Collaborating Network Providers
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The PriMED Greater Dayton Senior Care Advantage program provides a higher level of coordination, communication, transparency and physician-control.
Physicians and providers across America understand our national healthcare marketplace is moving from fee-for-service to a value-based model, and as a progressive, independent practice, we believe that PriMED Physicians should be at the forefront of the region in those trends, bringing new, better ways for independent physicians to practice. As such, we have continued to invest and develop our population health capabilities. We have transformed our practices, introduced an innovative hospital transition of care model and Care Management department, and recently implemented technology to ensure comprehensive identification of care gaps for our seniors.
To build on our success, we are proud to announce the Greater Dayton Senior Care Advantage program. Greater Dayton Senior Care Advantage is an advanced population health model that will provide high quality, more efficient care for our Medicare Advantage patients, by working with participating health plans. The program, beginning January 1, 2020, will shift the financial responsibility for total cost of care for Medicare Advantage patients to Greater Dayton Senior Care Advantage and delegate operational responsibility to us for many functions historically provided by the health plans.
In 2020, Greater Dayton Senior Care Advantage will have claims payment delegation for a large percentage of our Medicare Advantage business. This requires us to re-contract the existing network for the Medicare Advantage health plans in the Miami Valley region of Ohio, which includes network hospitals, physicians and ancillary providers. Referral coordination, utilization management and provider credentialing for Medicare Advantage patients will now be performed by the Greater Dayton Senior Care Advantage team. Our care and disease management programs will enhance those historically provided by the health plan. Physicians will now have the data and transparency around cost and quality of care that historically has only resided within the health plans.
As a result, our vision to deliver evidence-based medicine, for the care we provide, but also the care we recommend for patients, will finally be realized.
Enhanced Collaboration with Specialists is Critical
The comprehensive nature of the Greater Dayton Senior Care Advantage program, supported by specialized information technology and operating processes, will provide greater communication and coordination between primary care physicians and specialists than ever before. PriMED Physicians will have increased visibility and access to quantitative quality and cost metrics.
The combination of a team-based approach (with care managers, nurses, social workers, and physicians) along with the tools, data and technology to manage risk results in patients receiving consistent high-quality medical care from all physicians caring for them.
What are the benefits for physician specialists?
PriMED Physicians believe that we can enjoy the practice of medicine and deliver the best coordinated care for our patients by bringing innovation to the healthcare delivery system. The Greater Dayton Senior Care Advantage program will enable us, together, to deliver the best, evidenced-based care with more current data and analysis than ever before.
How it works
Greater Dayton Senior Care Advantage’s care management and disease management programs will be woven further into the medical care provided by PriMED and the consulting specialists, where appropriate.
Network provider contracting and credentialing will be performed under this model.
Utilization management will be coordinated through Greater Dayton Senior Care Advantage. Greater Dayton Senior Care Advantage will also process and pay claims for healthcare services provided to patients, thereby allowing for quality and cost transparency to better serve our patient population.
How do we complete the contracting process?
We are building our provider network to begin the Greater Dayton Senior Care Advantage program. We welcome our specialist colleagues to join us.
CORE Care Select is the contracting entity for Greater Dayton Senior Care Advantage.
Questions regarding network contracting should be directed to SeniorCareAdvantageContracting@SCA.com or (614) 350-2638.
Frequently Asked Questions and Answers for Providers