A Trusted Partner

"Practice Advancement Strategies has been a fundamental to our transformation process. In addition to providing quick and trusted responses to questions regarding PCMH standards and interpretation, they customized their support to meet our precise needs. We are proud to have them on our side as we advance in our perpetual aim for high quality, patient-centered care."

  • Value-Based Payment
  • Payment Reform Strategies
  • Approach

Value-Based Payment

Healthcare providers are coordinating patient care across the healthcare spectrum, spurred by reform at the federal and state levels that is shifting payment from volume- to value-based models. This shift has also been prompted, in part, by public and commercial payer pressures, combined with new health insurance designs that demand a more engaged consumer.

Value-based payment models move away from historical fee-for-service and tie payment to cost and quality standards. These models offer providers opportunities, but not without financial risk. Many providers are successfully participating in these models and many more will as state, federal, and commercial payer reform continues.

Value-based payment models impact physician reimbursement, and without proper preparation and implementation, practices may face significant reimbursement penalties. HANYS Solutions Practice Advancement Strategies has expertise in the various value-based payment models and is engaged in ensuring that these models are workable for all, regardless of where providers are on the readiness spectrum.

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.

Our Approach

Peer and group-based learning, coupled with interaction and post-activities, is a proven educational method that ensures knowledge transfer.

We deliver education and training to best meet the needs of the client, including in-person, web-based, and train-the-trainer.

Areas of focus include:

Team Development and Facilitation: Working in team-based structures can be challenging. We help the practice team work through the team-building process so that not only your site transformation team but also your care teams, providers, and staff function at their best.

Practice Staff Education: In addition to culture and change management, we provide practice staff with training on care teams, population health management, care management, and care coordination.

Roles and Responsibilities: Being a contributing member of a team begins with having clear roles and responsibilities.