SCALE Value Based Care
SCALE Value Based Care

Who We Are

SCALE Value Based Care

SCALE Healthcare is transforming healthcare and empowering physicians by simplifying the complexities of value-based care models. We provide customized value-based care solutions and capabilities to primary care and specialist providers, enabling them to focus on patient care and improving patient outcomes.

About us

About SCALE

The SCALE team is comprised of experts in the implementation, management and contracting associated with value based care programs. Collectively, through our partnership with CHESS Health Solutions we offer a comprehensive value based care platform.

We are here to meet you where you are on your value based journey. Whether you are new to VBC, currently engaged and looking for a new partner or looking to advance to full-risk.

Our Value Based MSO Services

SCALE/CHESS offer a broad range of services to meet your VBC & MSO needs

Transformation

  • Value-based care education
  • Customized practice-based optimization
  • Care model development and implementation

Analytics

  • Combined clinical and claims data
  • Supplemental data feeds
  • Customized reporting
  • Patient risk stratification

Compliance and Regulatory

  • Management of boards and committees
  • Evaluation of CMS/CMMI programs
  • Application and RFI’s to CMS
  • CMS audits
  • MIPS reporting consultatio

Care Coordination Hub

  • Transitions of care support
  • Quality gap closure outreach
  • ED follow-up/outreach
  • High utilizer review

Risk Documentation and Coding

  • Personalized and group education
  • Outpatient CDI program
  • CDI hub services

MSO Operations

  • Provider recruitment
  • Finance/HR/IT integration
  • Interim leadership
  • Group purchasing
  • Legal/Governance

Pharmacy Hub

  • Medication assistance
  • Medication adherence
  • Provider and patient resources
  • Medication Therapy Management

Consulting

  • Clinical Enablement Support
  • Practice Transformation
  • Value-based Care Performance
  • Contracting and Governance

Marketing

  • Brand Optimization
  • Patient acquisition and experience
  • Market diligence and strategy
  • Marketing KPI’s and ROI reporting

Operations

  • End of year dispute process
  • Re-attribution process
  • Engage providers with actionable information

Payer Contracting and Strategy

  • Value-based contract negotiation
  • Value-based contract strategies
  • Down-side risk sharing with value partners
  • FFS Market analysis and negotiation

Quality

  • Payer trend report month over month
  • Performance by group, provider, and patient
  • Optimize payer and government reporting

Revenue Cycle Management

  • Transparent reporting and analytics
  • Consultation or fully managed service
  • Integrated RCM into broader management program
  • Credentialing

Overview

Execution

Results

CASE STUDY:

Value Based Care

Client Profile

  • Size:
    20k+ members
  • Specialty:
    Primary Care
Learn More

Overview

  • The Client is a Medicare-focused population health company
  • The client was an early participant in the Direct Contracting Entity (DCE) Program since 2021
  • The client membership increased by 570% from 2021 to June 2022. Client membership is expected to increase by 390% from 2022 to 2023.
  • The client has been approved for the ACO Reach Program in 2023
  • The client is on a growth trajectory and is seeking new capital to support anticipated exponential growth over next 18-24 months
  • Increased reserves are needed to support increased Medicare membership

Needs & objectives for engagement

Lender engaged SCALE to complete an evaluation of the client with focus on:

  • Historical and projected performance
  • Growth & Development
  • Operational Execution
  • Market Research

Execution

SCALE deployed a team consisting of individuals from the Consulting & Payer Strategy business divisions, as well as external subject matter expertise

  • Interviews / meetings with the client & sponsor group leadership
  • Review of diligence materials provided (network overview, financials, growth & development competitive landscape, organizational charts, structure between the client & affiliated practices, DCE & ACO REACH materials, operations program, pipeline)
  • Data analysis
  • Interviews / meetings with Client & Ascend leadership
  • Review of diligence materials provided (network overview, financials, growth & development competitive landscape, organizational charts, structure between the Client & affiliated practices, DCE & ACO REACH materials, operations program, pipeline)
  • Data analysis
  • Cross-department collaboration resulted in a comprehensive and effective final report
  • Utilized external SME expert to assist with CMS Quality Measures & Risk Score Assessment
  • 5-week execution timeline

Results

  • First 6 months of 2022 data indicate MLR (Medical Loss Ratio) between 80 – 100+ percent, with shared shavings. Given limited performance, the current MLR is found to be consistent with similar CMS programs.
  • The client performed in 2 out of 3 quality measures in early 2022.
  • The client’s managed care structure appears operationally sound with best practices in care coordination, disease management, and quality performance. Improvements are recommended in the areas of clinical documentation & coding tied to their risk structure.
  • The client has a strong and experienced management team with specialties in managing capitation and population health.
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The SCALE Difference

The proof is in the numbers, through our partnership with CHESS Health Solutions…

Top Five
5

Quality Performance among 2021 Next Gen ACOs

Savings
$ 0 M

Achieved in MSSP and MA Contracts through 2021

Year Experience
0 +

20+ Years of experience in RCM & MSO Services

Year Experience
0 +

Years experience in Value Based Care

Experts
0 +

Healthcare Experts for Consulting

Practices
0
Supported through MSO Services across the nation
Lives
0 +
In value-based agreements
Physicians
0

Physicians Serviced by MSO

In 2022, all CHESS MA contracts saw a STAR Rating of 4.0 or above

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