Modus Accountable Teams MAT

Direct Contracting with high touch dedicated clinical teams led by specialty doctors

We only take you as a client if we can risk a portion of our fee to guarantee you a 2X ROI

A Winning Investment in Doctor-Patient Relationships

  1. Finding and recruiting the highest value Thoughtful Doctors
  2. Measuring patient quality of care/life throughout the care journey
  3. Real-time clinical practice guidelines
  4. Modus Doctors are responsible for medical management and navigation
  5. Clinicians are paid with aligned financial incentives with payers
    • Access Guarantee: paid a monthly fee
    • Engagement Guarantee: paid non-discounted Fee For Service FFS or Bundle
    • Upside risk bonus: a % of base pay equal to client annual savings %

Our Process

  • Charge a one-time fee for access to Modus Clinical Intelligence MCI data in any state

  • Using client’s claims data to evaluate spending by population type, disease category, and geography

  • Run an actuarial, clinical, and operations study to identify the potential impact on the client’s quality and cost

  • We ONLY offer to take on a client If we determine that we can make an impact on care quality and cost

  • If we take you on as a client, we will put a portion of our fee at risk to guarantee you 2X ROI

  • Work with the client to establish savings calculations from benchmark spending of four historical years

  • Recruit and manage a team of thoughtful clinicians to ensure client success.

  • Work with our client to set expectations of doctors such as preferred drugs formulary, ancillary services, or facilities

  • Population quality of care is constantly monitored and managed using Modus Quality of Life MQL score

  • Directly contract with the clinical team and pay them in three ways to ensure:

    a. Patient Access: a monthly fee PLUS
    +
    b. Patient Engagement: a per-encounter fee for service FFS or bundle, PLUS
    +
    c. Incentives alignment: a bonus contingent on the payers’ savings and quality improvements

  • Payers evaluate providers’ value based on apples-to-apples comparison

Our expectations of our payer partners

1. Assign all clinical authority and responsibility to Modus clinicians

  • Network design
  • Patients’ triage and navigation
  • Medical management: Pre-authorization and Utilization review

2. Weekly team meetings with Modus clinicians and claims professionals

3. Work with Modus to optimize workflow and patients’ experience

4. Accept Modus clinicians’ notes as full documentation for billing clinical encounters

5. Share claims data monthly

6. Claims Administrator:

  • Honors fee schedule set by Modus with providers for the fee for service and bundles
  • Electronic payment (in 7 days) to all Modus providers

Our expectations of our clinicians

(If invited to be in Modus Team)

  • Use Modus technology to manage the covered lives

  • Follow Modus policies, terms and conditions

  • Navigate covered lives (engage, educate, and triage) and Medical Management (referrals for approved providers/procedures)

  • Submit bid pricing for direct contracting

    a. Fee for Service at % of Medicare Fees
    b. Bundle price for surgery (itemized list)
    c. Monthly fee for covered lives, $/live