Skylight Health to Participate in Medicaid Value-Based Care Model in Colorado
September 29 2022 - 7:00AM
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.
Forward Looking Statements
This press release may include predictions, estimates or other
information that might be considered forward-looking within the
meaning of applicable securities laws. While these forward-looking
statements represent our current judgments, they are subject to
risks and uncertainties that could cause actual results to differ
materially. You are cautioned not to place undue reliance on these
forward-looking statements, which reflect our opinions only as of
the date of this release. Please keep in mind that we are not
obligating ourselves to revise or publicly release the results of
any revision to these forward-looking statements in light of new
information or future events. When used herein, words such as "look
forward," "believe," "continue," "building," or variations of such
words and similar expressions are intended to identify
forward-looking statements. Factors that could cause actual results
to differ materially from those contemplated in any forward-looking
statements made by us herein are often discussed in filings we make
with the Canadian securities regulators, and Canadian Securities
Administrators, available at www.sedar.com, and on our
website, at skylighthealthgroup.com.
For more information, please visit our website or contact:
Investor Relations:Jackie
Kellyinvestors@skylighthealthgroup.com416-301-2949
Neither the TSX Venture Exchange nor its Regulation
Services Provider (as that term is defined in the policies of the
TSX Venture Exchange) accepts responsibility for the adequacy or
accuracy of this release.
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