Managed Care

One-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans, and many states are transitioning to “Long-Term Managed Medicaid.” Meanwhile, Accountable Care Organizations (ACOs) are designed to coordinate care for the fee-for-service Medicare population, but are in effect de-facto insurance plans with respect to their incentive to reduce utilization (in fact, some “Next Gen” ACOs are now being paid like Medicare Advantage plans).

Success in this environment is predicated on the SNF’s ability to satisfy the increasing demands of health systems, ACOs and insurance plans by positioning themselves as “preferred providers,” thus increasing referrals.  Zimmet Healthcare can optimize your position by highlighting the outcome advantages unique to your facility. In addition, our related company, Case Management Solutions, offers a scalable, outsourced case-management platform that is guaranteed to increase managed care covered days, rate exclusion capture and collections, while freeing your staff from the frustration of fruitless communication with insurance plans.

ZHSG’s Managed Care Support services include:

• New Payment / Episodic Model Development
• Marketing Tools Based on Advanced Analytics
• ISNP Program Management / Reconciliation
• Outsourced Case-Management / Authorization
• Contract & Performance Analysis