HEALTH PARTNERS FOR THE ELDERLY, LLC

A Direct Contracting Entity recently formed as a Florida limited liability Company.

It was created by PrimeHealth Physicians, LLC (“PHP”), a medical group uniquely owned and managed by independent primary care physicians in Miami-Dade and Broward counties, to participate in the Centers for Medicare & Medicaid Services (“CMS”) Direct Contracting Model. Health Partners for the Elderly was selected by CMS as one of three (3) Direct Contracting Entities (“DCE”) in Miami-Dade County, Florida for the period commencing April 1, 2021, through December 31, 2026.

What is a Direct Contracting Entity Model?

This CMS model seeks to address four main areas:

1

Improving quality of care and health outcomes for Medicare Fee-for-Service (FFS) beneficiaries

2

Reducing Medicare expenditures through the alignment of financial incentives

3

Focusing on patient choice and direct care delivery

4

Maintaining access to care for beneficiaries, including those beneficiaries with complex, chronic and serious diseases.

Health Partners for the Elderly LLC has entered into an agreement with Medicare as a Direct Contracting Entity (DCE). The DCE designation applies to beneficiaries with Traditional Medicare or Medicare fee-for-service beneficiaries. This model’s main aim is to bring together all health care providers who share a common set of goals: improving patient care by working together more effectively through better coordinated care and services.

Why this is important to you as a Medicare Beneficiary?

This new initiative called direct contracting will combine the best of the traditional Medicare system with the best of the Medicare Advantage plans. The freedom to choose your own doctors and ancillary service providers in addition to the coordination of care and access to specialists and diagnostic tests that has become so difficult to navigate. By maximizing efficiency we will then be able to reduce costs which we all know are out of control and unsustainable.

Participating beneficiaries will enjoy the following benefits:

1. Access to home-based monitoring services such blood pressure monitoring services for patients with hypertension. This initiative will encourage patients to regularly check their blood pressure, thus educating patients and engaging them to be more proactive in their disease management,

2. Access to vouchers for over-the-counter medications recommended by a health care provider.

*Please refer to the benefit enhancement sections for additional enhancements

Direct Contracting Entity Beneficiary Rights

As a Direct Contracting Entity, we are required to adhere to a number of beneficiary protections including the following:

  • Maintain and surpass Medicare Benefits. A Medicare beneficiary who is voluntarily aligned through their Primary care provider with Health Partners for the Elderly Direct Contracting Entity (HP4E DCE) will always maintain the original Medicare benefits.
  • Maintain the option to select any Medicare participant provider or facility. You can still choose to go to any doctor or other practitioner who accepts Medicare anywhere.
  • Maintain the choice to change your primary clinician at any time and select another practitioner as your primary clinician.
  • Maintain the option to see any Medicare participant specialist for care. You choose your specialists. Your primary clinician may recommend a service or provider, but the choice is yours.
  • Maintain the same Medicare processes for all claims submitted for your services.
  • Maintain the same supplemental insurance benefits or your pharmacy plan.

Medicare Beneficiaries Benefit Enhancements

CMS is allowing the Direct Contracting Entity to augment the Medicare services that you currently receive from CMS. Examples include the following:

  • Preventive Healthcare Screenings & Education
  • Post-discharge home visits
  • Customer Service Advocates
  • Assistance with Pharmacy Services
  • In-Home Wellness Programs & Assessments
  • Care Coordination Services
  • Chronic Care Management Rewards
  • Care Management Home Visits

PROVIDERS

We are a physician driven organization. Our main objectives are:

  • Improve the quality of the healthcare services delivered in the communities we serve
  • Transform the physician’s practice from an episodic service to a coordinated based service
  • Reduce physician burnout by developing and providing the behind the scenes infrastructure that supports coordinated delivery of patient services
  • Provide compensation for adhering to and surpassing community-based and CMS Quality care benchmarks
 
Download a list of providers here.

REMUNERATION MODELS

There are several options to remunerate the provider for adhering to and leading in the implementation of this unique model, depending on the ones that best conform to your practice as follows:

 
(1) Profit sharing model
  • (2) Robust incentive structure
  • (3) Quality HEDIS toolkit
  • (4) Quality incentives
  • (5) Capitation for your Medicare patients
  • (6) One-on-one office transformation specialist

Medical Director

Alejandro Roca,

MD

PrimeHealth Physicians, LLC

Administrative Personnel

Cesar Ortiz

CEO 

PrimeHealth Physicians, LLC


Noris Reyes

VPO

PrimeHealth Physicians, LLC


Nancy Brown

Acting CFO

PrimeHealth Physicians, LLC

 

Terry Amaran

Director Revenue Cycle

PrimeHealth Physicians, LLC

Governing Body

Jorge Pereira, MD
Chairman and Participating Provider
PrimeHealth Physicians, LLC

 

Adam Rosen, MD
Managing Member and Participating Provider
PrimeHealth Physicians, LLC

 

Manuel Gonzalez, MD
Managing Member and Participating Provider
PrimeHealth Physicians, LLC

 

Lupe Bruneman, HCMBA
Patient Advocate
Advocate Health, LLC

 

Ed Barger
Medicare Beneficiary

 

Cesar Ortiz
Treasurer and Managing Member
PrimeHealth Physicians, LLC

 

Noris Reyes
Secretary and Managing Member
PrimeHealth Physicians, LLC

Health Partners for the Elderly, LLC 

Address: 14680 SW 8 Street, Miami, FL 33184 Primary Contact: Noris Reyes at noris.reyes@phpmds.com

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