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.
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:
Our collaborative approach begins with an assessment of the current state of the practice, which includes:
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:
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.
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.
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.