Opportunity for Clinical Improvement Assessment and Gaps in Care for Rheumatic Disease
The Rheumatology Medical Home Demonstration Project is being created in partnership with key stakeholders as a model for collaboration between hospital and community rheumatologists working together toward a common goal of improving patient care and population health outcomes. We will start with the opportunity for clinical improvement assessment and identify in gaps in care for RA.
Why Now? WRA, in partnership with key stakeholders, have created a model of collaboration both hospital and community rheumatologist can work together with the common goal- improving patient care and health outcomes. We will evolve and develop The Rheumatology Specialty Medical Home Demonstration Project with local and national payers.
How will we do this? Harmonizing measure specifications, streamlining and standardizing care, we will track multiple disease management data point in patients with co-morbid conditions, and will establish a comparative data platform to share in community-driven quality improvement and payment reform initiatives.
What are we going to do? A shared rheumatology-specific customized software that facilitates our QI initiative by mobilizing our specialty to measure practice-wide clinical quality parameters and improving clinical outcomes at the point of care. This provides patients and physicians critical “real-time” insights to make informed decisions gaining a complete longitudinal view of the patient’s journey.
By forming the foundation of a delivery system that goes beyond rheumatology, the (RMH) demonstration program strives to strengthen the roles of both primary care and specialty practices as they co-manage patients in a quality care delivery system. With the passage of healthcare reform and the call for improved quality, value, and demonstration of results, we invite you (rheumatologist) to join us on our journey as we demonstrate our value with The Rheumatology Medical Home Demonstration Project.
Taking the lead to accountable care
Medicare and private payers are demanding health care delivery accountability from providers. WRA believes that Rheumatology needs to take the lead in developing an accountable model like Oncology (Oncology Medical Home) and Cardiology (Clinical Outcomes Assessment Program) that also justifies appropriate treatment. Without this, the landscape of rheumatologic care will continue to condense, will become more fragmented, and patients will face less accessible and more expensive care, which also will be borne by patients and payers.
While we have a lofty goal in mind, our objectives this year will continue our focus on action steps and objectives that will demonstrate quality improvement for our specialty by:
BUILD
Building a network of State Societies and CSRO working together within rheumatology practices to establish a national Rheumatology Specialty Medical Home Demonstration Project under the Medicare program for the purpose of changing the Medicare payment for rheumatic disease care in order to enhance the quality of care and to improve cost efficiency, and other purposes.
DEVELOP
Develop different payment models and contracts with Medicare (Noridian) and payers to make the Rheumatology Medical Home Demonstration Project a viable model for Rheumatology
IDENTIFY
Identify and Engage Physician and State Healthcare Leaders and Stakeholders to lead our QI committee, comprised of a rheumatologist, private payers, practice administrators, PharmD, a patient, Industry, community group representation, (CRSO, NORM, ACR) Establish a forum of information exchange for practices to continually improve processes and outcomes
IDENTIFY
Identify measures, and conduct initial data quality review
PARTNER
Partner with all EHR vendor to help connect EHR Data Quality Improvement Activities (practices can participate without connection as well)
ESTABLISH
Establish Process to Continuously Monitor EHR Data Quality and Resolve Data Quality Issue
April 15, 2015, Senate Passes SGR Repeal, Embraces Value-Based Reimbursement. “Passage of this historic legislation finally brings an end of an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs.”
James L Madara, MD | Chief Executive Officer and Executive Vice President of the American Medical Association
The Leap to New Payment Models:
Washington Rheumatology Making Data Actionable
Faced with mounting regulations and declining reimbursements, many rheumatologists are recognizing that accountability and standards will inform payers and patients on how treatment decisions correlate to cost and quality.
New legislation proposes to dramatically shift how physicians are reimbursed. The shift from fee-for-service care to a value-based paradigm will be supported by health information technology capable of collecting electronic data from robust population health record systems. New alternative payment models will use a population health management platform to help to define a population, identify gaps in care, stratify risks, engage patients, manage care and measure outcomes. Quality metrics will need to be incorporated into a new hybrid form of value-based contracting that reflects appropriate treatment decisions, cost-effective care, while improving patient engagement, employer engagement, coordination of care, and patient adherence to medication and treatment plans.
Capture Quality Actionable Data
Data Quality is an essential ingredient for many of the functions that providers will have to perform in a world that is transferring to value-based payment. Any piece of information that is relevant to a decision, treatment or interaction needs to be available in real time.
