Medical home incentives
In addition to incentives for meeting performance targets, many payers are offering value-based incentives that relate to improved care coordination and case management.
Practices that have gained recognition as Patient-Centered Medical Homes (PCMHs), or that have met medical home recognition criteria set forth by payers, are most likely to be offered this type of incentive. Typically, medical homes must demonstrate improved care access, care coordination, and care quality to gain recognition.
The incentives offered to medical homes vary by payer, says Mary Witt, senior vice president of The Camden Group, a healthcare management and consulting services company based in El Segundo, Calif. They include funding for infrastructure development or care coordination, such as funding to hire a care coordinator in a practice; a percentage increase to a practice’s fee schedule; a per member, per month stipend for care coordination activities; or even shared savings opportunities, for instance, when a medical home manages to decrease emergency department utilization or hospital readmissions.
Still, while medical-home-related incentives are gaining traction, not all practices that become medical homes experience them, cautions Lutz. “At the end of the day, the physician may actually see [fewer] patients and do better economically as a result of participating and sponsoring these kinds of initiatives, but they have to do it in collaboration with a payer that’s going to be an active participant,” he says. “Depending on where you go in the country, some of these things are very well implemented … and in other parts of the country they’re just barely getting off the ground.”
To hear one physician discuss how her practice transitioned to a medical home, visit bit.ly/PCMH-transition.
Shared savings models
While not all payers are offering incentives to medical homes, transitioning to that model of care has other perks. Cook says it’s a great way for practices to gain experience delivering value-based care, and it’s also a great jumping off point for successful ACO participation.
In ACOs, groups of providers, including physicians, practices, hospitals, and/or larger healthcare systems, partner to improve the quality of care and reduce the cost of care provided to a particular patient population. If successful, the participants share in the cost savings with their payer partner. If not, in some arrangements, participants share in the losses.
Over the past two years, hundreds of ACOs have cropped up across the country. One is Coastal Carolina Quality Care, which has participated in Medicare’s advanced payment model ACO program since 2012.
“We felt that it would help us better focus and prepare for the future,” says Stephen Nuckolls, chief executive officer of Coastal Carolina Health Care, P.A., the multi-specialty medical group that formed the ACO. “We feel this type of aligned incentives is the way that medicine is moving and we wanted to go ahead and get some experience with that,”
Due to its ACO participation, Coastal, which is located in New Bern, N.C., has stepped up its focus on population health management, care coordination, cost control, and quality metrics, says Nuckolls. Those efforts may be paying off. Though CMS has not yet released Coastal’s first-year ACO performance report, Nuckolls says that the health system’s internal metrics are showing positive signs. “We are showing our emergency room utilization down year over year in excess of 30 percent,” he says. “We’re seeing hospital admissions down a little over 10 percent.

By: Aubrey Westgate

– Source: http://www.physicianspractice.com/medical-billing-collections/getting-paid-value-defining-new-reimbursement-models/page/0/2#sthash.eSREQ1EQ.dpuf