Archive for the ‘Primary Care Practice’ Category

CCMI’s Primary Care Initiatives Produce Modest, Mixed Results

February 8th, 2018 by Melanie Matthews

Comprehensive Primary Care Initiative Analysis

Comprehensive Primary Care Initiative Analysis: Mixed, Modest Results

The Center for Medicare & Medicaid Innovation’s (CCMI) Primary Care Initiatives have produced modest and mixed results, according to a final review of the program conducted by Kennell and Associates, Inc. and RTI International and released by CMS.

The six CMMI initiatives included in the review are the Comprehensive Primary Care (CPC) initiative, the Federally Qualified Health Center (FQHC) Advanced Primacy Care Practice demonstration, the Independence at Home (IAH) demonstration, the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, the State Innovation Models (SIM) initiative, and the Health Care Innovation Awards Primary Care Redesign Programs (HCIA-PCR), which CMS identified as the most focused on primary care redesign.

Initiative practices did make large strides toward becoming Patient-Centered Medical Homes (PCMHs) or advanced primary care practices. While less than 10 percent of initiative FQHCs had any PCMH recognition status prior to the initiative, 70 percent achieved NCQA Level-3 recognition by the end of the initiative. Similarly, the CPC evaluation found that CPC initiative practices improved their PCMH Assessment scores by about 50 percent.

While the review did not find consistent impacts across the initiatives or by setting within initiatives for any of the four core outcomes identified by CMS: fee-for-service Medicare hospital admissions, 30-day readmissions, outpatient ED visits, and Medicare expenditures, some of the initiatives did report some positive outcomes.

Of the 22 more granular initiative settings (seven CPC regions, FQHC as a whole, six HCIA-PCR awardees, and eight MAPCP states) for which cumulative results through Year 3 were available, 10 settings experienced improvement relative to their comparison group for at least one of the four core outcome measures at a significance level and three of these settings (two CPC regions and HCIA TransforMED) experienced improvement on at least two core outcomes.

Across four initiatives (CPC, MAPCP, HCIA-PCR, and FQHC), analyses indicated that the aggregate impacts on the core outcomes were small and not statistically significant.

Certain population subgroups and practice types across initiatives experienced more favorable outcomes, according to the analysis. Specifically, beneficiaries originally eligible for Medicare due to disability and beneficiaries with poor health (highest quartile of baseline HCC risk scores) experienced slower growth in Medicare expenditures. However, disability status and HCC risk score were not associated with statically significant impacts on overall rates of hospitalizations or ED visits, and non-dually eligible beneficiaries and those who were not originally eligible for Medicare due to disability experienced lower rates of 30-day readmissions.

The analysis also found slower growth in Medicare expenditures and lower rates of inpatient admissions and ED visits among practices with fewer than six practitioners and also among practices that were not multispecialty practices.

Other key findings from the analysis:

  • There are advantages to both state-convened and CMS-convened initiatives;
  • Practice-level factors are important in addressing transformation challenges; and
  • Initiative-level supports also helped practices meet transformation challenges.

Community Health Partnerships Can Change the Culture of Poverty: 2017 Benchmarks

November 28th, 2017 by Patricia Donovan

Community health partnerships address unmet needs, providing services related to transportation, housing, nutrition and behavioral health.

For residents of some locales, community health partnerships (CHP) —alliances between healthcare providers and local organizations to address unmet needs—can mean the difference between surviving and thriving, according to new CHP metrics from the Healthcare Intelligence Network (HIN).

“We could not survive without community partnerships. Our patients thrive because of them. They are critical to help change the culture of poverty that remains in our community,” noted a respondent to HIN’s 2017 survey on Community Health Partnerships.

Partnerships can also mean the difference between housing and homelessness. According to the survey, more than a quarter of community health partnerships (26 percent) address environmental and social determinants of health (SDOH) like housing and transportation that can have a deleterious effect on population health.

