As we enter the second year of data collection for Medicare’s Quality Payment Program (QPP), it is worth thinking through some higher-level thoughts and strategic goals. Adapting to the increasing amounts of quality-based reimbursement requires practices and providers to undergo “practice transformation”—adopt population health tactics through process changes, expanded use of data and changes in the work performed by providers and staff.
Unfortunately, there are no recipes or easy answers. Each practice must identify the needed changes based on their local environment, opportunities, as well as their organizational capacity to evolve.
Practices attempting to participate in any value-based programs need an organization-specific operational definition of transformation.
In the context of the Medicare program, transformation means to adopt the necessary policies and tactics that allow for the identification of high-risk patients (outliers) and patients who are not receiving expected care (gaps). Beyond addressing the individual patients, a practice must bake in process improvement activities based on patterns gleaned from monitoring for high risk patients. While the QPP provides a framework for the end points of these changes, practices need to decide the “what” and the “why” of the transformation.
Will the QPP’s Merit Based Incentive Payment program (MIPS) be the immediate end goal or will working to participate in Advanced Payment Models (APMs), regional clinically integrated networks and/or private payer quality incentive programs make the most sense?
Who in the practice will be asked to do the work of population health activities or will new staff be hired?
How will short and long-term success be measured outside of quality-based payments?
What is the opportunity cost of transformation—i.e. at what promised penalty or reward is the time and effort worth the risk?
Irrespective of the answers to these questions, the first step is to simply identify the disease processes, patient subgroups or specific outcomes that reflect the care your practice delivers and begin the process of identifying patients who are furthest from meeting the goals.
Strategic investments in using data
The QPP requires that practices use certified electronic health record technology (CEHRT) in some capacity. However, EHRs are just one aspect of the tools necessary to perform population health activities. The most commonly used EHR features do not typically offer a robust set of population health tools. As such, practices taking steps to transform must make the necessary strategic investments in using analytics/population health tools. Though this functionality is increasingly common in some EHRs, the most common population health tools are used by payers and organizations that bear financial risk.