Ean Shelley of ValueCare Suite talks about Increasing Pharmacy Revenue through Medicare’s Value-Based Care Programs
Ean Shelley
Co-Founder of ValueCare Suite
Phone: 262-443-5334
ean@valuecaresuite.com
Dr. Lisa Faast introduced Ian from Value Care Suites, highlighting their software designed for RPM and other value-based care services. Ian explained how the software simplifies Medicare billing for chronic care management (CCM) and remote patient monitoring (RPM), emphasizing the importance of compliance and the benefits of a fee-for-service model over revenue shares. He shared a case study of a pharmacy earning $850,000 annually from three offices, with CCM compliance rates ranging from 72% to 86%. Ian also discussed the importance of multi-parameter readings for RPM and the integration with Black Box RPM devices. Lisa emphasized the software’s role in maximizing revenue from existing pharmacy activities.
Action Items
- [ ] @Lisa Faast – Implement Value Care Suite in newly acquired pharmacies once settled
- [ ] Download the document with summary of all 20+ billable codes from diversifyrx.com
- [ ] Reach out to Ian for questions about additional billing codes like PCM and BHI
- [ ] Schedule individual demos of the Value Care Suite software with Ian
- [ ] Review the fee-for-service contract templates and BAA agreements provided by Value Care Suite
Authority
- Lisa Faast appears to be a key influencer, introducing Value Care Suite to pharmacy owners.
- Pharmacy owners are likely the key decision-makers for purchasing the software.
- Physicians play a role as partners in implementing the value-based care services.
Budget
- A sample revenue breakdown was provided, showing potential earnings of $845,000 per year for a pharmacy with three full-time and two part-time employees.
- The software includes a fee-for-service structure rather than revenue sharing.
- Reimbursement rates for various services were discussed, such as $62 for the first 20 minutes of Chronic Care Management.
Competition
- Manual methods of tracking and billing for value-based care services were mentioned as ineffective compared to the software solution.
- Other RPM companies were mentioned, but Value Care Suite was presented as superior due to its integration and ease of use.
Objections
- Concerns about the complexity of implementing value-based care services without proper software were mentioned.
- The need for physician partnerships and contracts was discussed as a potential challenge.
Need
- Difficulty in managing and organizing value-based care services without proper software.
- Low reimbursement rates for traditional pharmacy services.
- Challenges in tracking patient compliance and completing billable codes.
Sentiment
- The overall tone of the call was positive, with Lisa Faast expressing enthusiasm for the software and its potential benefits for pharmacies.
- Ian presented the software’s features and benefits in a positive light, emphasizing its ability to solve common challenges in implementing value-based care services.
Outline
Introduction to Value Care Suites and Lisa Faast
- Lisa Faast introduces herself and mentions she is in Italy for the meeting.
- Lisa expresses excitement about introducing Ian and his company, Value Care Suites.
- Lisa explains the common challenge pharmacies face in adding value-based care services due to the lack of efficient software solutions.
- Lisa highlights Ian’s software as a solution that simplifies the process and eliminates the need for manual labor.
Ian’s Introduction and Overview of Value-Based Care Programs
- Ian introduces himself as one of the co-founders of Value Care Suites.
- Ian outlines the agenda, focusing on the basics of value-based care programs and how to increase pharmacy revenue through Medicare-based programs.
- Ian mentions the importance of partnering with physicians and using a fee-for-service contract.
- Ian explains the non-revenue-generating activities in pharmacies and how the software helps bill for these activities.
Medicare Programs and Billable Codes
- Ian discusses the various Medicare programs, including chronic care management, remote patient monitoring, behavioral health integration, and transitional care management.
- Ian explains the importance of compliance with Medicare regulations and how the software helps ensure compliance.
- Ian highlights the financial benefits of these programs, including substantial savings for Medicare and increased revenue for pharmacies.
- Ian provides an overview of the estimated Medicare reimbursements for different billable codes.
Benefits of Partnering with Physicians
- Ian explains the benefits of having pharmacies partner with physicians to provide value-based care services.
- Ian mentions the increased revenue for both pharmacies and physicians through shared revenue or fee-for-service structures.
- Ian discusses the advantages of having pharmacy staff perform non-revenue-generating activities that can now be billed.
- Ian provides an example of a pharmacy’s revenue from using the software and partnering with physicians.
Challenges of Revenue Shares and Fee-for-Service Structures
- Ian explains the downfalls of revenue shares, including delayed payments, frequent miscalculations, and increased non-billable man-hours.
- Ian advocates for a fee-for-service structure, which simplifies the payment structure and incentivizes care team members to complete billable codes.
- Ian provides an example of how the software helps track time and automate billing summaries and invoices.
- Ian discusses the importance of completing billable codes to ensure revenue is generated.
Chronic Care Management (CCM) Program Requirements
- Ian outlines the requirements for enrolling patients in the chronic care management program, including having two or more chronic conditions and patient consent.
- Ian explains the importance of having a face-to-face encounter with the billing practitioner within the past 12 months.
- Ian discusses the different diagnoses that qualify for CCM and how the software helps generate patient care plans.
- Ian highlights the benefits of having a physician initiate the enrollment process to increase patient participation.
Complex Chronic Care Management and Annual Wellness Visits
- Ian explains the requirements for complex chronic care management, including up to six hours of care per month.
- Ian discusses the additional tasks that can be performed under CCM, such as coordinating with specialists and preparing for health risk assessments.
- Ian explains the benefits of helping patients prepare for annual wellness visits, including increased revenue for both pharmacies and physicians.
- Ian provides an overview of the preventive services that can be billed under CCM and how the software helps track patient eligibility and preventive services.
Remote Patient Monitoring (RPM) Program Requirements
- Ian outlines the requirements for remote patient monitoring, including taking 16 readings over a 30-day period.
- Ian explains the different billable codes for RPM, including setup and education, equipment budget, and monitoring services.
- Ian discusses the importance of using multi-parameter readings to increase compliance rates.
- Ian provides an overview of the different patient equipment solutions and the benefits of using devices that are easy to use and transmit data automatically.
Benefits of Multi-Parameter Readings and Compliance Rates
- Lisa Faast uses the analogy of buoys in the ocean to explain the benefits of using multiple data points for RPM.
- Lisa emphasizes the importance of having multiple devices to increase compliance rates and provide more clinically applicable information.
- Ian discusses the benefits of using devices that are easy to use and transmit data automatically, such as those provided by Black Box RPM.
- Ian highlights the importance of having a user-friendly system that allows for easy setup and tracking of devices.
Conclusion and Call to Action
Lisa encourages pharmacies to reach out to Ian for more information and to consider implementing the software in their practices.
Ian summarizes the key points of the presentation, including the benefits of using the software to manage value-based care programs.
Ian offers to provide demos and additional information to interested pharmacies.
Lisa Faast reiterates the importance of using the software to maximize revenue opportunities and improve patient care.