The Three-legged Stool:
This patented element of MedAlign provides the critical third leg of the stool, without which there is an inherent imbalance between payers and physicians. With the MedAlign system, two legs (doctors and payers) rely on the third leg (the MedAlign entity) to ensure transparent and fair accounting of cost savings and reimbursement. The MedAlign entity is responsible for calculating the professional management fees the payer pays physicians, computed as a percentage of savings within an episode-of-care. The MedAlign entity also participates in regular negotiations between doctors and the payer regarding fee schedules, episode-of-care updates, physician attribution issues and periodic fine-tuning of benchmark costs. For its efforts, the MedAlign entity is paid a percentage of savings, an amount proportionate to management fees paid to the doctors.
This patented element of MedAlign provides the critical third leg of the stool, without which there is an inherent imbalance between payers and physicians. With the MedAlign system, two legs (doctors and payers) rely on the third leg (the MedAlign entity) to ensure transparent and fair accounting of cost savings and reimbursement. The MedAlign entity is responsible for calculating the professional management fees the payer pays physicians, computed as a percentage of savings within an episode-of-care. The MedAlign entity also participates in regular negotiations between doctors and the payer regarding fee schedules, episode-of-care updates, physician attribution issues and periodic fine-tuning of benchmark costs. For its efforts, the MedAlign entity is paid a percentage of savings, an amount proportionate to management fees paid to the doctors.
The interests of physicians, payers, and patients are thereby properly aligned: 1) Physicians’ incomes are aligned with the MedAlign entity’s income because it is calculated as a percentage of what the doctors make in professional management fees, 2) Payer’s interests are aligned with the MedAlign entity, as the entity is under contract with the payer to save the payer money, and 3) Patients’ interests are protected because they can make medical decisions in conjunction with their own physician, without complicated medical management protocols or review panels.
The Future of Shared-savings:
Since 1996 MedAlign has worked with payers and physicians to pursue free-market payment reform which maintains both the patients’ rights to choose their own physicians as well as the physicians’ ability to treat their patients according to their best clinical judgment. MedAlign believes that free-market principles can show the way to superior payment reform. Central planning may work under certain circumstances, but the free-market’s “invisible hand” works best in most cases. Within MedAlign’s shared-savings model, physicians are the “invisible hand” that plans and coordinates the most efficient care pathway leading to the highest quality patient outcomes as well as significant savings to the payer.
MedAlign’s Intellectual Property and Consulting Services:
MedAlign, Inc. is a company dedicated to the reform of healthcare reimbursement. MedAlign has exclusive rights to US Patent 7389245 covering its proprietary shared savings methodology; other patents are pending. It is well known that specific healthcare idiosyncrasies alter free market mechanisms. MedAlign makes adjustments for these idiosyncrasies, aligning the interests of payers, patients, and physicians. Clinton B. Ashford, MD, FACOG and Jeffrey W. Baldwin, FACHE are available to discuss the MedAlign pay-for-performance and shared savings model. Please see contact information below.