Function Oriented, Value Based Payment Technology

What is Modus?


Modus is a function-oriented clinical process improvement system that pioneers non claim based quality metrics, data visualization and quantification. It’s designed to reduce unwarranted variation across providers and sites of care.

Modus software is designed by physicians with clinical insight to improve outcomes for musculoskeletal and post-acute care while simultaneously lowering health care cost.




How It Works

Providers view simple visuals that measure performance in real time while they are treating the patient and prescribing interventions (Opiates Rx tracked visually using morphine milliequivalent meter). This allows high performance providers to manage their own utilization (responsible autonomy) while delivering higher quality patient care focused on reducing opiates use and disability.

Why Modus

1. Powerful forces constantly influencing physicians prescribing habits which lead to an epidemic of opioids abuse, disability and unnecessary aggressive procedures.

2. The fee-for-service system rewards more care rather than better care.

3. The efficiency and quality of care received by patients varies tremendously.

4. Providers’ performance metrics are done retrospectively by analyzing billing claims data so there is no real-time feedback loop.

5. Patients and payers have no access to credible high quality data on specialty providers performance.

6. Payers and TPAs waste expensive resources attempting to manage utilization (eviCore).

7. Highly skilled clinicians waste talent and energy on data entry to validate payments.

The Solution

Real time quality metrics; For the first time, Modus gives High Performance Provider Organizations the tools that they need to truly manage their own utilization (responsible autonomy) while focusing on patients’ functional outcomes and following best practices. Using Modus, providers will communicate using a common platform and achieve greater efficiency by focusing on the patient's highest functional outcome and will be financially incentivized based on patient outcomes.

Designed by a group of physicians, Modus gives providers realtime performance metrics and real-time feedback with clear visuals of clinical and functional data, so that they can make decisions based on value care in real time.

The Modus system includes algorithms that perform visual / quantitative synthesis of functional and clinical data. The MODUS management approach ranks providers based how well they provide value in 4 key metrics:

  • Following best practices
  • Improving patient’s functional outcomes
  • Patient satisfaction
  • Controlling costs

Scorecard

The Modus Payment model is based on our data driven scorecard that outlines each provider’s adherence to best practices, patient’s functional outcome, patient satisfaction, and cost of care. Here is an example of our unique and innovative scorecard.

Shared savings $300,000
Best Practice

Functional Outcome

Service
Cost
Score
Share of Savings
Primary Care Physicians
AA 9570805075$12,810
BB 10060756577$13,173
CC 9840605048$8,241
DD9930905090$15,329
EE4035452562$10,568
FF9968651574$12,575
Physical Medicine Doctors
PMR19585909051$8,775
PMR210083851543$7,280
Spine Surgeon
SS16068806571$12,190
Psychologists
PS14065805044$7,472
PS26065806552$8,903
Physical Therapists
PT14080755048$8,113
PT27070901555$9,330
PT39065916585$14,496
Chiropractors
CH110060756577$13,173
CH29840605048$8,241

Our story

MODUS is the creation of a Physical Medicine & Rehabilitation physician with the goal to provide world class quality at the lowest possible cost. Spine pain represents a major source of unnecessary disability and tremendous costs. It is the most common industrial injury in the United States, involving 80% of Americans at some point in their lives and 31% at any given point in time.

Due to inappropriate and potentially harmful incentives of traditional fee for service payment, the use of spine surgery and/or epidural injections for people with spine pain caused the cost to skyrocket with poor functional and clinical outcomes . A recently published study of 23,918 visits showed that over the ten year study period, narcotic use increased by 50%, MRI’s increased by 56% and referrals to specialists such as surgeons increased by 105% without any significant improvement in outcomes.

MODUS brings an evidence based approach to the evaluation and treatment of spinal pain front and center. Our treatment and payment model provide accountability and empower high quality providers to give compassionate care based on scientific evidence. Modus creates a partnership between payers and providers and incentivizes doctors for making patient centered choices based upon the latest scientific information to achieve optimum cost effective clinical outcomes.

Ali Alhimiri, MD, Principal Founder and Chief Medical Officer

is a Physical Medicine & Rehabilitation Physician who provided a high level of cost effective quality and customized patient centered service since 2002 and is committed to continually improving patients’ access to evidence based care for back and spinal pain. He has successfully treated thousands of patients with pain and this experience led directly to the development of MODUS’ unique and innovative approach.


Charlie Rooney, Co-Founder, Chief Operating Officer

is responsible for deployment of the system, system training for providers, building provider networks, and negotiations with payers. Charlie has a Bachelors, Masters and PhD. in electrical engineering from Cambridge University, with experience over 30 years in business consulting and management. Currently CEO of Team Rehabilitation, a privately held physical therapy company with 44 clinics in Michigan, Illinois and Indiana. Team Rehabilitation has been rated a top employer in Michigan for the past 7 years in a row.


Andrew Shelby, Chief Technology Officer

is a Full-Stack Software Developer and Architect responsible for developing the MODUS System. He has over 20 years of diverse experience creating custom solutions from the ground up for industries including Automotive, Oil and Gas, Court E-Filing, Law Enforcement, Insurance and Government Agencies. As a government contractor, he has served as a key resource on several projects involving the United States Air Force, Federal Aviation Administration and CMS. Andrew has a continued passion for learning and using the latest technologies including iOS Mobile, IBM Watson, Microsoft Azure and Microsoft HoloLens.


Steve Bennett, Process Improvement Officer

is a certified Six Sigma Black Belt which has enabled him to lead programs that improve the quality of care, reduce risk, and optimize clinical outcomes. He has developed an improvement program that led to cost savings exceeding $350 million over seven years for BAA Airports, and over $500 million in 18 months for British Rail.


Robert Jackson MD, MMM

Robert Jackson is a Family Medicine physician in Western Wayne Physicians, an 11 physician, 3 office, private practice group located in Southeastern Michigan. He also provides leadership as President and Medical Director for two physician organizations: Accountable Healthcare Alliance and Accountable Healthcare Advantage (AHA). Dr. Jackson is a locally recognized voice in health care improvement.

Dedicated to improving the cost and quality of care in the communities he serves, Dr. Jackson serves on multiple professional boards and associations, and is an active community volunteer.

Dr. Jackson also serves as Medical Director for the Medical Advantage Group where he provides medical management expertise and clinical leadership. Dr. Jackson is board-certified in Family Practice, earned a medical degree from Wayne State University, and holds a Master of Medical Management from the H. John Heinz School of Public Policy and Management at Carnegie-Mellon University.


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To learn more about how MODUS can save you money and improve outcomes for your population contact us with your questions or for a live demonstration click here