Value-Based
Wound Care
for Health Plans

Health plans need a wound care strategy that reduces Medical Loss Ratio, prevents catastrophic claims, and improves Star Ratings — not a vendor that bills more to earn more. Old Mission Wound Care partners with Medicare Advantage plans, D-SNPs, and commercial payers to manage chronic wound risk under shared savings, fees-at-risk, and fully capitated models.

Reduce Your Wound-Related MLR
Value-based wound care for health plans

Stop Paying for
Wound Care That
Rewards Failure

The economics of wound care in American healthcare are backwards. A hospital generates significantly more revenue from an amputation DRG than from a healed ulcer. Fee-for-service wound vendors are incentivized to extend episodes, escalate to expensive biologics, and bill for volume — not outcomes.

For a health plan managing population risk, this misalignment is not just frustrating. It is a direct threat to your Medical Loss Ratio.

Old Mission Wound Care was built to flip that equation.

Address the misaligned economics of wound care

The Problem: Chronic Wounds Are a Catastrophic
Risk Hiding in Your Claims Data

Most health plans are driving their wound strategy using a rearview mirror. Claims data lags by 90 days. By the time you see the amputation claim, the limb is already gone — and so is $125,000 in first-year costs.

Catastrophic Risk

A non-healing chronic wound is an indicator of systemic cardio-renal-metabolic failure, not just a skin event.

Readmission Spike

Patients with active diabetic foot ulcers face a 2x higher risk of 30-day hospital readmission.

Cost Multiplier

A member with a foot ulcer costs the system 3x to 5x more annually than one without the same comorbidities.

5% OF MEMBERS
DRIVE
50%
OF COSTS
In any health plan, 5% of the members drive 50% of the costs. These are your diabetic, immobile, multi-morbid members dealing with pressure injuries and vascular wounds. If you are not actively managing this cohort with a specialized strategy, your MLR is sitting on a powder keg.
Systemic risk mitigation for health plans

Our Role: Systemic Risk Mitigation.
Not Just Wound Care

Old Mission Wound Care operates as a risk-aligned clinical partner, not an external vendor chasing utilization. We take responsibility for both wound outcomes and cost containment, positioning ourselves as an extension of your population health strategy.

What this means in practice: We do not just close wounds. We close the clinical gaps that generate catastrophic claims. Every engagement includes in-home vascular diagnostics, nutritional optimization, and structured SDOH assessments capturing the Z-codes your care management teams need.

We are not selling wound care. We are selling systemic risk mitigation for your highest-acuity members.

The Model: Flexible, Risk-Aligned Pricing
That Matches Your Appetite

We absorb the clinical volatility. You get cost certainty. PMPM fees cover all clinical costs associated with the wound.

Shared Savings

We establish a baseline Total Cost of Care and share savings 50/50. We absorb the downside if we miss targets.

Collaboration
Data Transparency
Zero Upfront Risk

Fees-at-Risk

Straightforward PMPM model with 20% of fees at risk against clinical stabilization metrics.

Built-in Accountability
Predictable Payments
Clear Targets

Full Capitation

Accept a lower PMPM floor rate and take 80/20 shared risk on savings and losses.

Deepest Alignment
Maximum Control
Long-term Partnership

The Proof: Outcomes
That Move MLR and
Star Ratings

Before transitioning to a value-based model, our clinical team delivered mobile wound care at scale across the exact member profiles that inflate your Medical Loss Ratio.

For health plans, the downstream impact is measurable: fewer amputations, fewer ER visits, fewer inpatient admissions, lower skilled nursing utilization, and stronger performance on HEDIS measures.

98%
Improvement Rate
1.3%
Readmission Rate

HEDIS Gap Closure Impact:

  • Comprehensive Diabetes Care (CDC)
  • Plan All-Cause Readmissions (PCR)
  • Emergency Department Utilization (EDU)
  • Functional Status Assessment (FSA)
  • Transitions of Care (TRC)

Close Care Gaps While
We Close Wounds

Every home visit is an opportunity: we perform diabetic retinopathy screenings, bone density assessments, and remote patient monitoring. We capture HCC codes that improve risk adjustment revenue and close HEDIS gaps that move your Star Ratings.

Quality Improvement

One clinical touchpoint for wound management and gap closure.

Risk Adjustment

Capture HCC codes and identify high-risk members early.

Real-Time Clinical Data,
Not 90-Day Claims

Old Mission provides real-time clinical data feeds on your wound population — trajectory, velocity, infection status, and risk stratification.

Wound Trajectory & Healing Velocity
Infection Risk Stratification
Integration into Existing Dashboards
Actionable Intelligence vs Reactive Claims

Quantify Your
Wound-Related MLR Exposure

If chronic wounds are inflating your Medical Loss Ratio or generating catastrophic claims, we should talk. A short actuarial conversation can clarify where the risk lives in your population and whether a value-based model makes financial sense for your plan.

Request an Actuarial Savings Analysis