How do Olympic athletes rise to success? They work in partnership with their trainers, coaches, and teammates to pave the best path to victory. Our strategy is similar in that we work with payers, providers, and patients to find winning solutions to healthcare’s most challenging problems. Ultimately that means better healthcare, smarter spending, and a healthier community.
We’ve added a policy update to Value Connections in our ongoing effort to provide you with the tools that you need to do be successful. You spoke: our members told us they want information on health policy and how it affects your organization and our community. We listened: Starting with this issue, we’re compiling a few relevant policy updates in conjunction with our friends at the Network for Regional Healthcare Improvement.
The most notable update relates to the Medicare Access and CHIP Reauthorization Act (MACRA) legislation. This legislation is the overarching change that will affect how Medicare payments are made to physicians. MACRA works in three main ways: it repeals the Medicare Sustainable Growth Rate (SGR) formula that calculates payment for physicians, creates a new framework to reward physicians for providing high quality care and reducing unnecessary costs, and merges three existing quality reporting programs to a consolidated model.
The MACRA Quality Payment Program is core to the CMS goal of paying for value and quality care. The Quality Payment Program has two paths: Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).
The Comprehensive Primary Care model (CPC+) is an advanced APM, which is often considered the path of least resistance, as the MIPS reporting requirements are more complex and burdensome. In CPC Classic, the Centers for Medicare & Medicaid Innovation collaborated with commercial and state health insurance plans in seven US regions to offer population-based management fees and shared savings opportunities to participating primary care practices. The Health Collaborative is pleased to share that we are now one of the fourteen regions selected to pilot CPC+ and this new way of paying for primary care—paying for keeping people well.
What does it mean that Ohio/NKY has been selected? We are now part of the CPC+ five-year initiative, and practices will soon be selected to participate. These practices will be paid in a way that will allow them to focus on population health, open access, and non-traditional delivery methods such as telehealth and eVisits. In the state of Ohio alone, there could be over 300 practices selected to pilot this model of care. It requires a significant amount of money for these practices to transform the way they deliver care, so we’re taking a proactive approach to implement changes in the smartest, most efficient way. This five-year initiative will begin January of 2017.
In the state of Ohio alone, there could be over 300 practices selected to pilot this model of care…so we’re taking a proactive approach to implement changes in the smartest, most efficient way.