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
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…
Quality Performance among 2021 Next Gen ACOs
Achieved in MSSP and MA Contracts through 2021
20+ Years of experience in RCM & MSO Services
Years experience in Value Based Care
Healthcare Experts for Consulting
Physicians Serviced by MSO
In 2022, all CHESS MA contracts saw a STAR Rating of 4.0 or above