practitioners, care managers serve as the point of contact between patients and the practice. They are essential to the success of these programs.

The care manager should be a dedicated resource who ensures the success of your programs.

There are a variety of responsibilities assigned to a care manager, including:

  • Coordinating medical treatment, including administering assessments, developing care plans and monitoring medication compliance;
  • Relationship building with patients;
  • Serving as advocates for and champions of the patients health; and
  • Connecting patients with support systems for continuation of care;

To help you find the right person for this role, we’ve prepared an article on the best practices when hiring a care manager.

3. Notify Your Patients of Your Management Transition

For the patient, you’ll want to create a seamless transition.

Give plenty of notice to those who use your preventive Medicare services through a full-service provider. 

They will undergo a change, in terms of who they interact with when receiving services. 

As well, it’s likely your practice may make small adjustments to their care coordination, based on you and your staff’s input.  

This notification may also serve as an opportunity to further inform your patients of other services that may benefit them. 

Software Can Help You Address Value-Based Care

Value-based care emphasizes health outcomes as a method to determine provider compensation. With alternative payment models, such as the Merit-based Incentive Payment System (MIPS), providers must report specific metrics and data to justify the rates they receive. 

Within such models, satisfactory or improved health results can create opportunities for providers to receive additional incentives, such as shared cost savings. But how do you use software to implement value-based care? 

Learn how care coordination software can help reduce your financial exposure within value-based reimbursement. Read more about how it can help your practice generate recurring revenue and cut costs. 

Then, book a discovery call with a ThoroughCare representative to discuss how you’d like to use care coordination software to serve your patients. 

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