These programs and initiatives are key drivers to improve data quality, requiring high-quality data that accurately represents care provided to patients. The term high quality is used to mean data that is stored in reliable, accurate, and actionable information.
The program focuses on quality improvement by:
Identify and stratify at-risk patients for appropriate care management
Track and monitor the health status of a specific population
Manage patients and conditions using timely interventions and enabled by real-time notifications
Manage a chronic care patient population in a holistic manner
Enhance the identification of at-risk patients
Aggregate outcomes for federally mandated quality improvement reporting
Engage the patient in their own care to improve outcomes
We Document Significant Improvements in Quality and Measure
“Gaps of Variance” in Care
At most rheumatology practices, the administration spends 80% of their time gathering data and 20% actually analyzing and taking action for improvement upon their data. WRA’s mission is to flip this ratio, whereas administrators and physicians can spend more of their time taking action on improvement designs that runs their rheumatology center more efficiently and intelligently.
Seamless integration agnostic to any EHR and IT system
Provides actionable business intelligence around population stats, reimbursement, treatment patterns, resource utilization and other key performance indicators
Allows for clinical intelligence reports to measure key quality and outcome metrics shifting the basis of practice reimbursement from volume of patients served to the quality and value of patient care
Saves provider and staff time and money and replaces manual data pulls demanded by federal initiative programs. Spend time analyzing data not gathering data
Flexible, cloud based visualization tools to quickly identify key trends and patterns and compare quality and cost with the average quality and cost reported by other physicians practicing in the same geographical area
Cloud-base and HIPAA compliant.
Establish Process to Continuously Monitor Quality
The benchmarking aspect of this model provides rheumatology centers quick-at-a-glance view of their patient population, their real-time status of meeting federal initiatives and compliance statistics to fulfill their obligations for demonstrating quality improvement. It also allows for centers to compare peer-to-peer centers of similar size with comparative data.
Displaying practice-level performance relative to that of others in the community provides a strong foundation for improvement. The WRA’s comparative performance reporting process involves the following components:
Automatic calculation of community-level and practice-level results;
Displaying performance levels for each clinical quality measure and a five point composite score using randomly blinded practice, site, and provider
Delivering automated simple, color-coded performance dashboard relative to targets to each participating member
Recognition for making comparative improvements even if below target values
Disseminating results to all members in a convenient and private forum
WRA will strive to make all this automated and transparent. All WRA member practices can access their data through a collaborative portal, and they each receive information summarizing community-wide data, individual practice data, and comparative data, which they can display to their care teams, and in their patient waiting rooms. By promoting transparency in this way, we aim to more actively engage patients in the becoming active participant in their care with their physician and engaged in the process as well. Practice Administrators can also use this data to foster dialogue between their providers for QI improvements, initiate value based contracts with payers, and together initiate pilot programs that specifically demonstrate improved outcomes, less cost and patient engagement across the health ecosystem.
WRA now wishes to invite rheumatologist to Ignite. Commit. Participate.
This program directly supports the opportunity to build The Rheumatology Specialty Medical Home Demonstration Project for Improvement of Gaps or Variations in Care for Rheumatoid Arthritis and other rheumatic diseases. This new program features a simple way to use a HIPAA compliant, web-based and integrated population health system within any EHR system
We will begin our pilot program with a limited number of practices and implementations, and expand the capacity throughout the year. Accordingly, it will be important to register your interest in participation as soon as possible. As a test site, you will be part of an exciting project that has great potential to benefit rheumatology practices nationwide.
*The JointMan® Clinical Population Health Tool for Rheumatologist is free to community practices and transforms practices with easy access to actionable intelligence and supports clinical decisions that are aligned with WRA Rheumatology Specialty Medical Home best practices. It is seamlessly embedded in the care process. Ensuring that patients and physicians are active participants in all design elements and new learning is captured in a longitudinal view of the patient journey for our specialty
Visit Quality Improvement Initiative
Sign up and Get Started Now
Establish Process to Continuously Monitor Quality
WRA now wishes to invite rheumatologist to participate in this program that directly supports the opportunity for Improvement of Gaps or Variations in Care for Rheumatoid Arthritis and those of administrative simplification. This new program features a simple way to use a HIPAA compliant, web-based and integrated population health system within any EHR system.
We will begin our pilot program with a limited number of practices and implementations, and expand the capacity throughout the year. Accordingly, it will be important to register your interest in participation as soon as possible. As a test site, you will be part of an exciting project that has great potential to benefit rheumatology practices nationwide.
Rheumatology Medical Home Demonstration