Providers

Providers

Pathways Health Partners Direct Contract Participant and Preferred Providers are members of a high performance network of clinical providers dedicated to the advancement of Value over Volume based clinical care. Pathways provides expertise successfully navigating the growing complexities in the business of healthcare today.

 

Medicare Direct Contracting

 

We are experiencing a profound shift in how healthcare is delivered in the United States. Healthcare payment reform continues to accelerate its evolution from volume-based reimbursement to value-based payment models with variations in risk arrangements and quality metrics. The historic disconnect between payors, providers, and facilities has perpetuated a fractured healthcare delivery environment.

Pathways Health Partners’ Direct Contracting Entity (DCE) bridges the revenue gap between traditional Medicare and Medicare Advantage patient populations, in your practice. Our holistic approach to population health management merges the common goals of Medicare Advantage and Medicare Shared Savings of better outcomes, improved patient experience, lower costs, and improved clinician experience.


Medicare Advantage Managed Services

Our managed services organization (MSO) is a high performance group of primary care physicians who collaborate with our clinical care managers, hospitalist’s and preferred provider network to perform at risk for our select Managed Care plan partners. For these members, Pathways Health MSO bears “global” financial risk for their care.

Inpatient Medicine

Our inpatient medicine team ensures safe and successful transitions of care for vulnerable high-risk patients, including admissions from emergency department, ICU transfers, and discharges to post-acute care settings.

Medicare Direct Contracting

Direct Contracting Entities like Pathways Health Partners contract with CMS to deliver healthcare to fee-for-service Medicare beneficiaries aligned with participating physicians. CMS pays a monthly capitation fee to Pathways, and in turn, we’re responsible for delivering the full scope of patient care – at full financial risk.

Marketing Requirements

DCE Participant and Preferred Providers must submit any marketing materials to the DCE for CMS approval. Providers may submit draft marketing materials through this portal:

 

Marketing Support