By Amy Kotlarz
This January, 2017, Medicare plans to usher in a whole new way of paying for health care.
The federal government has proposed tracking how well medical practices are delivering care and then tying that performance to pay in 2019.
Clinicians will be compared to their peers based on health outcomes of their patients over the year, cost of care, quality improvement efforts, and patients’ ability to access their medical information.
“The shift from volume to value of care has been coming for several years now, and it’s likely that it won’t remain confined to just the Medicare population,” said Dr. Thomas Mahoney, chief medical officer of Finger Lakes Health Systems Agency. “We expect that other public and private payers will soon follow suit.”
To get ahead of this curve, Finger Lakes Health Systems Agency and the New York eHealth Collaborative are recruiting primary care, pediatrics and specialty care providers to take part in New York State’s new Practice Transformation Network.
The no-cost program coaches practice staff on new ways to engage patients in their own care, help staff work together as a team, and use data to hone in on areas of concern, like high rates of uncontrolled diabetes or hypertension within a practice. The network provides training through mentoring, webinars, group projects and peer learning opportunities. Providers also have the chance to earn free CME and MOC credits.
“To succeed in the new payment models, practices will need to develop new processes now, because measurement begins January 2017,” said Michelle Casey, chief program officer of FLHSA. “It’s quickly going to be shifting into overdrive.”
That’s where the network comes in. Quality Improvement Advisors will walk clinicians through the five phases of practice transformation. For instance, practices will be taught how to adopt a quality improvement strategy, how to integrate data-informed decision making into their daily work and how to improve communication with an array of service providers and specialists.
“It takes years, not weeks or months, for this transformation to occur,” Casey said. “It’s like asking people who are playing tennis to learn how to play basketball. It’s a wholesale culture change. When I started this practice transformation work, I thought it was going to be mostly technical, but it turns out, it’s about 80 percent relationships about 20 percent technical. It’s teaching people to play a team sport.”
The national focus on practice transformation has been prompted by the proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This new reimbursement plan requires Medicare payments to go through one of two models.
In the Merit-based Incentive Payment Systems (MIPS) model, there will be clear winners and losers, as performance will determine fee adjustments from - 9-percent to + 9-percent. MIPS will focus on quality, resource use, clinical practice improvement activities and technological advances in care information. Physicians are able to choose the activities and measures to demonstrate performance.
The second model, Advanced Alternative Payment, also incentivizes quality and value and requires practices to use electronic health records and bear financial risk or be a patient-centered medical home.
“The legislation sets a high bar for practices to qualify, and most existing patient-centered medical home practices do not yet meet this standard,” Mahoney said.
To prepare practices for these changes, the Practice Transformation Network plans to work with more than 11,000 clinicians across the state. A partnership of FLHSA and the New York eHealth Collaborative, the network is funded through a four-year, $48.5 million award through the Center for Medicare and Medicaid Innovation.
As the programmatic/clinical lead of the grant, FLHSA will provide expertise on designing and implementing transformation activities. It is also is providing regional support for the nine Finger Lakes counties it serves produce educational material and other technical assistance for providers around the state. Practices that have taken part in FLHSA’s previous Center for Medicare and Medicaid Innovation Award are eligible after July 1 to participate in the Practice Transformation Network.
“Our community was able to learn lessons from CMMI Award to put us in a good position to have significant experience moving forward with meeting the new standards and increasing the breadth and depth of practices operating as a true person-centered medical home,” Casey said.