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The Transforming Clinical Practices Initiative (TCPi) is a free, federally funded support network that will help you and your care team navigate provider compensation changes coming soon as a result of the Medicare Quality Payment Program (also known as MACRA) and commercial insurance companies moving to value-based payment. You do not need to be a Medicare provider to participate. We are pleased to announce that TCPI is close to capacity (2,000 clinicians). If you are interested in learning more about the program please contact us to schedule a personal phone call with a TCPI team member. Click here for a timeline, and here for an FAQ.
TCPi engages health plans, providers and coaches in payment reform discussion
By Heather Grimshaw
There was energy and excitement in the room as specialty care providers shared stories about health reform efforts that led to better patient experience and care as well as reduced or avoided costs during the Alternative Payment Summit hosted by the Transforming Clinical Practice Initiative (TCPi) March 18. The positive energy and interest in engaging in discussion about what level of cost savings warrants a change in payment was noted by health care purchasers, who discussed options for specialty care providers to participate in value-based reimbursement models in the state, and the need for more provider leadership when it comes to systems change.
“I’m energized to see so much engagement and such good work being done,” said Patrick Gordon, chief executive officer, UnitedHealthcare Community & State Colorado. “We have a significant opportunity to bend the cost curve” when it comes to health reform, he explained and added, “we need smarter ways to compensate providers,” he added.
The key to identifying that compensation is continued conversations between health plan and provider representatives, a willingness to share and discuss data that shows unique value and to partner more closely on value-based payments that support provider innovation.
Shane Mofford, director of rates and payment reform, Health First Colorado (Medicaid), shared information about the alternative payment model from Health First Colorado, which was designed to reward providers who demonstrate better outcomes. “We spend a lot of money to obtain health outcomes, not health services, and the quality component [of value-based payments and quality initiatives] help us bridge that gap. It's truly a unique moment" in healthcare, he told attendees.
The quality component Mofford refers to is a core component of TCPi and the Colorado State Innovation Model (SIM), two federally funded, Governor’s office initiatives managed by the SIM office that help providers gather, use and report data to succeed with alternative payment models (APMs).
Colorado TCPi practices have identified more than $50 million in estimated savings through process and care changes made at a practice level and continue to improve care while reducing or avoiding unnecessary costs.
“SIM has been a great catalyst for change in the state,” Mofford said and added, “there will be more opportunities to take on risks and to be rewarded for outcomes.”
Presentations from practice representatives illustrated how reform efforts spearheaded by TCPi led to better patient outcomes and the reduction in or avoidance of unnecessary costs.
“It was such a beautiful transformation journey,” said Lisa Lewis, MD, Sustaina Center for Women, a TCPi practice. “Our lives are totally different because of TCPi, which helped us focus on the patient” and make small changes that led to big improvements.
Lewis was one of three practice representatives, who shared stories about TCPi-funded work with national and state experts at the meeting. The group included clinicians, practice managers, contract experts, health purchasers and practice coaches funded by TCPi to help practices improve efficiencies and prepare for success with APMs that reward the value, not volume, of health services.
“I’m energized by the progress these practices have made,” said Bob Smith, executive director, Colorado Business Group on Health, which is helping employers buy better, not more, health care. Smith noted the inherent challenges to reforming the system, which is still based on fee-for-service payments.
“Fee for service is a disincentive for redesign” because it rewards the volume of services provided, Smith explained. “We’re [employers] spending our money where there’s no payback. We have to change the way the marketplace works,” he added.
Smith advocates for more leadership from self-insured employers and health providers, who need to collaborate to change the system and demand different types of payment models from health plans that reward health outcomes instead of service volume.
Several health plan representatives who participated in the summit agreed that providers need to be more vocal when negotiating contracts and showcasing how their work leads to reduced costs and better outcomes.
Practice changes that influence patient care and costs
Presentations at the summit show how large and small practice changes can lead to impressive results.
Lewis talked about how training a medical assistant (MA) to offer “911 visits” for non-emergent cases enabled patients to get care when and where they need it and avoided unnecessary and expensive emergency visits. Tallying avoided costs ($257,908 in on year) and showcasing how MA visits expanded patient access earned Sustaina Center for Women’s a more lucrative contract with one commercial payer. Read more.
