Many physicians are subject to participation in the new Merit-Based Incentive Payment System (MIPS) through CMS’s ongoing payment model reform initiatives encouraging providers to deliver better healthcare at lower costs.
CMS is just the tip of the spear. Commercial payers are developing their own pay-for-performance contracts as they slowly transition away from fee-for-service reimbursement. Yet many independent practice physicians and even employed physicians lack a strong strategy to participate in a healthcare environment where the Triple Aim is the ultimate mission.
Physicians should seize the opportunity to catalyze practice transformation by seeking out opportunities to participate in pay-for-performance contracts. First, these contracts offer practices the opportunity to pursue new revenue opportunities in a tightening reimbursement environment. More important, these contracts can fund investments needed to establish advanced care teams and pursue greater degrees of clinical integration that will be essential as payment for value takes hold throughout the country.
To thrive in this transformed economic environment, physician practices need to focus on the following areas:
- Develop a clear value proposition to take to commercial payers. Independent physician practices will need to develop new relationships with commercial payers and establish mutually beneficial goals that support the ultimate mission of patient value. These stakeholders also need to track and monitor progress towards achieving those specified objectives and goals.
- Measure performance at regular intervals. To succeed in value-based payment arrangements, providers must meet predefined thresholds to unlock corresponding financial incentives. Frequent reviews of performance data enable mid-course corrective actions to achieve those targets. When practices have good working knowledge of performance data, they also demonstrate commitment to the payer/provider relationship. That healthy relationship opens up the door for regular interaction to uncover problems and keep performance on track.
- Take the long view. Quality and efficiency targets can span multiple years and require many process workflows. Payers and providers must develop mutually agreeable measures that are administratively feasible and focused on improving the efficiency and quality of healthcare received by patients.
Value-based contracting is fundamentally focused on rewarding the healthcare provider for proper care coordination that improves health outcomes and patient experience while lowering costs. As your practice begins to see more opportunities to participate in pay-for-performance contracts, you will be wise to seize the opportunity to develop the monitoring and reporting competencies that will be essential in the not-too-distant future as CMS and the private sector continue to bring customer-centric innovations to the market.
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