Value-based care (VBC) is the goal but getting there has proven to be a challenge. For years, independent groups have struggled to align their technology with risk contracts without drowning in overhead. The financial math of VBC rarely works. TPMG is a rare value-based care success story – a decade in the making.
Healthcare IT Today sat down with Jeff Morrison, Vice President and CMIO at TPMG, to uncover how this independent, multi-specialty group cracked the code. By maximizing their eClinicalWorks platform and being smart with risk contracts, TPMG has successfully navigated VBC for the past 12-years without burying their providers in clerical work.
Key Takeaways
- Stop leaving money on the table for care management. CMS programs like Advanced Primary Care Management offer per-member-per-month revenue for work practices already do, provided the technology can track it.
- Ditch the manual dialer to close care gaps. Pushing bulk messages through a centralized hub to schedule Open Access visits is a faster, more effective way to hit HEDIS measures.
- Automate the reporting slog to maintain momentum. Direct integrations that package and send quality files to an ACO eliminate the administrative friction that usually derails value-based initiatives.
Capture Revenue for Care Management
TPMG did not wait to capitalize on the Advanced Primary Care Management program. They activated the specialized module within eClinicalWorks and rapidly enrolled over 9,600 patients. This added a vital per-member-per-month revenue stream for care they were already delivering.
Morrison recognized the immediate financial benefit of aligning their EHR with CMS incentives. “It’s a great tool. It helps create a revenue stream to help us with activities that help patients,” he explained. The technical execution was straightforward. “We just turned it on and started getting patients to sign up.”
Morrison appreciated how quickly TPMG was able to move from implementation to billing.
Automate Outreach to Close Care Gaps
Chasing down patients with treatment/care gaps in a VBC program is a labor-intensive nightmare. TPMG overcame this bottleneck by using the ProviderHub function of eClinicalWorks to track HEDIS measures like blood pressure control. The system identifies exactly who needs attention and allows the TPMG team to act instantly.
Instead of manual phone calls, the TPMG uses automated, bulk messaging to drive patients into Open Access scheduling.
“We can go to the non-compliant group and with a few clicks of a button, send them all a message saying – ‘Hey, can you call the office or can you make an appointment in open access so we can get you in so we can make sure your blood pressure’s controlled?'”
Eliminate the Quality Reporting Burden
The administrative weight of VBC can crush independent practices. Extracting and formatting data for ACO submission requires significant backend resources. TPMG solved this by using their EHR to handle the heavy lifting.
The process of submitting electronic clinical quality measures (eCQMs) is almost entirely hands-off at TPMG. “It’s called a QRDA I file and it is just processed by eCW,” Morrison stated. “We just tell them [eClinicalWorks], ‘Hey, we need these measures, these eCQMs, submitted back to the ACO,’. They process it and off it goes.”
This removes a significant administrative burden from the TPMG administrative team.
The Bottom Line
Succeeding in value-based care requires more than just clinical excellence. It requires strong commitment from leadership, a willingness to “stick with it”, smartly assessing financial/clinical risk, and IT infrastructure that makes the practice of VBC easier. Through hard work and dedication, TPMG is proving that an independent practice can thrive under risk models without burning out its staff – especially when it has IT systems that can support VBC efforts.
What Healthcare IT Leaders Are Asking
How can an EHR support Advanced Primary Care Management (APCM) billing? An EHR supports APCM billing by tracking patient enrollment, capturing consent, and logging the required care management activities. By using dedicated modules, IT teams can automate the documentation process, ensuring that providers meet the criteria for per-member-per-month Medicare payments without adding manual data entry to their workload.
What is the most effective way to improve HEDIS measure compliance using technology? The most effective approach is centralizing population health data into a single dashboard that identifies non-compliant patients in real time. From there, IT systems can facilitate bulk messaging, allowing clinical staff to send targeted appointment invitations via patient portals or SMS, directly connecting patients to open scheduling slots.
How does automating QRDA I file submission benefit an ACO participant? Automating QRDA I file submission eliminates the need for manual data extraction and formatting. When an EHR is configured to directly process and transmit these quality files to an ACO, it reduces administrative overhead, minimizes human error, and ensures that the practice receives accurate credit for the quality of care delivered.
Learn more about TPMG at https://tpmgpc.com/
Learn more about eClinicalWorks at https://www.eclinicalworks.com/
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