Guiding Site Transformation

"They guided us through the PCMH process. The work plans, site-specific training, and focus on the people side of change helped us gain buy-in and accelerate the adoption process. They knew what we were going to say about our practice concerns or pain points before we even said it—and then they offered strategies to assist. They helped us understand the intricacies of not only the NCQA PCMH standards, but how to ensure true practice transformation."

  • Value-Based Payment
  • Payment Reform Strategies
  • Approach

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.