How does MedAlign work?
The MedAlign system requires no extra paperwork and can be implemented within any fee for service plan or system.
The MedAlign system encourages physicians to practice the art, not the rulebook, of medicine. In fact, many times the best care is the simplest, most innovative, and least invasive. For example, a physician managing the process will more likely choose to prescribe a $10 antibiotic, whose efficacy is as good or better than the new $100 competitor promoted by a drug representative. An orthopedist might use a $3,000 hip prosthesis for an elderly woman, rather than a "high performance" $9,000 device designed for a younger, athletic person. Physicians will promote the use of the less expensive mail order drug system whenever possible due to its lower costs. Under MedAlign's model, there is an incentive for physicians to review such information with their patients and make better and more cost-effective choices while maintaining excellent quality of care.
How the MedAlign System Works:
The MedAlign system utilizes claims from the existing fee for service reimbursement system. As such, MedAlign can be implemented quickly within any public or private healthcare plan or system and permits all parties to share in the savings achieved.
- MedAlign is independent of the third party payers and physicians.
- MedAlign establishes the benchmarks for the cost of an episode of care based on historic costs as well as nationally recognized criteria available to all parties.
- Physicians will file claims as usual and be paid by the third party payer per their contract.
- MedAlign processes claims data received continuously from the payer; determines when the patient's episode of care has ended; attributes the episode of care to the appropriate physician; and compares the total cost of the episode of care to the respective financial benchmark.
- The MedAlign system then calculates the incentive payment when the episode of care is complete, normally when the patient has been free of the healthcare system for their condition for 45 days.
- On a monthly basis MedAlign provides data to the payer on the savings involved and the management fees to be paid to physicians achieving those savings.
- No incentive payments are made if the benchmark is exceeded.
- Incentive payments for chronic conditions such as diabetes are paid after determining an appropriate benchmark for the patient's condition over a one-year period. If the cost for the previous month is below the benchmark, the physician is paid an incentive for that month.
- By calculating and paying incentives on a monthly basis, MedAlign reinforces the physician's behavior to promote quality and cost effectiveness in managing the episode of care.