The industry of healthcare is moving toward value-based care and clinicians will feel increasingly pressured to make better the quality of care they give as the federal government sustains to tie this to more and more of their payments. Coordinating with payers and information technology companies makes it simpler for care delivery agencies, specifically small and solo practices, to overcome all of the new challenges during the period of transition.
Companies of health information technology have developed and launched devices with the purpose of assisting providers prepare for the QPP (Quality Payment Program) and improve outcomes, though EHR vendors yet have a long way to go to make their systems more user-friendly. The incentive for payers to try to assist as best they can during the transition is their requirement for building and maintaining a network of quality providers in their competitive market.
The public-private partnership of CMS initiatives have been assisting participating practices across the U.S. to improve on meeting quality of care requirements since the year of 2012. Results for the 2nd round of the CPC initiative in the year of 2015 demonstrated $57.7 million gross savings were generated in Part A and Part B expenditures. The CMS has yet to release any results for CPC+, which it started to roll out in April 2016.
CEO of Infina Connect Healthcare Systems, Mark Hefner recently said, "CPC program appeared to reduce unimportant hospitalizations and [emergency department] visits.” Hefner considers that "CPC+ gives significant opportunity to redesign care and deliver higher value coordinated care at a lower cost.”
On the other hand, Julie Simer, special counsel in Buchalter Nemer’s healthcare practice group, explained that the initial outcomes with the previous CPC model "demonstrated that savings weren’t sufficient to cover the incentives."
The regions opted for CPC+ Round 2 — based on payer alignment and market density — are Louisiana, North Dakota, Nebraska, and the Greater Buffalo Region of New York. The participating payers are Blue Cross Blue Shield of Louisiana, BlueCross BlueShield of WNY, Amerigroup Louisiana, Inc., Blue Cross Blue Shield of Nebraska, AmeriHealth Caritas Louisiana, Inc., Blue Cross Blue Shield of North Dakota and Independent Health Association, Inc.
The practices are the missing piece in the Round 2 puzzle. Those that aren’t eligible are practices that did not apply for Round 1, those that did apply and were not accepted, as well as those that are not in the chosen regions.
Practices in the selected regions have until the day of July 13 to fill out an application for participating in either Track 1 or Track 2 of CPC+ Round 2 from the year of January 2018 through 2022. Track 2 is intended for practices that can meet 6 health IT requirements, which involve producing and displaying the outcomes of electronic clinical quality metrics to support actionable feedback for decision-making.