Samantha Weiner talked about how Critical Care, Pulmonology and Sleep Associates saved $122,000 with a lung health initiative that engages patients through regular communications that include text messaging. The practice is on track to save $450,000 in 2019. “There is a cost to us” to redesign our care, Weiner noted, “but we know it’s important to provide the best care to our patients.”
Rena Bach, chief executive officer for SurgOne, shared the team’s approach to reducing the number of pills included in opioid prescriptions and talked about how the team engaged and educated patients to set appropriate expectations for pain related to surgery, design and use a patient opioid contract and reduce the number of pills prescribed to avoid waste and prevent addictions. Surgeons now prescribe 12-15 opioids for pain instead of 30 pills.
“Our physicians and administrators worked hand in hand to approach this issue,” Bach said. “Our physicians are excited about this,” she added. “We’re all in.” Read more. [link]
That sentiment—that health care providers are willing to transform practice operations to influence care and costs—resonated with audience members and panelists, who appreciated the level of engagement and interest in continuing reform efforts after TCPi ends in September.
“The joy of my work is to hear, to see and to feel the work that is happening with transformation,” said Robert Fleming, PhD, TCPi director, Centers for Medicare & Medicaid Services, who attended the Colorado event. “Those three adjectives describe what TCPi is—a meaningful, impactful bridge from volume to value.”
Attendees left the meeting invigorated about the ways in which TCPi created a solid foundation for future growth.
“The progress you’ve made is phenomenal,” Mofford said during the health purchaser panel, and it provides justification for paying differently.
Investing in patient-family engagement improves morale, productivity for TCPi practice
One of the goals for Southwest Retinae Consultants, Durango, during its participation in the Transforming Clinical Practice Initiative, is to enhance patient-family engagement (PFE) efforts, and to engage more fully in community events.
Representatives from TCPi, a governor’s office initiative that is funded by the Center for Medicare & Medicaid Innovation, encouraged the team to strengthen its PFE and to collect and share success stories.
“We repurposed marketing efforts/monies into supporting patients and the community,” says Jennifer Batchelor, COA, practice administrator. “Our marketing efforts were expensive and did not reflect practice values. We redirected that money into tangible activities that reflect our practice culture, values and the wishes of the care team.
Activities include sponsoring and participating fundraisers around our patient’s needs, supporting and participating in local senior activities such as the Lions Club, Rotary Clubs, and local senior health care events, and sponsoring school events and local arts programs that encourage people to get involved. Doctors also speak at several local events for Indian Health Services, local Rotary clubs and continuing education opportunities for physicians.
“We believe that a financial investment in our team, care processes and community will be more effective in growing our business while preparing for success in a world in which demonstrated care quality, efficient use of resources and excellent patient experience has a direct effect on compensation,” Batchelor adds. “This new direction has improved morale and had a positive effect on relationships among team members and with patients, their families and the community. It’s a win-win. We wanted more involvement with patients to sustain and build our reputation of excellent care, exceptional experience of care and better engagement with patients and families. We believe a tangible emphasis on patient-centered care exemplifies our values and will ultimately result in financial success.”
The team is committed to excellent care that, by definition, engages patients as partners in their care, and to organizing the practice in ways that are valuable to patients. “We want patients to experience exceptional care, recognize it as a practice hallmark and talk with friends and neighbors about it,” Batchelor explains.
“Our tagline, ‘Helping you SEE better to LIVE better’ is demonstrated daily by our doctors’ focus on helping people to see better, which naturally improve patients’ lives and we continue to seek new ways to illustrate that commitment.”
The goal, she adds, was to turn patients into fans, who would rave about their experiences and expand the group’s marketing reach through word-of-mouth advertising.
“To accomplish this, we focused on engaged listening, and hired a scribe so doctors could be active listeners,” Batchelor says. Scribes have allowed doctors to focus on patient examinations and prompt discussions about patients’ lives, their hobbies and interests. “We believe this approach is more patient-centered and encourages patients to understand their conditions and develop treatment plans that include medication management,” she adds.
And that has paid off.
“Patients say they feel highly valued, appreciated and more thoroughly cared for because of our efforts,” which we believe will have a positive effect on our business, she adds. “We expect this approach to result in better care, lower costs and word-of-mouth marketing as patients share their positive experiences.”