“To date, we have housed 49 families/individuals who were formally homeless or near homelessness,” added another respondent.

“Social health determinants are more important than ever to managing care,” said another. “Community health partnerships make a big impact when it comes to rounding out care.”

Motivated to improve population health, healthcare providers are joining forces with community groups such food banks, schools and faith-based organizations to bridge care gaps and deliver needed services. The majority of community health partnerships are designed to improve access to healthcare, say 70 percent of survey respondents.

Eighty-one organizations shared details on community health partnerships, which range from collaborating with a local food bank to educate food pantries on diabetes to the planting of community gardens to launching an asthma population health management program for students.

Seventy-one percent conduct a community health needs assessment (CHNA) to identify potential areas for local health partnerships. Priority candidates for 36 percent of these partnerships are high-risk populations, defined as those having two or more chronic medical conditions.

Overall, the survey found that 95 percent of respondents have initiated community health partnerships, with half of those remaining preparing to launch partnerships in the coming year.

Other community health partnership metrics identified by the 2017 survey include the following:

  • Local organizations such as food banks top the list of community health partners, say 79 percent.
  • The population health manager typically has primary responsibility for community health partnerships forged by 30 percent of respondents.
  • Foundations are the chief funding source for services offered through community health partnerships, say 23 percent. However, funding remains the chief barrier to community health partnerships, say 41 percent.
  • Forty-five percent have forged community health partnerships to enhance behavioral health services.
  • Two-thirds attributed increases in clinical outcomes and quality of care to community health partnerships.
  • Forty-four percent reported a drop in hospital ER visits after launching community health partnerships.

Download an executive summary of results from the 2017 Community Health Partnerships survey.

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    Infographic: Physician Health and Patient Care Impacted by Practice Demands

    October 6th, 2017 by Melanie Matthews

    The demands of practicing medicine are negatively impacting primary care doctors and their patients, according to a new infographic by MDVIP.

    The infographic examines how stress is impacting physicians and how this affects patients, along with details on what’s contributing most to physician stress.

    UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

    Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

    Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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    Infographic: Measuring Total Investments in Health

    November 21st, 2016 by Melanie Matthews

    Current spending on medical care is increasing, but does not always translate to improved health. Research has, however, shown a positive relationship between spending on social services and improved health and there has been a growing number efforts to measure “total spend on health” or the investments being made to produce health, according to a new infographic by Leavitt Partners.

    To better understand total spend on health, defined as health expenditures that extend beyond traditional clinical care costs or total cost of care measures to include costs related to social determinants of health, Leavitt conducted, with support from the Robert Wood Johnson Foundation, an assessment of related research and initiatives.

    The infographic examines the key challenges of analyzing total spend on health and next steps for healthcare leaders, researchers and other stakeholders in this area.

    Empowered Digital Patients

    The move from fee-for-service to value-based healthcare is driving the need for increased capabilities in population health management, including addressing all of the areas that may impact a person’s health. There is growing recognition that a broad range of social, economic and environmental factors shape an individual’s health, according to the New England Journal of Medicine. In fact, 60 percent of premature deaths are due to either individual behaviors or social and environmental factors. Healthcare providers who adopt value-based reimbursement models have an economic interest in all of the factors that impact a person’s health and providers must develop new skills and data gathering capabilities and forge community partnerships to understand and impact these factors.

    During Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System a December 8th webinar at 1:30 p.m. Eastern time, Dr. Randall Williams, chief executive officer, Pharos Innovations, will share his insight on the opportunity available to providers to impact population health beyond traditional clinical factors.

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    Appointment Data Opens Door to Population Health Management of Rising Risk Patients

    August 9th, 2016 by Patricia Donovan

    The rising risk population represents a healthcare organization’s “low-hanging fruit,” says Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital.

    Sometimes the most powerful population health management intervention is simply to convince a patient to make an appointment.

    This is the first step Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital (MGH), would recommend to any organization hoping to better manage its rising risk population, a group the physician describes as “low-hanging fruit.”

