#USA #New York #Medicare Advantage #primary care #AMC Health

AMC Health Introduces an Innovative Primary Care Model

AMC Health has announced a groundbreaking approach in its Accountable Primary Care offering, a performance-based model aimed at delivering validated savings of $4.2 million for every 1,000 high-risk Medicare Advantage members. This initiative seeks to revolutionize healthcare management by focusing not only on identifying patient risks but also on actively managing those risks.

A New Type of Care Management

Unlike traditional models, where healthcare providers merely flag at-risk patients, AMC Health empowers its affiliated clinicians to intervene directly. They conduct visits, adjust treatment plans, and ensure that care gaps are closed effectively. As Nesim Bildirici, Founder and CEO of AMC Health, explains, this model emphasizes responsibility and capability, daring to place the company’s fees at risk based on its ability to deliver results.

“I believe that continuous, proactive care should become the standard for managing high-risk chronic populations,” Bildirici stated. With over 24 years of clinical and operational infrastructure development, AMC Health positions itself uniquely in the market, validating its commitment to transforming healthcare outcomes.

Utilizing Data and Technology

A key aspect of this new model is the integration of data from patients' homes and the use of clinically validated AI to monitor patients. This innovative approach enables healthcare providers to identify which patients require attention promptly. For instance, AMC Health’s caregivers can prescribe medications, coordinate referrals, and adjust treatment plans based on real-time data, ensuring that patients receive the appropriate care in a timely manner.

“Primary care becomes more powerful when physicians can see what is happening with patients between visits,” remarked Martin Maimon, MD, MPH from AMC Health Virtual Medical Group. This proactive approach not only aims to help keep patients stable but also helps in averting costly hospitalizations.

Financial Equity through Performance Compensation

Health plans partnering with AMC Health will not face implementation fees or any kind of base compensation fees, as the company aligns its financial incentives with healthcare outcomes. Compensation comes from validated savings as measured against the health plan’s own claims data. For a standard cohort of about 12,000 member months over a year, AMC Health guarantees a minimum of $4.2 million in savings, equivalent to $350 per member per month (PMPM).

The model ensures that medically necessary services provided through AMC's clinical network are billed at the health plan's in-network rates, thereby maintaining the integrity of the overall cost-of-care calculations.

Proven Experience in Chronic Care Management

AMC Health's extensive background as a continuous care company underpins its ambitious new model. With more than two decades of experience supporting patients with complex health conditions, the company's offerings span across remote patient monitoring, virtual care, and integrated clinical technology.

Additionally, retrospective studies involving Medicaid beneficiaries with heart failure have shown remarkable success, demonstrating significant savings and reduced readmission rates, further validating AMC Health's methodologies.

This model is particularly beneficial for health plans aiming to serve high-risk populations, including those with conditions such as heart failure, COPD, hypertension, and patients frequently using emergency departments.

Conclusion

Health plans interested in exploring this innovative model can reach out to Tres Teague, Vice President for Health Plans, at [email protected]. As AMC Health continues to pioneer new ways to enhance patient care while simultaneously reducing costs, the focus remains firmly on achieving effective and measurable health outcomes.

With its promising savings and enhanced care strategy, AMC Health is positioned at the forefront of a progressive shift in how healthcare is managed for high-risk populations.