Cisne Health negotiates advantageous contracts with Medicare Advantage plans. As an affiliated provider, you receive a capitated monthly fee for each Medicare Advantage plan member. Most importantly, you choose the level of risk-reward you want to share – or take no risk at all.
The recurring, per-member-per-month (PMPM) capitation rate in our agreements works out to roughly double the national average of what primary care physicians earn per month, on average, in fee-for-service contracts for treatment of “Original Medicare” patients who are not on Medicare Advantage plans.
Unlike the unpredictability of fee-for-service revenue, this is a consistent, recurring monthly payment for you to take care of a population of Medicare Advantage plan members.
No and no. We don’t tell you or try to influence how you practice or how you take care of your patients. You are simply affiliated with Cisne Health through our agreements with Medicare Advantage plans.
No. You continue to see your existing Medicare patients. The difference is that you get paid a recurring, monthly payment for each of your Medicare patients who signs up for the Medicare Advantage plan(s) in which you will participate.
We facilitate the availability of Medicare Advantage plan representatives to be present in your office to explain the plan details at different times during the Medicare Annual Enrollment Period (AEP), also known as the open enrollment period, beginning October 15 and ending December 7.
You may gain additional Medicare Advantage patients and associated PMPM payments through their own selection of you as a provider or who may be assigned to you by the MA plan if the patient does not have a provider preference.
That is very unlikely. In fact, many of your Medicare Advantage patients may simply be Medicare beneficiaries who are already your patients but decide to switch to the Medicare Advantage plan for which you will be a provider.
As in all Medicare populations, some patients need more care and monitoring for chronic health problems than others. But a 2017 review from the U.S. Government Accountability Office found that sicker beneficiaries are far more likely to select Original Medicare or disenroll from their MA plan and return to Original Medicare than healthy beneficiaries.
People who are healthy tend to enjoy their MA plan and cheaper premiums than if they were in Original Medicare paying for their Medicare Part B monthly premium, a Part D prescription drug plan and a Medicare supplement plan (Medigap).
That may have been a valid concern in the past, but if you check out the specialists who participate in Medicare Advantage plans these days in all areas of Florida, you will see than many of the top specialists in your area participate. When we review Medicare Advantage plan options with you, you can review the provider directories to see which specialists participate with those plans.
There are some documentation requirements specific to Medicare Advantage, but Cisne Health helps make it quick and easy to apply our user-friendly checkbox system to quickly meet plan documentation requirements. We also help you quickly identify any care gaps that you would want to address to stay proactive in keeping your patients in the best possible health.
No. We will work with your billing staff so they can continue to focus on billing and collections for your fee-for-service patients while we manage coding and billing for your Medicare Advantage patients. Remember, you don’t pay any money to Cisne Health so there is no extra cost to you for our Medicare Advantage coding and billing services.
We work with a variety of the best Medicare Advantage plans and insurers. We will review plan options with you during our initial conversation.
We are paid by the Medicare Advantage plans in two ways:
1) We receive an administrative fee from the MA plan to handle coding and billing, provide you with care coordination support and help coordinate marketing of the Medicare Advantage plan to your Medicare patients during the open enrollment period;
2) We earn a share of any savings achieved if the primary care physicians with whom we are contracted meet those patient care benchmarks.
If you choose zero risk, Cisne Health takes on the risk and we receive payment from achieved savings.
If you choose to accept some level of shared risk in exchange for the opportunity to share in the savings, you set the level of risk you want to share and that matches the percentage share you receive of any savings.
Some of our affiliated physicians start with a zero-risk agreement in the first year but may choose some level of risk-reward in the second year or third year of a renewed agreement.
We are completely transparent. We don’t play hide-and-seek games with our affiliated physicians regarding how you get paid and how we get paid.
We will discuss and present several Medicare Advantage plan options to you. When you are ready to sign up, you receive a contract from Cisne Health. Once you are on board, we help you get credentialled with the plan and arrange for help from the plan representatives to present the plan details to your Medicare patients during the open enrollment period.
You can discontinue our agreement at any time based on 60 days advance notice in writing.
Of course. If you like, we will happily put you in touch with a doctor who is working with Cisne Health and familiar with how we support our relationships with primary care physicians.
In the meantime, here are comments from some of the primary care physicians affiliated with Cisne Health.