Download presentation
Presentation is loading. Please wait.
1
ALAMO FAMILY HEALTH TEAM 1
2
Market Overview Fee-For Service Value-Based Service
Minimizing total cost Delivering better quality Expanding total patient volume Demanding price increase from payers Consolidating market position Locking up referral stream Alamo Family Health
3
Scenario CMS has enacted regulatory changes cited in the Medicare Access & Chip Reauthorization Act of 2015 (MACRA) MACRA Reimbursement by federal government via value-based payments over the next several years VALUE-BASED PAYMENT Need to develop multi-year approach that will minimize negative financial impact from transition in payment models MULTI-YEAR APPROACH Alamo Family Health
4
11.49% 65 years or older Our Organization SAN ANTONIO 10% Medicaid
55% Hispanic or Latino 8 FT-family physicians $11M Revenues 25 Patients/physician/day Owned and operated by eight full-time family practice physicians 2016 Annual revenues of ~$11M (breaking even) ~25 patients per physician per day Patient population is about 55% Hispanic or Latino 10% Medicaid 30% Medicare 60% Commercial & Other Alamo Family Health
5
Operational Plan QUALIFYING FOR MIPS
Evaluation on 4 measures: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Resource Use Selected measures to match health needs of our patient population without imposing significant resource burdens MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) Addresses multiple quality reporting programs Encourages efficient patient care Offers our practice the greatest potential for adjustments to offset financial impact of MACRA Merit-based Incentive Payment System (MIPS) Addresses multiple quality reporting programs Encourages efficient patient care Offers our practice the greatest potential for adjustments to offset financial impact of MACRA Qualifying for MIPS Evaluation on four measures: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Resource Use Selected measures to match health needs of our patient population without imposing significant resource burdens Alamo Family Health
6
Quality Measures Alamo Family Health FALLS: RISK ASSESSMENT
(CROSS CUTTING MEASURE) DIABETES: FOOT EXAM Quality Measures: Falls: Risk Assessment (Cross Cutting Measure) Documentation of Current Medication in the Medical Record (High Priority Measure) Screening for High Blood Pressure and Follow-Up Documented Diabetes: Foot Exam Body Mass Index (BMI) Screening and Follow-Up Plan Colorectal Cancer Screening DOCUMENTATION OF CURRENT MEDICATION IN THE MEDICAL RECORD (HIGH PRIORITY MEASURE) BODY MASS INDEX (BMI) SCREENING AND FOLLOW-UP PLAN SCREENING FOR HIGH BLOOD PRESSURE AND FOLLOW-UP DOCUMENTED COLORECTAL CANCER SCREENING Alamo Family Health
7
Advancing Care Information (Required)
E-Prescribing Health Information Exchange Provide Patient Access Security Risk Analysis Not Required: Immunization Registry Reporting Medication Reconciliation Patient-specific Education Secure Messaging View, Download, or Transmit (VDT) E-Prescribing 0% Health Information Exchange 20% Provide Patient Access 20% Security Risk Analysis 0% Alamo Family Health
8
Advancing Care Information (Additional)
Not Required: Immunization Registry Reporting Medication Reconciliation Patient-specific Education Secure Messaging View, Download, or Transmit (VDT) Immunization Registry Reporting Medication Reconciliation Patient-specific Education Secure Messaging View, Download, or Transmit (VDT) 10% Each Alamo Family Health
9
Improvement Activities Resource Use
Use of Certified EHR to Capture Patient Reported Outcomes EHR CMS calculates based on claims, so no reporting requirements Improvement Activities: Use of Certified EHR to Capture Patient Reported Outcomes Implementation of Medication Management Practice Improvements *Resource Use: CMS calculates based on claims, so no reporting requirements Medication Management Practice Improvement Manage medications to maximize efficiency, effectiveness and safety Alamo Family Health
10
EHR Implementation BENEFITS COSTS
Increase the efficiency of our practice Implementation cost and annual fees Benefits: Increase the efficiency of our practice Allow patients to take control of their care through patient portal Centralize patient data Staff cost savings Costs: Implementation cost and annual fees Initial provider training Allow patients to take control of their care through patient portal Initial provider training Temporary reduction in patient volume Centralize patient data Staff cost savings Alamo Family Health
11
CUSTOMER RELATIONSHIP
Increased Community Presence Alamo Family Health Schools Businesses Partnership with local schools and businesses; provide preventative health and wellness services Benefits: Employees can benefit from health screenings without taking time off Potential to shift patient mix to include more commercial payors Establish relationships with prospective patients Employees can benefit from health screenings without taking time off ACCESSIBILITY Potential to shift patient mix to include more commercial payers INCREASE CUSTOMER VOLUME Establish relationships with prospective patients CUSTOMER RELATIONSHIP MANAGEMENT Alamo Family Health
12
Additional Quality Measures
Sponsorship Sponsor annual walk/5K to increase awareness for colon cancer screening awareness Community Outreach Partnership with charitable community organizations and host info sessions on good nutrition and heart health, encourage clinic visits for preventative care screenings Sponsor annual walk/5K to increase awareness for colon cancer screening awareness Partnership with charitable community organizations and host info sessions on good nutrition and heart health, encourage clinic visits for preventative care screenings Alamo Family Health
13
of weekend and evening hours nurses practitioners by 2018
Going Beyond 8 to 5 Implementation of weekend and evening hours Hire two extra nurse practitioners by 2018 Nurse hotline Secured physician portal Implementation of weekend and evening hours Two extra nurses practitioners by 2018 Nurse hotline Secured physician portal Alamo Family Health
14
Medicare Patients Increase
Current Financial State Medicare Patients Increase 40% 33% 30% 2016 31% 2017 32% 2018 33% 2019 34% 2020 35% 2021 Alamo Family Health
15
Financial Effect of Transition
Change in payer mix – from growth rate of over 65 population in San Antonio Change in patients/day based on EHR and productivity ASSUMPTIONS EHR Implementation Bringing on additional staff to cover extended hours MAJOR COSTS Reduction in support staff Improved office utilization through extended hours MIPS adjustments FINANCIAL IMRPOVEMENT Alamo Family Health
16
Five Year Forecast Alamo Family Health
17
Five Year Forecast Different scenarios Net impact EHR
Margin comparison Alamo Family Health
18
Conslusion Trasition from FFS to VBS Additional Quality Measures MIPS
EHR Implementation Selected Quality Measures Financial Forecast Alamo Family Health
Similar presentations
