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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. Our experienced facilitators and quality improvement experts are equipped to support physicians who are participating or are thinking of participating in popular provider programs.

Aligned Program, Initiative,
Financial Incentive or Resource
ABCS Quality Measures included Support Available Through H3
Chronic Care Management (CPT Code 99490)  All   X
CMS-directed Quality Improvement Organizations (QIOs)   All   X
Healthcare Effectiveness Data and Information Set (HEDIS)   All   X
Medicare Accountable Care Organizations (ACOs)   All   X
Medicare and Medicaid EHR Incentive Programs
(Clinical Quality Measures, Clinical Decision Support)
  All   X
Merit-Based Incentive Payment System (Proposed for 2017)   All   X
Million Hearts   All   X
Patient-Centered Medical Home (PCMH)   All   X
Physician Quality Reporting System (PQRS)   All   X
Value-Based Payment Modifier Program   All  X
CDC State-Based Tobacco Control Programs  Smoking Only  X
Regional Private Insurer Quality Improvement Programs   All  X

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. Providers not attesting to meaningful use are now being penalized on Medicare Part B claims.

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. PCMH certification may become a way to receive Medicare and possibly Medicaid incentives.

Physician Quality Reporting System
PQRS encourages individual eligible professionals and group practices to report on quality of care to Medicare. Those who report satisfactorily will avoid future penalties on Medicare Part B claims.

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.

Northern Illinois University Illinois Health Connect Alliance of Chicago American Medical Association University of Chicago University of Chicago Medicine IL-HITREC Illinois Department of Public Health Metastar Northwestern University CHITREC Purdue Healthcare Purdue University Telligen

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