Over 20K+ Medicaid members to Begin Participation in Colorado in 2023
TORONTO, Sept. 29, 2022 (GLOBE NEWSWIRE) -- Skylight Health Group Inc. (TSXV:SLHG) (“Skylight Health” or the “Company”), a healthcare platform combining technology, and analytics focused on transitioning patients into value-based care to drive better health outcomes and experiences in the United States, today provides an update on the addendum to its current Medicaid contract into Colorado’s new Alternative Payment Model 2 (APM 2) for effective start date January 2023.
Skylight currently has over 20K Medicaid members in Colorado
The Company will begin participating in the new care model in January 2023 and is expected to have over 20K attributed Medicaid members
VBC ties reimbursements to the quality of care delivered, rewarding healthcare providers for both efficiency and effectiveness as opposed to the fee-for-service (FFS) model, which relies on historical bill charges or annual fee schedules
In addition, VBC models focusing on members' long-term health outcomes deliver higher profitability to providers
The new APM 2 allows primary care providers to shift from fee-for-service to a capitated value-based-care per member per month reimbursement model as well as shared savings in improved patient quality thresholds
This addendum is expected to allow Skylight to benefit from increased funding for its Medicaid members to improve on quality and care management
This greatly accelerates Skylight’s shift to value-based-care, leveraging analytics and decision support tools of the Company’s joint venture with Centene Corp and CHS Medical
Skylight Health continues to see opportunities to expand value-based contracting efforts beyond traditional Medicare and Medicare Advantage. Colorado has a large Medicaid population that struggles with access to quality primary care providers. Skylight’s focus in this market is to work with payors to maximize services available to Medicaid members through improved reimbursements to care coordination and quality efforts. A fixed capitation value-based care model will also provide a more consistent revenue stream enabling Skylight to focus care to its Medicaid members and work to improve quality and health outcomes. This is a positive step forward in value-based care contracting with Medicaid in Colorado with the new innovative model that is currently an upside only risk agreement.
The APM 2 model is designed to improve member outcomes and reduce health disparities by creating stable investments in primary care. Under its flexible capitation model, providers can receive stable revenue for practices and allow investments in means of care that are not currently being rewarded (i.e., outreach and care coordination). Through gainsharing payments, practices can share in the cost savings deriving from enhanced chronic care management.
The Medicaid contract is in addition to the current Medicare value-based contracts. Skylight currently has over 2,400 Medicare lives at full risk where it plans to exit 2022 with approximately 5,000 lives and targets over 10,000 by 2024. This growth is expected to come primarily from its existing Medicare attributable population.
Prad Sekar, CEO & Co-Founder of Skylight Health said, “Value-based-care is at the core of our Company, and we are excited to provide this new model of healthcare to our patients in Colorado. This further accelerates our shift to VBC and we expect to see increased quality of care delivered as healthcare providers are rewarded for efficiency and effectiveness, ultimately offering better economics for Skylight Health as a whole.”
About Skylight Health Group
Skylight Health Group (TSXV:SLHG) is a healthcare platform in the United States utilizing software and services to transition patients into a value-based care model and drive better health outcomes and experiences. The Company operates a multi-state health network comprised of physical practices that provide services from primary care, sub-specialty, allied health, and laboratory and diagnostic testing. The Company focuses on transitioning small and independent practices from a traditional fee-for-service (FFS) model to value-based care through tools including proprietary technology, data analytics and infrastructure. In an FFS model, payors (commercial and government insurers) reimburse on an encounter-based approach. This puts a focus on volume of patients per day. In a value-based care model, the providers offer care that is aimed at keeping patients healthy and minimize unnecessary health expenditures that are not proven to maintain the patient’s well-being. This places an emphasis on quality over volume. Through this model, Skylight Health is able to improve patient outcomes, reduce cost of delivery, and drive stronger financial performance.
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