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Educational Resources for
Our Partners & Providers
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Hierarchical Condition Coding- HCC coding is the method of transmitting patient health complexity in a way that helps to predict future healthcare needs. Required to be re-addressed each calendar year, this helps set the expense benchmark in a value -based arrangement. It is important to capture your patients' diagnoses with specificity so that CMS can accurately set the cost of care for your patient population.

Annual Wellness Visits

An Annual Wellness Visit (AWV) plays an important role in patient care and in the overall success of an ACO. An AWV is not the same as a yearly physical. The purposes of an AWV are to: capture all chronic conditions, close gaps in care, develop a comprehensive patient care plan, increase patient engagement and satisfaction, identify high-risk patients, and increase attribution.

Providers must understand the different types of Physical Exam Coverage that CMS offers in order to optimize patient care and revenue.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.

CMS offers several different ACO tracks and payment models.

Clinical Quality Measures

Clinical Quality Measures (CQMs) are measures specified in a standard electronic format that use data electronically extracted from electronic health records (EHR) and/or health information technology (IT) systems to measure the quality of healthcare provided.

The Centers for Medicare & Medicaid Services (CMS) develop, implement and administer several different patient experience surveys. CAHPS surveys are an integral part of CMS’ efforts to improve healthcare in the U.S. Some CAHPS surveys are used in Value-Based Purchasing (Pay for Performance) initiatives. These initiatives represent a change in the way CMS pays for services. Instead of only paying for the number of services provided, CMS also pays for providing high quality services.

In 2024, the Oklahoma Health Care Authority (OHCA), in partnership with contracted entities (CEs) or health plans, implemented a new healthcare delivery model called SoonerSelect. LifeCare has established partnerships with each of the contracted health plans in Oklahoma to deliver care to SoonerSelect members.

Pharmacy Benefit Managers

Pharmacy benefit managers work as third parties that go between health insurance providers and drug manufacturers. Pharmacy benefit managers (PBMs) help negotiate costs and payments between drug manufacturers, pharmacies, and healthcare insurance providers. PBMs also create prescription drug lists, called formularies.

Voluntary Alignment

The Centers for Medicare and Medicaid (CMS) first introduced Voluntary Alignment for all Medicare programs in 2017 to encourage beneficiaries to take a more active role in their care. Patients can voluntarily align with a primary care physician of their choosing through two ways:
1) Visiting mymedicare.gov (electronic voluntary alignment)
2) Filling out a form and returning it to their provider (paper voluntary alignment)

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