Five Reasons Why MSOs Should Partner With ilumed

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The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Healthcare management services organizations (MSOs) like yours work hard to help providers be more efficient administratively and operationally. You play an essential role in helping the healthcare system function better for less cost. But what if your healthcare MSO could do even more to help your providers improve care delivery and improve their financial standing?

Thanks to ilumed, now you can. Partnering with ilumed gives your providers access to resources and services neither you nor they can provide to improve patient outcomes and provider finances at no cost to you or your providers. It’s all made possible through the ACO REACH model, an innovative value-based care model from the Centers for Medicare & Medicaid Services (CMS).

Lincoln Health, a healthcare MSO serving the eastern and southeastern U.S., has worked with ilumed since 2023, beginning with three providers and 9,000 patients, which have expanded to six providers and 11,000 patients in 2024. “ilumed is one of the top 10 ACO REACH organizations,” said Robert Cardenas, Chief Financial Officer. Here’s why Lincoln Health believes other healthcare MSOs should partner with ilumed.

1. Enhanced reimbursement and payment model

ACO REACH offers a unique payment model that’s better for providers because they can earn three different types of payments:

  • ilumed offers an enhanced fee-for-service rate or a monthly capitation rate. As Robert said, “This is one of the things ilumed offers that emphasizes our services.” It’s often higher than most of the other ACOs out there.” With this payment, providers earn more than they would under Medicare’s standard fee-for-service rate, which helps them earn predictable revenues.
  • Providers contracted with ilumed can also earn a quality bonus payment for high-quality care regardless of the cost of that care. At ilumed, we don’t just wish providers luck after contracting—we help them elevate their care delivery model too. “The quality bonus payment sets ilumed apart,” said Robert, “because they have the resources providers need to keep patients healthy and out of the emergency room.”
  • ilumed's shared surplus savings payment is split between ilumed and the provider for high-quality care at reduced costs. Think of it as the ultimate value-based-care incentive. “The shared surplus savings percentages are often more favorable than what an MSO could directly offer,” said Robert. “ilumed helps providers keep patients healthier, which optimizes the providers’ profitability in the form of shared surplus savings.”

Providers can earn more in the ACO REACH model than they otherwise would in either a traditional MSO model or the Medicare fee-for-service model. Learn more about ilumed’s ACO REACH financial model in this eBook.

The ACO REACH model offers providers and healthcare MSOs another huge benefit: no downside risk. That’s right, providers enjoy upside-only financial benefits above Medicare’s fee- for-service schedule.

All in all, ilumed offers MSOs and their providers a better bottom line. “ilumed worked with our providers to make sure they have predictable cash flows and sustainable long-term financial models that optimize their bottom lines while maintaining high quality of care.”

2.  Hands-on provider mentorship from leading experts in the field

ilumed's Chief Medical Officer, Dr. David Priscal, has delivered best-in-class healthcare for decades, working for Medical Care Consortium Inc., Family Physicians Group and Humana before joining ilumed. “I’ve known Dr. Priscal for 15 years and respect his experience and expertise in Medicare healthcare delivery,” said Robert.

Dr. Priscal and Executive Vice President of Clinical Services, Dr. Hymin Zucker, take a hands-on approach to mentoring providers who contract with ilumed in transforming their care delivery model for the better. “They’ve changed the way our providers look at patient care,” said Robert.

Here are just a few of the changes Dr. Priscal and Dr. Zucker help providers make:

  • Seeing patients quarterly instead of annually or on an ad-hoc basis to help patients stay on track with treatment plans, lifestyle adjustments and preventive care.
  • 72-hour post-discharge follow ups if any patients were admitted to the emergency room or hospital to be sure they understand their discharge instructions and offer additional support and resources if needed transitioning home.
  • Addressing care gaps for chronic conditions like diabetes, hypertension, and heart disease as well as social determinants like food insecurity, financial strain and loneliness.

“Dr. Priscal visits our providers on a quarterly basis,” said Robert. “He and Dr. Zucker have weekly and monthly calls to see how they’re doing with key factors in keeping patients healthy.”

It’s this kind of personal attention and problem-solving that sets ilumed apart from other ACO REACH entities. “Our providers have never had partners follow up and work with them to instill a mindset where the patient comes first and keeping them healthy is what it’s all about,” said Robert. “That’s the whole concept of value-based care. With ilumed, you’ve got access to the top brass. It’s having the connection and working as true partners.”

3.  Care-delivery differentiation

At ilumed, patient care is always front and center. It’s what drives our C-suite, case managers, social workers, and outreach staff because we know we can heal the ills of today’s healthcare system by putting patients and providers ahead of profits. We do right by patients and their doctors because that’s the only way to transition from a sick care system to a true healthcare system.

“The ilumed way of doing things means adopting policies and protocols so providers can be at the top of their game. It’s the implementation and execution of the workflows that makes ilumed important,” said Robert. “When we need to invest in patients, ilumed stands by us.” Here are just a few of the ways we invest in patients:

  • Case management
  • Home visits
  • Social services support
  • Disease and chronic-care management
  • Concierge services for appointment and transportation scheduling

“ilumed supports our case management and we work cohesively for patients,” said Robert, “and with ilumed, we’ve been able to provide care-gap closures.” Chronic conditions like arthritis, diabetes, heart failure and hypertension worsen outcomes and increase costs. ilumed's targeted approach to chronic-care management means patients get the support they need to make lifestyle changes and adhere to their treatment plans.

Our chronic care management strategies work for patients and providers. Overall, ilumed helped Lincoln Health providers improve their overall care-gap closure rate from 8.5% to 40% and their A1C care-gap rate from 7% to a whopping 70%.

4.  Enhanced patient benefits

As healthcare MSOs support providers’ administration and operations, enhancing Medicare benefits isn’t something most can do. With ilumed, aligned beneficiaries have access to benefits they couldn’t otherwise get on traditional Medicare:

“The transportation ilumed offers to get our patients from pharmacies, doctors and hospitals is one of the best in the business,” said Robert. “That’s a cost our providers would assume, and many don’t have the ability to offer that.”

With ilumed, MSOs and providers can offer patients more personalized services and support for no additional costs. We wrap our arms around patients and the providers who care for them to improve outcomes while reducing costs.

5.  Coast-to-coast footprint

ilumed serves providers and beneficiaries across the nation, which means we understand how to think locally while driving change nationally. We can help your MSO expand too. “If we weren’t partnered with ilumed, we would have to stay regionalized,” said Robert. “With ilumed, we are part of a national brand and nationally recognized ACO REACH organization.”

Ready to team up with ilumed?

ilumed can help you do more for your providers and their patients than you’ve ever dreamed of—and we can help you do it without any cost to you or your providers. If you’re ready to elevate value-based care with 21st-century technology and a compassionate team of servant leaders, you’re ready to work with ilumed. Get in touch today.