Payment Reform Strategies
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP), a new payment approach that rewards high-quality patient care through participation in Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS).
Evaluating and understanding the impact of value-based payments on physician reimbursement will impact a practice’s successful transition. We support this transition by analyzing the current state, along the various-value based payment spaces and developing an improvement plan.
Provider challenges include:
- A limited understanding of QPP requirements
- Aligning multiple groups with disparate electronic health records
- Motivating providers to understand and embrace change
- Aggregating data to report accurate, meaningful information
- Understanding the increased role of cost measures starting in 2018
- Alignment with health plans and physician offices
- Identifying resources needed for sustainable success
Our collaborative approach begins with an assessment of the current state of the practice, which includes:
- Physician Quality Reporting System and Meaningful Use performance
- Practice operations
- Clinical quality measure performance
- Cost of care measure analysis
- Insurer/managed care analysis, including incentive programs and value-based payment (VBP) arrangements
- Physician eligibility, education, engagement, and reimbursement models
- MACRA path: MIPS, MIPS APM, or Advanced APM
Using the results of the assessment, a team is established and a plan and structure are developed to successfully meet and sustain the future state of the provider, practice, or system. Plan development includes:
- Measure selection
- Physician education, reimbursement/payment models to transition from fee-for-service to VBP
- Change management and creating a culture of transparency and continuous quality improvement
- Establishing structure and processes for data sharing, transparency, and performance dashboard rollouts
- Improvement activities including Plan-Do-Study-Act cycles, practice transformation, workflow redesign, etc.
- Leveraging Accountable Care Organization activities for success
We work collaboratively with the practice, group, and/or system to customize an approach that will achieve success under MACRA and value-based reimbursement models.