Over the past few weeks we’ve shown how the Northern Physicians Organization (NPO) was able to improve care coordination through EMR and HIE integration. The projects that were completed resulted in numerous incentives and this is significant as the structure for reimbursements in the United States is changing. This week, we will discuss how these types of projects have a reciprocal relationship with value-based reimbursements.
Value-based Reimbursements
Typically, the U.S. healthcare system operated and still operates on a fee-for-service reimbursement system. This means that healthcare professionals are paid per person per visit. Some of the drawbacks of this structure include compromises to preventative measures (as patients would wait until already feeling sick to come in) and a lack of differentiation between effective and ineffective visits (as providers are paid either way). For this reason, reimbursements are moving towards a value-based model. This incorporates outcomes in provider reimbursements and may be based on clinical quality and cost, performance criteria, a continuum of patient’s long-term care, etc. Value-based models encourage a holistic view of healthcare and require communication and coordination between healthcare professionals.
NPO Perspective
As the U.S. healthcare system continues to transition from the traditional fee-for-service reimbursement model to one based on value and performance metrics, it is extremely difficult for organizations to survive without effective care coordination across providers. In Michigan, programs like the Physician Incentive Group Program and the Patient-Centered Medical Home are essential to the alignment between payment and care reformation.
Physician Group Incentive Program
The Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (PGIP) supports and encourages practice transformation by rewarding organizations for improved performance in healthcare delivery. PGIP supports initiatives that promote care coordination and physicians who meet quality and population-based care measures are eligible to receive higher value-based incentives.
One initiative that the PGIP has is the Health Information Exchange (HIE) Initiative, which supports physician organizations that participate in statewide data sharing cases. Through the projects completed with INTERFACEWARE, NPO was able to meet the requirements and receive those incentive rewards.
“Incentive programs like the Physician Group Incentive Program are critical for our organization and our members,” Ed Worthington, IT Director at NPO, explains. “The incentive rewards from these projects enable us to advance this important work and continue to make the structural and process changes needed to improve healthcare quality.”
Patient-Centered Medical Home
The Blue Cross Blue Shield of Michigan has launched the largest regional Patient Centered Medical Home (PCMH) program which places an emphasis on coordination of care activities across all aspects of the patient’s care. PCMH-designated physicians earn value-based reimbursements for office visits to compensate them for the extra time and effort required to practice as a medical home. One focus is the coordination of patient care across the health system through the process of active collaboration and communication. NPO is authorized to train and nominate physicians in their organization for the PCMH-designation and currently has nearly 40 PCMH-designated physicians.
In 2017, in comparison with non-PCMH practices, PCMH practices across the state of Michigan experienced the following results:
- 19% fewer adult ER visits
- 25% fewer adult ambulatory care sensitive inpatient stays
- 23% fewer adult primary care sensitive ER visits
- 20% fewer pediatric primary care sensitive ER visits
- 15% fewer overall pediatric ER visits
“The Patient-Centered Medical Home model is instrumental in promoting improvements to care coordination efforts by aligning those efforts with reimbursements based on quality measures,” Marie Hooper, Executive Director at NPO, states. “We are proud to have so many members achieve the PCMH-designation and are committed to ensuring they receive the reimbursements they deserve.”
With iNTERFACEWARE’s support, NPO was able to qualify for these incentives that will be reinvested to improve the quality of healthcare.