1. Member Contracting and Support

Kairos works to ensure each member organization is included in every possible payer network, receives the highest payment and best possible outcomes, and benefits from enhanced efficiencies.

Services:

• Payer and market research, payer contracting, negotiation, renegotiation and contract support. This includes value-based incentive contracting (including group contracts), shared savings arrangements, and special needs plans.
• In depth research and comparative analysis on the impact to member operations, costs, and risk.
• Assessment of facility services, costs, utilization, etc. to determine member needs and deliver the best contract outcomes.
• Communication directly with payers, evaluating terms and information necessary for Kairos’ contract analysis and recommendations.
• Recommendations on the proposed term of the provider agreement, the quality of the payer and the benefit plan, the nature and scope of covered services, the operational/administrative requirements, the service costs and any other factors or criteria that are material to the member’s contracting decision.
• General contracting support, policy recommendations, non- contracted payer research and recommendations.

2. Member Support Services

Member support is available to enhance operational accuracy and effectiveness to maximize reimbursement for delivered services.

Services:

• Phone support for admissions, billing, collections, registered nurse assessment coordinators (RNACs), social services and therapy related to payer coverage, payment, authorization, verification, denial, etc.
• Regulatory and payer policy research (coverage criteria, claim requirements, network issues, inclusions and exclusions, etc.).
• Contract summary to reduce member challenges related to the payer contract content and payer policy requirements for the admission and billing process.
• Reimbursement and billing process answers on unusual payer situations (i.e. auto, workers’ compensation, etc.).
• Individual recovery requests requiring up to two hours for resolution (extended recovery projects come under consulting services).
• Payer credentialing and re-credentialing.
• Insurance and reimbursement support training for facility and corporate staff.
• Contracting support and collections training.

3. Data Analytics and Support

Data reports support value-based payment discussions, identify data trends that payers and CMS are monitoring, assist with discussions on costs, and reveal market standing and movement.

Services:

• Access to CMS Claims Data Reporting, which supports planning for accountable care organization (ACO), bundled payment and other alternative payment initiatives. These reports also support member-marketing initiatives along with market and organizational assessments for expansion.
• Access to monthly CMS Star, Short and Long Stay Quality Measure reports. These reports are now available on the member access side of the Kairos website and include trending charts by measure, as well as comparison option reports to assess the member’s position to the local market.
• Availability of Kairos associates to educate, review and provide outcomes analysis.
• Additional data reporting will be evaluated and added based on future member needs and availability to Kairos.

1. Value-Based Care Consulting

Kairos offers services that focus on supporting members as they move from traditional fee-for-service reimbursement models to value-based payments. The services help improve population health with a focus on improving quality of care, improving satisfaction and decreasing costs.

Kairos Health Systems’ (Kairos) Value-Based Care & Purchasing (VBCP) Readiness Assessment is intended to help organizations understand their current level of value-based care delivery, identify opportunities for improvement and approaches to improve their network position. The comprehensive assessment focuses on:

• Establishing organizational goals for the process.
• Determining an organization’s preparedness for participation in value-based care delivery and new alternative payment models.
• Conducting a core capabilities assessment to identify strengths, best practices and opportunities for improvement.
• Sharing results and providing effective strategies for short and long-term needs.

Use of these services help members meet and exceed requirements to participate in value-based networks and benefit from incentives available through value-based programs that involve quality and outcome incentives, shared savings models, bundled payments, readmission penalties and other alternative payment models (PMPM-based, capitation, newly developed).

Note: These services are available under separate agreements for each activity/project.