Prevention Plus

PREVENTION PLUS PROFESSIONAL

Statistics show that only between 10-13% of Medicare patients have had their Annual Wellness Visit. Why is that? Most practices do not have the staff or the time and the cost vs. benefit is simply not strong enough.

The Problem

Physicians are constantly struggling to keep up with growing demand in the face of shrinking reimbursements. In an effort to combat shrinking reimbursements, to stay ahead of shifting healthcare policy and ensure the survival of their practice, doctors are scratching their heads and crossing their fingers trying to solve this dilemma.

Medicare, long criticized for kicking in only once people got sick, in 2012, started paying primary care physicians to talk to their senior citizen patients once a year about staying healthy. This is the Annual Wellness Visit

The Solution

PPP has created an innovative and comprehensive solution that both improves patient care and outcomes as well as providing practices with a significant increase in profit with only nominal costs.

Our Prevention Plus program is anchored by the Annual Wellness Visit. However, the scope of the program goes well beyond the AWV and now provides the patient an extra layer of care. Why do we do that?

Taking this specific approach to adhere to the CMS intent to develop, deliver and update a personalized help plan to prevent disease and disability. We want to identify AND address a patient’s current health and risk factors.

We have brought together exceptional web based applications, advanced DNA technology, Chronic Care Management and a protocol to improve the health and quality of life of seniors.

These efforts have resulted in the delivery of the most efficient and effective and profitable solution for the Medicare Annual Wellness Visit.

Chronic Care Management

As of January 1, 2015, CMS has started paying MONTHLY reimbursement for care coordination services to eligible Medicare beneficiaries with 2 or more chronic conditions.

Research consistently shows that effective chronic care management reduces the cost of care for chronic disease patients while improving their overall health.  Until now, providers have not been reimbursed for non-face-to-face chronic care management services.

Chronic disease patients are often left to manage between-visit care for themselves.  This creates a break in communication, resulting in medication noncompliance, increased healthcare expenses and an increase in the likelihood of poor health outcomes.

While it is possible to tackle CCM alone, why would you?
We ensure that you benefit from this profit generating opportunity WITHOUT adding to your expenses, increasing providers workload or making any changes to your current workflow.

THE PROGRAM COMPONENTS

We have selected these specific programs to maximize the Annual Wellness Visit and provide the opportunity to identify and reduce critical risk factors that will lead to prevention and care strategies for beneficiaries.

Health Risk Assessment
The Prevention Plus AWV begins, for the patient, with a comprehensive Health Risk Assessment (HRA). CMS requires the HRA to collect self-reported patient information. Our cloud based, HRA software is fully compliant with CMS guidelines.
(CMS Bulletin 7079)

The AWV must include a Personal Preventative Plan Services. This means the PPPS must contain the following bullet points, which are delivered in the Health Risk Assessment. (CMS Bulletin 7079)
Establishment of a written screening for the beneficiary, such as a checklist for screenings and services for the next 5-10 years. (CMS Bulletin 7079)
Establishment of a list of risk factors and conditions for which interventions are recommended or underway including any mental health conditions or health risk factors identified in the HRA. (CMS Bulletin 7079)
Furnishing of personalized health advice to the beneficiary and referrals, as identified in the AWV, health education, preventative screenings or counseling services aimed at community-based lifestyle interventions, to reduce health risks and promote self-management and wellness, weight loss, physical activity, tobacco-use cessation, fall prevention, flu shots, blood tests, mammogram, bone density, nutrition counseling and more. (CMS Bulletin 7079)

Cognitive/Depression Assessment
According to the Journal of American Geriatrics, as high as 76% of dementia and pre-dementia patients go undiagnosed in the primary care setting.

Medicare Chronic Care Management requires a care plan that includes a cognitive, psychosocial and functional status of the patient to be enrolled in this program.

CMS reports, older adults have the highest risk of suicide of all age groups.
These beneficiaries are important particularly in the primary care setting because 50% to 75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care.
The Alzheimer’s Association says that assessment for cognitive impairment detection, is essential as millions of Americans advance to an age when they are at greater risk for developing Alzheimer’s and other dementias.

The Key Benefits of our Cognitive Assessment:

Patients indicated with cognitive/depression issues need to have these risks addressed.
The test results are automatically scored for ease of review by the physician.
In keeping with CMS objectives, our cognitive assessment, will identify any deficits and will lead to pro-active preventative steps that will help the patient maintain an independent lifestyle as long as possible.

Medication Management Program
Why have a Medication Management Program?

Drugs work on some people and not on others. The Human Genome Project found that 50% of the population has inherited genetic variants, in the liver, which prevent proper metabolizing of drugs.
125,000 people die a year from ADRs. More than deaths from guns and car accidents combined.
Insurance companies spend $177B a year to care for patients with ADRs.
Some drugs have such narrow therapeutic range that the FDA recommends genetic testing for patients taking those 122 drugs. Including Plavix, Warfarin, Tramadol, Fluvoxamine, Amitriptyline, Thioridazine, Coreg, Celebrex and others.

Patient and Practice Benefits

This once in a lifetime test has a report provides the physician with a virtual map of how the patient’s liver is metabolizing medications.
This is the only way to know if a patient is receiving the optimal efficacy from their specific medications.
Genotyping the patient reduces hospital readmissions.
Improves medication compliance and reduces ineffective drug therapy.
Individualized patient prescribing provides the right drug, the right dose the first time.

Support for Medication Management

Reimbursed by Medicare.
Supported by AMA, FDA, American College of Cardiology
Centers of Excellence include Mayo Clinic , Cleveland Clinic, Duke University, Stanford University, University of Florida, Ohio State University, Vanderbilt University and many others.

Hereditary DNA Cancer Screening
Rather than treat a disease, let’s prevent the disease.

Next Generation Sequencing from CLIA and CAP lab.
Looks at DNA chain 500 times to identify variants.
Looks at 31 genetic variants that can lead to multiple types of cancers
Can indicate for 8 solid tumor cancers, Colorectal Cancer, Breast, Ovarian, Endometrial, Skin, Prostate, Pancreas and Stomach.
Patient must have specific personal or family history to be indicated for the screening.
Covered 100% by Medicare for qualified beneficiaries

Greatly improves survival rate when these cancers are caught in Stage 1

Service, Support, Software & Program Management

We are a provider advocate for the practice.