Finding financial success through value-based care
A strategic approach to value-based program participation
MPV New Jersey MD Services is a large physician network with 115 physicians who cover 16 specialties at 16 locations throughout New Jersey. The organization participates in multiple value-based care programs. It is a Patient-Centered Medical Home (PCMH), part of an Accountable Care Organization (ACO), and a participant in value-based programs with private payers. Shared savings is the organization’s main source of additional reimbursement, followed by upfront payments for care coordination.
Since transitioning from a fee-for-service network, MPV New Jersey MD Services has experienced great success navigating the value-based landscape: Its revenue has increased by 10%, and its ACO is the third most successful in the country.
Strategic planning upfront helped lay the foundation for success. When selecting practices to participate in an ACO, the organization sought those already headed in that direction. “Our criteria were that the practices had to be patient-centered medical homes,” said Dr. Edward Gold, MPV New Jersey MD Services lead physician. “That, or they had to commit to becoming a patient-centered medical home within a year. We supplied consulting services for them to get PCMH recognition. And we were careful; we didn’t do a land grab by letting everybody join. That is a mistake that a lot of organizations make.”
To maximize its performance, MPV New Jersey MD Services also works to ensure that all of its value-based programs require the same quality measures, which greatly simplifies administration and management. “In fact,” Gold said, “when we negotiate with the project payers, we basically tell them, ‘If you want to make a deal with us, you have to use the same quality measures that CMS uses.’ We are not having different quality measures for every different plan. That would drive you nuts. The tracking would be crazy.”
In its early years with the ACO, the practice didn’t limit itself to measures considered "low hanging fruit." The ACO took on the challenge of reducing hospital admissions. Within five years, it had reduced discharges to, and length of stay at, nursing homes — major quality measures with significant bonus opportunities.
Transformative staffing and processes
To help meet its quality measures, the ACO embedded care coordinators in each practice. “These are registered nurses who assist with transitions of care, a key part to participation in these programs,” Gold explained. “They help patients transition from emergency departments to their home or outpatient facilities, along with reaching out to high-risk patients.”
The ACO also added medical assistants. They see the patient before the doctor enters the exam room, review medications, handle patient health reminders, and complete basic screenings.
This helps speed up the visit and makes best use of the physicians’ time — while ensuring that the practice doesn’t lose too much volume despite the deeper level of engagement with patients.
Since MPV New Jersey MD Services became a value-based practice, its revenue has increased by 10%, and its ACO is the third most successful in the country.
Together, the care coordinators and medical assistants help fill gaps in care. “They help bring people back in and keep them in,” explained Gold. “If you look at our statistics, we have a high level of doctor’s office visits, but a low level of hospital admissions.”
Care coordinators and medical assistants have also helped physicians work from a value-based care mindset versus one of fee-for-service. “These folks are face-to-face with the doctors,” Gold said. “They know them. It’s not a voice from a call center. They can walk up to the doctor and say, ‘Doctor, your diabetics are out of control. We have to do something here.’”
In addition, the care coordinators work with the medical assistants to ensure interventions reach the patient; medical assistants manage the extensive use of health reminders that are critical to meeting quality measures. These checks and connections are part of formal workflows to ensure consistency and efficiency.
Technology ties it together for financial success
Practices participating in value-based care programs rely heavily on electronic health records (EHRs). MPV New Jersey MD Services uses Greenway’s Intergy EHR and Intergy Practice Analytics to meet reporting requirements. Practice Analytics is critical to the practice’s profitability, providing doctors with quarterly reports that show whether the practice is meeting various quality measures. For measures that need improvement, the practice can create customized reports to help track progress. Care plans designed to maximize performance are organized within the EHR.
MPV New Jersey MD Services and its fellow ACO members are living proof that value-based care can be profitable. Through the Medicare Shared Savings Program alone, the ACO realized profits of over $50 million — $15 million of which went to doctors. With physicians seeing improved patient outcomes, plus significant bonuses, value-based care is a win-win.
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