Skylight Health to Participate in Medicaid Value-Based Care Model in Colorado

Rhea-AI Summary

Skylight Health Group (TSXV:SLHG) announced that over 20,000 Medicaid members will participate in Colorado's new Alternative Payment Model 2 (APM 2) starting January 2023. This shift towards value-based care focuses on quality of care, rewarding healthcare providers for efficiency rather than the traditional fee-for-service model. This model supports improved patient outcomes, increases funding for quality care management, and creates a stable revenue stream for practices. Additionally, Skylight aims to expand its value-based contracting efforts beyond Medicare.

Over 20K+ Medicaid members to Begin Participation in Colorado in 2023

TORONTO, Sept. 29, 2022 (GLOBE NEWSWIRE) -- Skylight Health Group Inc. (TSXV:SLHG) (“Skylight Health” or the “Company”), a healthcare platform combining technology, and analytics focused on transitioning patients into value-based care to drive better health outcomes and experiences in the United States, today provides an update on the addendum to its current Medicaid contract into Colorado’s new Alternative Payment Model 2 (APM 2) for effective start date January 2023.

• Skylight currently has over 20K Medicaid members in Colorado
• The Company will begin participating in the new care model in January 2023 and is expected to have over 20K attributed Medicaid members
• VBC ties reimbursements to the quality of care delivered, rewarding healthcare providers for both efficiency and effectiveness as opposed to the fee-for-service (FFS) model, which relies on historical bill charges or annual fee schedules
• In addition, VBC models focusing on members' long-term health outcomes deliver higher profitability to providers
• The new APM 2 allows primary care providers to shift from fee-for-service to a capitated value-based-care per member per month reimbursement model as well as shared savings in improved patient quality thresholds
• This addendum is expected to allow Skylight to benefit from increased funding for its Medicaid members to improve on quality and care management
• This greatly accelerates Skylight’s shift to value-based-care, leveraging analytics and decision support tools of the Company’s joint venture with Centene Corp and CHS Medical
  

Skylight Health continues to see opportunities to expand value-based contracting efforts beyond traditional Medicare and Medicare Advantage. Colorado has a large Medicaid population that struggles with access to quality primary care providers. Skylight’s focus in this market is to work with payors to maximize services available to Medicaid members through improved reimbursements to care coordination and quality efforts. A fixed capitation value-based care model will also provide a more consistent revenue stream enabling Skylight to focus care to its Medicaid members and work to improve quality and health outcomes. This is a positive step forward in value-based care contracting with Medicaid in Colorado with the new innovative model that is currently an upside only risk agreement.

The APM 2 model is designed to improve member outcomes and reduce health disparities by creating stable investments in primary care. Under its flexible capitation model, providers can receive stable revenue for practices and allow investments in means of care that are not currently being rewarded (i.e., outreach and care coordination). Through gainsharing payments, practices can share in the cost savings deriving from enhanced chronic care management.

The Medicaid contract is in addition to the current Medicare value-based contracts. Skylight currently has over 2,400 Medicare lives at full risk where it plans to exit 2022 with approximately 5,000 lives and targets over 10,000 by 2024. This growth is expected to come primarily from its existing Medicare attributable population.

Prad Sekar, CEO & Co-Founder of Skylight Health said, “Value-based-care is at the core of our Company, and we are excited to provide this new model of healthcare to our patients in Colorado. This further accelerates our shift to VBC and we expect to see increased quality of care delivered as healthcare providers are rewarded for efficiency and effectiveness, ultimately offering better economics for Skylight Health as a whole.”

About Skylight Health Group 

Skylight Health Group (TSXV:SLHG) is a healthcare platform in the United States utilizing software and services to transition patients into a value-based care model and drive better health outcomes and experiences. The Company operates a multi-state health network comprised of physical practices that provide services from primary care, sub-specialty, allied health, and laboratory and diagnostic testing. The Company focuses on transitioning small and independent practices from a traditional fee-for-service (FFS) model to value-based care through tools including proprietary technology, data analytics and infrastructure. In an FFS model, payors (commercial and government insurers) reimburse on an encounter-based approach. This puts a focus on volume of patients per day. In a value-based care model, the providers offer care that is aimed at keeping patients healthy and minimize unnecessary health expenditures that are not proven to maintain the patient’s well-being. This places an emphasis on quality over volume. Through this model, Skylight Health is able to improve patient outcomes, reduce cost of delivery, and drive stronger financial performance.

Forward Looking Statements

This press release may include predictions, estimates or other information that might be considered forward-looking within the meaning of applicable securities laws. While these forward-looking statements represent our current judgments, they are subject to risks and uncertainties that could cause actual results to differ materially. You are cautioned not to place undue reliance on these forward-looking statements, which reflect our opinions only as of the date of this release. Please keep in mind that we are not obligating ourselves to revise or publicly release the results of any revision to these forward-looking statements in light of new information or future events. When used herein, words such as "look forward," "believe," "continue," "building," or variations of such words and similar expressions are intended to identify forward-looking statements. Factors that could cause actual results to differ materially from those contemplated in any forward-looking statements made by us herein are often discussed in filings we make with the Canadian securities regulators, and Canadian Securities Administrators, available at www.sedar.com, and on our website, at skylighthealthgroup.com.

For more information, please visit our website or contact:

Investor Relations:
Jackie Kelly
investors@skylighthealthgroup.com
416-301-2949

Neither the TSX Venture Exchange nor its Regulation Services Provider (as that term is defined in the policies of the TSX Venture Exchange) accepts responsibility for the adequacy or accuracy of this release.

FAQ

What is Skylight Health Group's new Medicaid initiative in Colorado for 2023?

Skylight Health Group will begin participating in Colorado's Alternative Payment Model 2 (APM 2) starting January 2023, encompassing over 20,000 Medicaid members.

How does APM 2 change reimbursements for Skylight Health Group?

APM 2 shifts reimbursement to a capitated value-based care model, rewarding healthcare providers based on the quality of care delivered rather than traditional fee-for-service.

What are the expected benefits of Skylight's participation in APM 2?

Skylight expects increased funding for Medicaid members, improved care management, and better health outcomes through value-based care.

How many Medicare lives does Skylight Health Group plan to support by 2024?

Skylight aims to support over 10,000 Medicare lives by 2024, expanding from approximately 5,000 lives projected by the end of 2022.

What role does Skylight's joint venture with Centene Corp play in this initiative?

The joint venture with Centene Corp enhances Skylight's capabilities in analytics and decision support tools, facilitating the shift to value-based care.