Your partner in the transition to value-based payments from traditional fee for service
Fee for service payment models for health care in the United States have grown unsustainable. While the United States economy spends >18% on health care (three times more than other countries), it does not exhibit better outcomes. Analysis of health care costs determined that of total health care spending, 30% has been identified as unnecessary, ineffective, overpriced and wasteful.
In order to transform how health care providers are reimbursed for services rendered, the Centers for Medicare & Medicaid Services (CMS) introduced an array of value-based care models. Private payers have in turn adopted similar models of accountable, value-based care.
Goal of Value-Based Payments
Replace fragmented, fee-for-service care with comprehensive, coordinated care using payment models that hold organizations accountable for cost control and quality gains. By advancing the triple aim of:
- Providing comprehensive and coordinated care for individuals
- Improving population health management strategies
- Reducing health care costs
“I believe that the culture of treating illness and emphasizing volume is slowly shifting to encouraging wellness and valuing quality. Annual wellness exams are a necessary part of that paradigm shift. People are living longer and healthier lives, and the focus on wellness is a change that is hopefully here to stay.”
– Thomas Coburn, MD CHI Saint Joseph Health Primary Care
Driven By Data
Value-Based care is driven by data. In many cases it is not the quality of the care that needs improvement, it’s documentation of that quality care.
When patients receive more coordinated, appropriate, and effective care, providers are rewarded.
Quality Reporting Resources
Our innovative care management strategy centers on the primary care component of health care. It is critical that primary care providers are connected seamlessly with all network providers, each with access to the tools and resources they need to provide the right care, at the right time, in the right place.
We use the most sophisticated and secure technology to:
- Monitor & report quality measures
- Produce patient-specific reports including open gaps in preventive care and risk stratification
- Access to data allowing you to make information-powered clinical decisions and reduce duplicative services
- CHI Saint Joseph Health Partners is your Kentucky-based resource for MACRA.
CHI Saint Joseph Health Partners monitors six different third-party payor shared savings/quality measure performance contracts, totaling 48 separate quality measures. Measures include preventative care screenings, immunizations, and completion of annual well visits as well as medications prescribed and monitored. Click on the tabs below to learn more about quality reporting resources.
Wellness exams are nationally recognized as the standard for high quality care and most payors are now incentivizing providers to perform these important exams annually on all patients, regardless of age.
The Annual Wellness Visit Toolkit is available to help you document a comprehensive AWV, including resources such as a gap analysis tool and action plan, as well as answers to frequently asked questions. We've also created a grid to help communicate the difference of a "Welcome to Medicare" visit, an Annual Wellness Visit and a physical exam.
While "Welcome to Medicare" and physical exams cannot be completed via TeleHealth, the AWV can. Our toolkit is accessible electronically or can be downloaded for use within your practice.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Medicare sustainable growth rate formula, strengthened Medicare access by improving payments to physician and other clinicians, and rewarded value and outcomes by establishing the Quality Payment Program (QPP). As part of CHI Saint Joseph Health Partners, our providers participate in MACRA on the Advanced Alternative Payment Model (APMs) track.
Published MACRA Resources
- CHI Saint Joseph Health Partners Overview of MACRA
- Center for Medicare & Medicaid: What is MACRA?
- HealthAffairs Blog: Growth of ACOs and Alternative Payment Models in 2017, 6/28/17
- HealthCare Finance: Why Value Based Care will Survive Republican Healthcare Overhaul, 1/3/17
- CMS Finalizes Rule Canceling Mandatory Bundled Payment Models, 11/30/17
Improve Medication Adherence with these Tips
Consider converting the patient’s prescription to a 90-day supply (when available).
This reduces the barrier of frequent travel to the pharmacy. (tip: Set your electronic medical record default to a 90-day supply.)
Review your patient list for patients that you consider high risk for non-adherence or develop a questionnaire to help understand patients’ adherence and potential barriers. Our clinical pharmacist can work with your patients to reduce additional barriers preventing them from maintain their prescribed regimen.
- Send to a home delivery or mail order pharmacy, further reducing the burden of travel.
- Prescribe a year’s supply of prescriptions at each annual visit to prevent refill gaps.
- If your patient is overdue for follow-up, send a one-time 30-day refill and immediately contact patient to schedule a visit.
- Schedule appointment with patient within the first seven days of discharge from an inpatient setting (or as soon as you are aware of discharge) to complete a medication reconciliation.
- Educate patients on how and when to take their medications and explain why this medication is important and potential adverse effects. Suggest pairing medications with a routine activity, use of a pillbox, or setting an alarm.
- Educate on “silent symptoms” and long-term compilations of diagnosis.
- Screen for depression as a potential contributor for not taking medications.
- Develop protocols or questionnaires to help understand potential adherence barriers.
- Recommend opt-in to pharmacy auto-refill and reminder calls.
- Prescribe generics to reduce cost barriers. Many are available with a $0 copay.
- Encourage members to review their plan or contact their insurer’s Member Services.
- When adjusting medications, issue a new prescription to ensure directions reflect the change.
- Ask patient to bring all medication to each visit.
- Discontinue unnecessary medications and consider lower doses.
- Consider once daily dosing or combination products when appropriate.