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Alignment with Pay-for-Performance Programs
Education, coaching, webinars, and other tools are chosen with quality improvement and financial incentive programs in mind. Facilitators and quality improvement experts are equipped to support physicians who are participating or are thinking of participating in popular provider programs.
The table below is reproduced as the project published it. Program rules described here are those of the mid-2010s and are not current guidance.
| Aligned program, initiative, financial incentive or resource | ABCS quality measures included | Support available through H3 |
|---|---|---|
| Chronic Care Management (CPT Code 99490) | All | Yes — support was available through H3 |
| CMS-directed Quality Improvement Organizations (QIOs) | All | Yes — support was available through H3 |
| Healthcare Effectiveness Data and Information Set (HEDIS) | All | Yes — support was available through H3 |
| Medicare Accountable Care Organizations (ACOs) | All | Yes — support was available through H3 |
| Medicare and Medicaid EHR Incentive Programs (Clinical Quality Measures, Clinical Decision Support) | All | Yes — support was available through H3 |
| Merit-Based Incentive Payment System (Proposed for 2017) | All | Yes — support was available through H3 |
| Million Hearts | All | Yes — support was available through H3 |
| Patient-Centered Medical Home (PCMH) | All | Yes — support was available through H3 |
| Physician Quality Reporting System (PQRS) | All | Yes — support was available through H3 |
| Value-Based Payment Modifier Program | All | Yes — support was available through H3 |
| CDC State-Based Tobacco Control Programs | Smoking only | Yes — support was available through H3 |
| Regional Private Insurer Quality Improvement Programs | All | Yes — support was available through H3 |
Examples: How You May Participate
Chronic Care Management
Providers can receive approximately $40 per month for each Medicare patient they see with two or more chronic health conditions. To receive the reimbursement, the clinic must provide a patient with non-face-to-face services for 20 minutes per month.
Medicare and Medicaid EHR Incentive Programs
EHR Incentive Programs provide payments to eligible professionals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Meaningful use aims to improve quality, safety, efficiency and reduce racial disparities; engage patients and families; improve care coordination, and population and public health; and maintain privacy and security of patient information.
Merit-Based Incentive Payment System (MIPS)
This proposed program will incentivize or penalize Medicare providers based on four performance categories: Meaningful use, PQRS, Value-Based Payment Modifiers and clinical practice improvement.
Patient-Centered Medical Home
This model shifts how care is organized and delivered. A team of healthcare providers is accountable for meeting a large majority of the patient’s physical and mental health needs, and focuses on five key areas: comprehensive care, patient-centered, coordinated care, accessible services, and quality and safety.
Physician Quality Reporting System
PQRS encourages individual eligible professionals and group practices to report on quality of care to Medicare.
Value-Based Payment Modifier
This provides payment to a physician or group of physicians under the Medicare Physician Fee Schedule based upon the quality of care furnished compared to the cost of care during a performance period.