Modus Risk Network MRN

Direct Providers Network Contracting

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

Our Process

  • Charge a $40k one-time fee for access to Modus Clinical Intelligence MCI data in any four states

  • 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 network of Thoughtful Clinicians to ensure client’s 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 network clinicians and pay them in three ways to ensure:

    a. Patient Access: a monthly fee, PLUS
    +
    b. Patient Engagement: a per-encounter fee for service 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

  • Assign all Clinical authority and responsibility to Modus clinicians

    a. Network design
    b. Patients navigation
    c. Medical management: Pre-authorization and Utilization review

  • Weekly team meetings with Modus Clinicians and payer claims professionals

  • Work with Modus to optimize workflow and patients’ experience

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

  • Share claims data monthly

  • Claims Administrator:

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

Our expectations of our clinicians

(If invited to be in Modus network)

  • 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