Preparing for Value-Based Payment: Five Essential Skills for Success
As physician payment increasingly becomes tied to value, these five habits can help you succeed.
Fam Pract Manag. 2017 May-June;24(3):25-30.
Author disclosure: no relevant financial affiliations disclosed.
Public and private payers are increasingly shifting the risk of providing health care from payers to physicians and other health care providers by tying reimbursement to value. This shift is part of an effort to achieve the “triple aim” of improving population health, reducing health care costs, and improving the patient care experience. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reaffirmed this shift and created new incentives for physicians to transition to value-based, alternative payment models. Also in 2015, the U.S. Department of Health & Human Services (HHS) announced a goal of moving 50 percent of Medicare payments into alternative payment models linked to value by 2018. The HHS announcement came the same week that the Health Care Transformation Task Force, an alliance of major health systems, insurers, and other industry players, announced a goal of placing 75 percent of its business into value-based payment arrangements by 2020.1 The year 2015 also saw the creation of more than 400 Shared Savings Accountable Care Organizations (ACOs) serving nearly 7.2 million beneficiaries, or 14 percent of the Medicare population.2 Medicaid, which covers more than 70 million people, has many states now participating in alternative payment models as well.
Although the market is moving rapidly toward valued-based payment, many physicians understandably feel skeptical, reluctant, or unprepared. A recent survey of primary care physicians across the country showed that only 41 percent felt they know which quality measures apply to their patients under value-based models, 65 percent said they do not have all the health care information they need about their patients, 36 percent said they were satisfied with access to patient data within their existing workflow, and 68 percent felt they do not have the tools to succeed in a value-based system.3 What can be done to help primary care physicians who are already overburdened by administrative tasks? How can they perform well under MACRA? What can physician members of an ACO do to contribute to their organization's success, and their own? The following five principles, which have helped my organization achieve early wins in value-based payment, may assist other physicians in addressing these issues and maximizing their earning potential.
1. Get to know your patients and your data
To accomplish its goal of tying Medicare payments to quality or value, the Centers for Medicare & Medicaid Services (CMS) must know exactly which Medicare patients are yours – and which are not. Attribution models vary. For example, under MACRA's Merit-Based
Referencesshow all references
1. Lowes R. Providers and insurers jump on ‘value-based’ pay bandwagon. Medscape Medical News. January 29, 2015. http://www.medscape.com/viewarticle/838897....
2. Abrams MK, Nuzum R, Zezza MA, Ryan J, Kiszla J, Guterman S. The Affordable Care Act's payment and delivery system reforms: a progress report at five years. Issue Brief (Commonw Fund). 2015;121–16.
3. Finding a Faster Path to Value-Based Care. Bowie, MD: Quest Diagnostics and Inovalon; 2016.
4. Schottenfeld L, Petersen D, Peikes D, et al. Creating Patient-Centered Team-Based Primary Care. AHRQ Pub. No. 16–0002-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
5. Advanced Primary Care: A Foundational Alternative Payment Model (APM) for Delivering Patient-Centered, Longitudinal, and Coordinated Care. Leawood, KS: American Academy of Family Physicians; 2017. https://www.aafp.org/dam/AAFP/documents/advocacy/payment/apms/ES-AdvancedPrimaryCare-121316.pdf. Accessed January 10, 2017.
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