Which model is right for your practice?

For physician practices, the traditional fee-for-service model is unsustainable. Medicare payment changes introduced by MACRA and MIPS directly incentivize your practice to improve the cost and quality of care for your patients. In light of this change, Alternative Payment Models (APMs) offer a feasible path to:

  • Ease the burden of new reporting requirements
  • Improve practice performance on cost and quality metrics
  • Capture new revenue for your practice through incentives and shared savings

For primary care practices, the most comprehensive Medicare program available is the Medicare Shared Savings Program (MSSP). The next best model for primary care is the Comprehensive Primary Care Plus (CPC+) initiative. Both of these models offer useful guidance and tangible incentives to help shift your practice toward value based care.

Considerations for Independent Practices

Both MSSP and CPC+ offer varying levels of risk and responsibility for participating providers. For independent practices, success in these models requires hard work and focus.

As you plan your practice strategy, keep in mind these key points:

Quality performance is essential.

Tracking and improving quality metrics for your patient population are essential to improving patient outcomes and driving down healthcare cost. Practices who exceed on quality metrics will receive greater financial incentives for their efforts.

Focused, data-driven changes yield positive returns.

Redesigning practice behaviors and workflow based on practice and patient-level data will help your practice become more efficient while improving cost and quality performance. Integrating financial and clinical data to develop a 360-degree view of your patients will help your practice achieve positive returns in cost savings and new revenue.

Partners are available and willing to help.

Many organizations are available to help you navigate the changing health care environment. Aledade partners with independent practices to help them learn, prepare, and succeed under value based care, including MSSP and commercial payer agreements.

Physician Eligibility and Enrollment

According to CMS’s decision announced on May 27, 2016, primary care physicians may participate in both the MSSP and CPC+ programs.

MSSP Eligibility

To participate in the MSSP program, physicians must:

  • Be enrolled in Medicare Part B
  • Be part of a group practice, independent practice, hospital-employed medical group, Federally Qualified Health Center, or Rural Health Clinic
  • Participate in a practice, medical group, or provider network with greater than 5,000 attributed Medicare beneficiaries
  • Participate in an ACO that meets the governance and process requirements outlined by CMS

CPC+ Eligibility

To participate in CPC+, physicians must:

  • Be located in a designated CPC+ region (14 regions across AR, CO, HI, KS/MO, MI, MT, NJ, NY, OH/KY, OK, OR, PA, RI, and TN)
  • Use Certified Electronic Health Record Technology (CEHRT)
  • Participate in a primary care practice (i.e., primary specialty designation in family medicine, internal medicine, or geriatric medicine)
  • Participate in a practice that provides care to at least 150 attributed Medicare beneficiaries
  • Demonstrate CPC+ support from multiple payers
  • Meet specified practice structure and ownership criteria
  • Perform care delivery activities that include: assigning patients to a provider panel, providing 24/7 access for patients, and supporting quality improvement activities

Capabilities and Roadmap for Success

To succeed in value based care, practices must develop a wide range of capabilities that improve practice efficiency and empower physicians to manage the total cost and quality of care for their patients. In Aledade’s model, we work with your practice to provide the strategy, technology, data analytics, practice redesign, and scale necessary to successfully transform your business from fee-for-service to value based care.

Aledade works directly with your practice to better understand your patient panel, identify customized cost and quality opportunities, and focus on achieving early wins. Within the first 6 months, Aledade works to integrate our technology and data network into your practice, partner with your office staff to drive clinical initiatives, conduct workflow and practice redesign, and deliver utilization and revenue improvements to your practice.

Learn more about how Aledade helps practices succeed in value based care.

Is Your Practice Interested in Learning More?

If you’re interested in learning more about how Aledade can help your practice navigate the new healthcare economy, please complete the form below. We will provide you a free, customized opportunity analysis to help you understand the benefits of joining an Aledade ACO.