    “The appointment does not require significant investment in any health IT or other resources,” said Dr. Zai during Targeting High-Risk and Rising-Risk Patients: A Multi-Pronged Strategy, an August 2016 webinar now available for replay. “All you need is appointment data. The key is to identify existing data you already have in your organization and start there, so that you impact outcomes.”

    Dr. Zai, whose hospital has been ranked number one in the nation by U.S. News & World Report, likened the notion of an organization acquiring a sophisticated health data analytics system prior to identifying clinical outcomes to “building a house without an architect.”

    However, having done its due data diligence, MGH’s population health management approach embraces technology. The MGH approach, which targets rising- and high-risk patients, has moved far beyond appointment-setting, constructing a safety net program with the goal of improving clinical outcomes for 300,000 patients in its entire primary care network— a network spanning MGH and Brigham and Women’s Hospital.

    To this end, MGH developed a new set of clinically meaningful measures, but not before soliciting physician feedback on its existing set. In response, doctors identified more than 200 challenges to the old measures that MGH addressed in its new decision support system.

    With new measures in place, MGH then created central population health coordinator teams to support primary care physicians in population health management, freeing clinicians to care for patients.

    The selection of technology to support MGH’s primary care safety net presented its own challenges. “Frequently, the tools you end up with—for data aggregation, analytics, care coordination, and patient outreach—don’t actually talk to each other. You need a system to pull all of these functionalities together. That’s the strategy we took,” said Dr. Zai.

    The new MGH population health management system enables clinicians to identify and share gaps in care with MGH care coordinators and population health managers, so they can intervene and try and close those gaps, he continued.

    The system also tracks outcomes. After using the system for only six months, MGH reported improvement in every one of its newly developed performance framework measures. Not only is the ability to review outcomes appealing to payors, but 85 percent of MGH physicians surveyed also expressed satisfaction with the system—as well as its concurrent financial incentives.

    In closing, Dr. Zai reiterated the need for collaboration: between staffers doing the work and the informatics tying those efforts neatly together. “One cannot work without the other. That technology is just a tool. Just as you cannot give a hammer to someone and expect them to build a house, you need the talents working together with technology to make that happen.”

    Click here to listen to an interview with Dr. Zai on reducing the natural inertia of low-risk patients to move into the high-risk stratum.

    MACRA Mantra for Physician Practices: “Chase the Quality, and the Dollars Will Follow”

    July 19th, 2016 by Patricia Donovan

    Physician practices should position themselves to be paid for volume now and value in the future, McKesson’s Eric Levin advised webinar participants.


    If provider discontent doesn’t prompt a delay, the controversial MACRA legislation will become reality in just six months, shaking up traditional physician reporting and reimbursement as healthcare knows it.

    And while the proposed MACRA rule is still in flux, the bones of the law aren’t expected to change, notes Eric Levin, McKesson’s director of strategic services. From this point forward, he says, care coordination will be the ticket to success in eventual MACRA value- and performance-based healthcare models.

    “As clinical alignment and care coordination increase, if you are not participating in some type of value-based care program, most likely you’re not being reimbursed or rewarded for that work,” Levin told participants in The New Physician Quality Reporting: Positioning Your Practice for MACRA’s Merit-Based Incentive Payment System, a July 2016 webinar now available for replay.

    In outlining MACRA’s intent, Levin chiefly focused on the Merit-Based Incentive Payment Systems (MIPS) rather than the second reimbursement path, alternative payment systems (APMs), since the majority—88 percent—of physicians is expected to qualify under MIPS rather than APMs.

    Zeroing in on MIPS, Levin reviewed eligibility, performance categories and data submission options, among other points. He then detailed the plethora of current and planned technical assistance options from CMS—including eventual practice transformation networks to provide peer-level support to physicians—before offering practical ways physician practices can prepare now for MACRA.

