Not Ready for Value-Based Payments? Help Is on the Way!

August 8th, 2016 - New CMS payment models require providers to transform the way they care for patients. Now, clinical practices can get FREE technical help to manage the change.

For providers, the hardest thing to see is the care that patients don’t receive. Regrettably, missing care can mean the difference between a patient who controls diabetes, and one who loses vision or kidney functions. It could even mean a heart patient who gets adequate follow-up care, and one who returns to the hospital in less than a month.

Closing the gaps in care has been a national priority ever since the Affordable Care Act (ACA) became law in 2010. The Centers for Medicare and Medicaid (CMS) have made it clear that future payment for treating Medicare and Medicaid patients will depend on how well providers manage their patients’ health, not on the quantity of services rendered.

So, providers need to quickly transform their practices from a fee-for-service model to a value-based payment model. To do that, they have to be able to identify gaps in care and measure their success in closing the gaps for each patient. It’s a big change, with a lot of moving parts, and it involves a chain of care delivered in different settings. Health information technology (HIT) and the Health Information Exchange (HIE) are crucial to making it work.

Fortunately, help is on the way, and it is free. CMS is funding a Transforming Clinical Practice Initiative to guide providers through the change in how they deliver care and get paid for that care. Now, HealthlinkNY participants can get the technical help they need—at no cost—from Strategic Interests, a leading New York HIT consultancy with expertise in payment reform. The Rochester-based firm offers program management, implementation, and change management to help providers transform their practices.

Kristy Aton, manager of training and development at HealthlinkNY, says, “The collaboration between HealthlinkNY and Strategic Interests brings another valuable technical resource to participating providers. Strategic Interests is someone we trust.” She adds that HealthlinkNY will use its understanding of individual provider HIT capabilities, as well as its HIE expertise, to facilitate the practice transformation process. “We will assist in anyway we can,” she explains.

Strategic Interests will find the best way for provider organizations to use and share information with each other when caring for the same patient, and how to keep care gaps “front and center,” according to Al Kinel, president of the firm. “While each practice has their own particular needs and challenges,” says Kinel, “the goals are to help practices identify higher-risk patients and opportunities to improve care, and develop a practical approach to addressing gaps in care.”

Strategic Interests will help practices measure performance, which will lead to further quality improvements. Those measures will be the backbone of a value-based payment model—not just for Medicare and Medicaid patients, but for health insurers and self-insured employers as well, which will likely follow CMS’ lead.To learn more about free practice transformation vendor assistance for those practices that are eligible, contact Strategic Interests at NYSPTN@strategicinterests.com or 585-797-2360.

About Strategic Interests

Strategic Interests is a healthcare technology consulting firm based in Rochester, NY that provides advisory and implementation services to help providers, payers, RHIOs and other stakeholders collaborate on complex initiatives to improve care and enhance financial performance. For more information, visit www.strategicinterests.com