The McKesson value-based care team employs a combination of tactics to help practices in The US Oncology Network achieve success in the Merit-Based Incentive Payment System (MIPS). One of the challenges with the new MIPS program is the need to focus on the current year’s performance, while taking steps to ensure that practices are successful in future years.
To ease the transition into the MIPS program, the Centers for Medicare & Medicaid Services (CMS) allowed clinicians to “pick their pace” for 2017. A preset minimum threshold was established—a MIPS composite performance score of 3—to avoid a negative payment adjustment. All clinicians who submitted any data in 2017 received a performance score of at least 3 and avoided a negative payment adjustment.
Because the program is budget neutral, the preset threshold in 2017 resulted in disappointingly low positive payment adjustments to clinicians, but this protected clinicians who performed below the median or mean from receiving a negative payment adjustment. Beginning in 2022, however, clinicians will not know the minimum threshold for the year that is needed to avoid a negative payment adjustment until after the year has ended.
The MIPS program is like simultaneously training for a sprint for this year’s performance and training for a marathon for long-term success. To accomplish this, practices need to strike a balance between performance in the current year, with an eye to what strategies make sense for the practice’s specific patient population and future goals.
Choosing a Strategy
The Triple Aim of the MIPS program comprises better care, smarter spending, and healthier people. As part of the marathon conditioning, the McKesson value-based care team helps practices consider how the 4 categories—quality, cost, promoting interoperability, and improvement activities—can be applied in cancer care to improve patient outcomes, while reducing the cost of care. By taking a step back and looking at how to improve oncology care through care coordination, patient engagement, and access to care, each oncology practice can leverage its choices for measures and improvement activities, to enhance synergy. For example, the practice can select “improvement activities” to improve performance in the quality measures that are important to oncology care; its performance metrics will then measure the effectiveness of its improvement activities.
Using a strategy to select improvement activities and quality measures that focus on the same goal, namely, care coordination or advance care planning, can boost performance in several measures of improvement activity. With more than 270 quality measures and 100 improvement activities to choose from in the MIPS program, this approach can be applied in all medical specialties, and certainly in oncology practices.
In parallel with the marathon conditioning, the sprint training comes into play by keeping an eye on performance in those carryover quality measures from the Physician Quality Reporting System, or what we sometimes refer to as the back-pocket measures. These measures are an important part of patient care, and are often already ingrained in the practice’s workflow, but some of these measures are topped out or may not gain the improvement needed for the cost reduction required for future success in the MIPS program.
The McKesson Example
Each oncology practice at The US Oncology Network is assigned a McKesson transformation lead from our value-based care team. All the practices have a designated quality program lead to work with the transformation lead. This relationship allows one-to-one support and provides our team the opportunity to gain an understanding of the unique strengths and challenges for each practice.
The quality program leads build quality programs within the practice, recruit physician champions, and enlist the engagement of leadership and the care teams. This sets the framework for continuous quality improvement and is intended to help practices achieve long-term success in the MIPS program or in other value-based care programs.
Bimonthly “health checks” are conference calls that are held with each of our practices. Regular attendees include the McKesson transformation lead assigned to the practice, and the practice quality program lead. Many of our larger oncology practices include additional members from their care teams. Because many of the quality program leads have multiple responsibilities within the practice, reminders about upcoming deadlines and a review of clinician performance scores are an important part of these calls, for the current year (ie, the sprint training).
Regular review of performance reports enables the practices to identify areas when additional training or review of workflow is needed. The majority of practices in The US Oncology Network use iKnowMed, an oncology electronic health record (EHR) system, and can generate on-demand reports to monitor quality. iKnowMed users also have access to an integrated reporting platform that helps oncology practices gain insights from data to drive better outcomes for their patients and practice.
Sharing these reports with their clinicians, leadership, and care teams helps to build momentum and accountability. The transformation team can also leverage subject matter experts from the broader McKesson team to join the monthly calls, as needed, when planning and implementing new programs or processes as part of the marathon conditioning.
Quality Payment Program Forum calls provide a platform to bring all The US Oncology Network quality program leads together with the entire transformation team on a biweekly basis. These forum calls provide an opportunity for the quality program leads to ask their peers and the practice transformation team questions related to the MIPS program requirements, workflow, and change management. The forum’s agenda targets current hot spots in the MIPS program, new tools, and serves as an opportunity to share best practices.
Quality Measure Office Hours
The iKnowMed EHR system supports 20 quality measures. Eleven of these are specific to oncology, with 3 of them being custom measures for the McKesson Qualified Clinical Data Registry (QCDR). The data are submitted directly to CMS for the “quality” category, along with the “promoting interoperability” and “improvement activities” categories, using the McKesson QCDR.
Biweekly quality measures office hours calls, taking place on the opposite weeks from the forum calls, are held as a question and answer session to discuss the quality measures specifications, iKnowMed documentation steps, workflow, and clinician performance reports. A thorough understanding of the inclusion and exclusion criteria for the denominator and numerator of a measure, as well as required documentation fields, is essential to being able to identify the root causes in measures where a practice is underperforming. Updates about changes in report logic, data submission registration, and selection of reporting options are also part of these calls.
Monthly Education Sessions
Education sessions are held monthly and devote 1 hour to a specific topic. These may be MIPS program requirement–related, such as security risk assessment, or more general topics about improving performance, such as engaging the care team. These education sessions are offered to all McKesson customers.
A Quality Payment Program Resource Guide is published in the help menu of iKnowMed to ensure that our practices have quick access to MIPS rules, the quality and promoting interoperability measures specifications, documentation videos, and workflow.
Because direct patient care is always the priority for oncology practices, all calls are recorded and made available to the quality program leads and the care team members who are unable to attend the call.
A MIPS and an Oncology Care Model newsletter was created to provide upcoming dates and deadlines. In addition, the McKesson value-based care team utilizes a service desk process called Remedyforce, as well as an e-mail address to answer questions on an ad hoc basis. These inquiries help to indicate what additional education and resources are needed.
The Triple Aim
The McKesson transformation team believes in the Triple Aim of the MIPS program, and we understand the challenges faced by oncology practices to be successful in the current year of the program, as well as the significant benefits and risks in the program for the long-term.
The burden to oncology practices is understanding the rules and flexibility of the MIPS program, building a quality improvement program, and changing the culture within their practice, all while trying to improve care coordination, patient engagement, and access to care.
Just as the MIPS program has flexibility in the rules to make it easier for practices to participate and select measures specific to their patients, we have built flexibility into how we support our practices. To be respectful of the quality program leads’ time, we provide education and assistance in various ways, including multiple online resources and recordings. We balance education about what is needed this year—the sprint—with what to build to reach long-term success, the marathon.