    His six immediate action steps for practices included dipping a toe into analytics and data aggregation. “Look at the data. Learn how to risk-stratify. See the gaps in care you currently have and where those can be filled in so you’re not just measuring but actually improving quality,” Levin advised. The CMS Quality and Resource Use Report is useful for estimating a practice’s MIPS score, he added.

    In offering six additional tactics to become MACRA-ready, Levin recommended physician practices acquaint themselves with national benchmarks as a primer in quality measurement.

    And on Levin’s accompanying five-point MACRA implementation checklist is a reminder to stay current on CMS’s proposed and final MACRA rulings. Fostering relationships with technology vendors wouldn’t hurt either, he added.

    His final points covered additional MACRA implementation resources, including education from provider associations, as well as the benefits of Patient-Centered Medical Home recognition and engagement in CMS’s Chronic Care Management initiative in MACRA preparation.

    “These programs will really help you begin the value-based journey if you have not started.”

    Levin emphasized providers should not wait for the final rule. Rather, physician practices should “learn how to focus on quality outcomes and costs, helping focus on the patient as well as that patient-provider relationship. Look at how you can identify ways to increase inexpensive patient encounters.”

    Before concluding, Levin answered participants’ questions on how MACRA and MIPS will impact specialty providers; lessons practices can take from participation in the Physician Quality Reporting System, Meaningful Use and other value-based initiatives to enhance MACRA success; recommendations for small and solo practices; and other key concerns.

    Learn more about Levin’s presentation.

    Infographic: Proven Preventative Healthcare Practices

    July 1st, 2016 by Melanie Matthews

    Adopting simple, proven preventative practices could save Americans billions in healthcare costs per year and allow most to live longer lives. Nurses trained in basic screenings and counseling can have profound impacts, according to a new infographic by the University of San Francisco’s Online Master of Science in Nursing program.

    The infographic highlights 20 proven preventative services and the impact on the number of lives saved and healthcare costs if more people had access to these services.

    Increasing demand for quality-based, pay-for-value healthcare has elevated the health coach’s contribution to chronic care management and population health. From supporting ‘rising risk’ populations telephonically to conducting home visits for recently discharged high-risk, high-cost individuals, health coaching offers an essential care management touch point.

    2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

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    Infographic: 12 Physician Practice Models

    January 18th, 2016 by Melanie Matthews

    Healthcare industry challenges and government mandates are changing the way some physician practices operate, according to a new infographic by BillingParadise.

    The infographic outlines how 12 different physician practice models work to help physicians understand and choose a model best suited for them.

    One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it’s unique approach to this revenue opportunity is ramping up nicely. And, the organization’s approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

    During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar at 1:30 p.m. Eastern, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization’s experience with CMS’ chronic care management reimbursement this year and how they are leveraging this experience for CMS’ newest billable event in 2016—advance care planning.

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    Infographic: ACA’s Impact on Primary Care Practitioners

    November 27th, 2015 by Melanie Matthews

    Most primary care practitioners are reporting no change in their ability to provide quality care after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014, according to a new Visualizing Health Policy infographic. Their opinions about the healthcare law are sharply divided along political party lines. Generally, primary care physicians have a more negative view of health reform’s effect on the cost of patient care, but a more positive view of the law’s impact on patient access to healthcare and insurance.

    The infographic looks at the number of primary care clinicians who say they’re seeing more newly insured patients or patients covered by Medicaid since the ACA’s major coverage provisions took effect in January 2014.


    Dual-Eligibles Demos: Early Results and Their Implications offers timely intelligence about efforts to provide integrated care programs for beneficiaries who are dually eligible for Medicare and Medicaid—so-called “dual eligibles”—a group of 9 million beneficiaries who account for more than $300 billion in annual health care spending.

    Dual-Eligibles Demos: Early Results and Their Implications also includes a case study of the nation’s largest CMS-backed duals demo in California—one that has many insurers participating, including national for-profit firms, large local non-profits and smaller plans.

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