The Winning Strategy for Value Based Care

Take Medicare up on its offer to pay you to make the transition.

April Koontz LCSW

April Koontz LCSW Follow

June 11, 2019

Business person explaining value based measurement requirements on a computer screen to a doctor.

Thriving in today’s healthcare world requires strategic thinking at its best—especially for physicians. Fortunately, with the bipartisan-led Medicare Access and CHIP Reauthorization ACT (MACRA) legislation–  there’s now a permanent solution to the Medicare Part B Sustainable Growth Rate (SGR) reimbursement problem. But the solution, Medicare’s Quality Payment Program (QPP), doesn’t come without big change requirements in the way physicians run their practices.

The ‘what’ of MACRA is pretty clear. Improve care at a lower cost and make sure your patients are happy with your service. The ‘how’ of MACRA is the potential ‘show stopper’. It’s easy to get completely overwhelmed, even paralyzed by the firehose of acronyms and evolving mandates when all you want to do is practice good medicine and get paid for it.

Like it or not, MACRA’s here to stay and if you’re going to continue treating Medicare patients, you’re going to have to decide which route you’ll take: Merit-based Incentive Program (MIPS) or an Alternative Payment Model (APM). You can choose not to see Medicare patients, but you’ll run into the same transition to value based reimbursement in the commercial world, too. Virtually all commercial payers are moving toward contracts with providers that have a glide path toward risk. Putting the operational pieces in place now to better manage both your healthy and sick patients is the key to future-proofing your individual practice or the practices across your ACO.

The good news is that the transition doesn’t have to be as painful as you may think. To minimize the risk and operational hassle, step back and ask yourself this question:

What incremental changes can I make now to ensure better care for my patients AND my business regardless of what happens in DC or the industry?

Then adopt these Guiding Principles as a strategic first step:

Guiding Principle #1: Prove you provide better care and the money will follow.

Whether you’ve just started collecting and reporting on MIPS measures or are actively participating in an ACO, remember, your business is only as healthy as your sickest AND healthiest patients, and it’s non-existent without them. To avoid costly acute episodes and drive solid patient satisfaction, you have to be able to identify, proactively engage, and understand each individual patient’s barriers to achieving better health.

Guiding Principle #2: Take Medicare up on its offer to pay you to provide better care.

Taking advantage of current FFS programs like, Annual Wellness Visit (AWV), Transitional Care Management (TCM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI) provides a ‘jumpstart’ to proactively understand the needs of your individual patients, engage them in wellness activities and get paid for the ‘in-between’ visits you’ve already been doing – all keys to success in the value-based reimbursement world.

Guiding Principle #3: Recognize that you need more than people and your EHR alone to succeed.

Your staff and EHR are critical to the operation of your business, but neither may be able to manage the overwhelming day-to-day demands of engaging and managing the specific requirements of these programs. You may need to augment one or both to achieve success.

Look for a trusted partner.

At first glance, using your existing staff and technology to capitalize on the revenue from these programs may seem like the most financially viable option. Why pay someone else when you can do it yourself, right? If you have the resources and technical infrastructure to build and sustain these programs then insourcing absolutely makes sense.

Unfortunately, many practices have tried using their EMR and staff and discovered it’s unmanageable. The clinical and administrative details are extensive and most EMRs weren’t designed with the scope of service and time tracking requirements in mind. Couple these with the demands of competing clinical and operational priorities, and it’s virtually impossible to consistently deliver a high-value service that drives continued patient engagement, the fundamental core driver of measurable success.

You need a partner with a proven track record in successfully deploying these programs to first help you determine the best path for a successful and sustainable implementation – insourcing, outsourcing or a hybrid approach.

Interested in learning more about how you can successfully deploy Medicare’s FFS programs in your practice or in the practices across your ACO? Smartlink can help. We provide a single platform that enables physicians to leverage Medicare’s annual wellness, behavioral health and care management programs as a strategic bridge in the journey from fee-for-service to value-based reimbursement. The secure platform seamlessly interfaces with EMRs and can be used alone or in combination with our experienced care management services team. For more information, download our ‘Jumpstart Your Transition to Value-Based Care Whitepaper’ here.

April Koontz LCSW

April is the Sr. Product Marketing Manager for Smartlink Health. She's a clinical social worker who's passionate about health IT, behavioral health, coaching family caregivers, and helping people have meaningful conversations about end of life planning. Oh, and she's a songwriter, too.