National health spending has grown faster than the economy for decades, and the current rate of growth is not sustainable. Reimbursement has heavily rewarded quantity of care, while minimizing the importance of care quality and value. The Medicare Access and CHIP Reauthorization Act (MACRA) intends to reduce health care spending and overall utilization by rewarding providers for improved quality and outcomes by:
- Replacing the Sustainable Growth Rate (SGR) formula for determining fee-for-service;
- Creating a new framework for rewarding health care providers for giving better care; and
- Combining existing quality reporting programs (Meaningful Use, Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBM)) into a single, new system called the Merit-Based Incentive Payment System (MIPS).
In anticipation of MACRA, to assist clinicians in achieving large-scale transformation, CMS launched the Transforming Clinical Practice Initiative (TCPI). Established by the Affordable Care Act, the initiative supports over 140,000 clinicians over the next four years in their efforts to transform care and achieve the Triple Aim. Practice Transformation Networks (PTNs), funded by TCPI, are peer-based learning networks designed to coach, mentor, and assist clinicians in developing core competencies specific to practice transformation.
The Great Lakes Practice Transformation Network (GLPTN) is one of 29 PTNs to carry out this work. Led by Indiana University, Altarum heads the effort in Michigan and is joined by Purdue University, Northwestern University, and University of Kentucky. The largest PTN in the nation, the GLPTN has recruited over 15,000 clinicians (130% of target) in Indiana, Michigan, Illinois, Ohio, Kentucky, and West Virginia to provide better health and improved care at a lower cost for a population of more than 10 million Americans.
The network, working across lead organizations and managing multiple subcontractors, has trained more than 50 quality improvement advisors to coach clinicians through the 5 phases of patient-centric practice transformation, provide direct technical assistance in meaningful use, PQRS, and local quality improvement efforts to help prepare clinicians for participation in value-based payment systems.
Leveraging our position as leaders in innovation and the delivery of technical assistance, as well as Altarum’s capability to promote appropriate care through deployment of clinical decision support solutions and care coordination strategies, the GLPTN provides direct-to-provider technical assistance with evidence-based, data driving quality improvement efforts including the development and deployment of electronic PQRS monitoring tools that allow providers to monitor the impact of their quality improvement efforts on an ongoing basis. This 4-year program began in 2015 and will run through 2019.