Examples of the team’s efforts to become more patient-centered include training to become active listeners, an investment in free resources for patients and their families and ongoing solicitation of patient and family input about what’s important to them and ways to integrate their preferences into care processes.
“Feedback about extended wait times, ease of the referral process, exam availability and direction on community resources helps expand our ‘inside’ perspective so that we can make them feel completely cared for,” explains Haley Jones, lead scribe/medical assistant.
The team is employing active listening skills to improve communication with patients and families, who might be looking for different types of resources. “We will identify and provide resources that patients and family members seek and will encourage staff and doctors to be involved in community events,” Jones adds.
The team’s interest in patients goes beyond providing quality eye/retina care.
“The work we’ve done has improved morale as well as the attitude and satisfaction among providers and staff,” Batchelor explains. “This approach, which connects our team to meaningful work that transcends clinic walls, encourages the team to demonstrate a commitment to patients and the community. We are demonstrating our willingness to contribute to the lives of those around us. We have also invested in cultural awareness and ensure that we have educational materials in multiple languages for patients, who are not proficient in English, employ bilingual staff and offer interpretation services as needed.
The largest adjustment, she says, was a change in mental focus on patient experience and satisfaction and community involvement. The investment of time and money has improved patient confidence in our doctors because patients recognize an interest that goes beyond eye care and start to realize that we care about them as people, not just as patients. The efforts have improved staff morale and led to improved productivity, she adds.
“TCPi helped us focus our vision on patients and their families and encouraged us to seek new opportunities to care for them,” Batchelor explains. “The initiative has given us tools to overcome barriers to true patient and family involvement, and to expand opportunities to support patients in various ways, such as supporting seniors, who are struggling to do things on their own, or identifying groups and activities for patients, who suffer from low-vision or other debilitating diseases. We will continue to implement our plan with the help of the TCPi team and plan to share our successes with other health care providers to illustrate the benefits of delivering value-based care. Repurposing marketing dollars to hire a scribe for doctors and train providers and staff in active listening techniques has enabled us to partner with patients in managing their care, which includes medication management and shared decision making,” she adds. “We actively solicit patient input to inform practice operations and practice priorities.”
TCPi practices get top MIPS score
Practices engaged in the Transforming Clinical Practice Initiative (TCPi) are reporting success with the Merit Based Incentive Payment System (MIPS). Two TCPi practices received a MIPS score of 100 and many others score in the 90s, which means they will get positive payment adjustments. More than 90% of MIPS-eligible providers in TCPi have reported and will avoid a negative payment adjustment, due to their work.
Join them. Practices must submit performance data before March 31 to avoid penalties and potentially earn a positive payment adjustment under MIPS, one of two options to participation in the Centers for Medicare & Medicaid System Quality Payment Program (QPP). SIM and TCPi practices are uniquely qualified for success in QPP due to the work they're doing with their practice facilitators and CHITAs. Get details on what practices need to submit for MIPS as well as advanced alternative payment models (the other track in QPP) through the Colorado QPP website.
Many of the practices that received 90-100 on their MIPS reporting acknowledge the help they received from TCPi-funded clinical health information technology advisors (CHITAs) to prepare them!
Note: If athe podcast below will not play, please click here for a list of all SIM podcasts with download links.
Docs designing healthcare reform
Listen in to a discussion about how the Transforming Clinical Practices Initiative (TCPi) empowers doctors in Colorado to redesign the healthcare system to support the delivery of high-quality care with Carol Greenlee, MD, FACE, FACP, owner, Western Slope Endocrinology, Grand Junction, state and national faculty for TCPi; Barbara Martin, RN, MSN, ACNP-BC, MPH, director, Colorado State Innovation Model; and Allyson Gottsman, program manager, Colorado Health Extension System: www.youtube.com/watch?v=U61sRTsOKkg&feature=youtu.be.
The Colorado PTN will prepare clinicians to be successful with new models of compensation that require new models of care delivery, effective care coordination, and demonstrated value of care.
Why it matters:
MACRA legislation is set to make a major change in compensation with significant “carrots and sticks” What you don’t know, and don’t prepare for, can hurt you.
Who can participate:
Only 2000 Colorado clinicians and their staff will be able to participate in TCPi. This includes both independent and system practices.