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AdvantageCare Physicians Achieves Improved Health Outcomes and Savings through CMS and NCQA Initiatives
NEW YORK, Nov. 20, 2019 /PRNewswire/ -- AdvantageCare Physicians (ACPNY), one of New York's largest primary and specialty care practices, announced today the pathbreaking performance of its participation in multiple federal and state-wide health incentive programs. ACPNY clinical teams have been evaluated under the Centers for Medicare & Medicaid Services (CMS)-led Delivery System Incentive Reform Payment Program (DSRIP) and Merit-based Incentive Payment System/Alternative Payment Model (MIPS APM)in addition to the New York State Patient Centered Medical Home (NYS PCMH) and Healthcare Effectiveness Data and Information Set (HEDIS®) Outreach programs administered by the National Committee for Quality Assurance's (NCQA).
Dr. Navarra Rodriguez, ACPNY's President and Chief Medical Officer, is participating in a DSRIP panel discussion at the upcoming Crain's New York Health Care Summit to be held on November 21st. Dr. Rodriguez will be joined by other local health leaders to reflect on the efforts to curb hospital use and improve health care quality over the last five years, while setting the stage for further discussion on how DSRIP can be improved in its next iteration.
With 37 medical offices across the five boroughs and Long Island, ACPNY takes a team-based approach to care where physicians work with nurses, social workers, nutritionists, behavioral health specialists and other professionals. ACPNY providers specialize in treating the physical, mental and lifestyle aspects of an individual's health in order to deliver comprehensive care that is continuous, convenient, and community-oriented.
ACPNY Performance Results and Savings
The organization was awarded $4.7M in DSRIP Program payments in the first half of 2019, and is eligible for additional financial incentives for the remainder of 2019, following targeted efforts at improving the health outcomes for Medicaid patients in chronic disease management, including:
- Robust data driven reporting and alignment to claims
- Outreach campaign to maximize Care Team opportunity to close care gaps
- Successfully passing chart audit reviews for compliance of care gap closure
- Patient engagement for an educational workshop on-site to promote self-management care
Quality Payment Program (MIPS APM)
As a participant in the Hudson Accountable Care Organization, ACPNY is subject to evaluation under the MIPS APM, which holds clinical participants accountable for the cost and quality of care provided to Medicare beneficiaries. As of August 2019, ACPNY has received final performance feedback with an 1.39% upward payment adjustment to Medicare FFS claims based on its 2018 performance year, representing a 200% increase over the prior year.
New York State Patient Centered Medical Home (NYS PCMH)
The NYS PCMH recognition program, developed in collaboration between NCQA and the New York State Department of Health, promotes care delivery models where the primary care team and patients are responsible for managing the full spectrum of health care needs. ACPNY submitted annual reporting for 33 currently recognized NYS PCMH offices, and has thus far received approval for continued recognition for all 33 offices through November 2020.
HEDIS Outreach Initiatives
For the 2018 performance year, ACPNY attained 5-Star ratings for the following seven measures from NCQA's HEDIS, the most widely used performance measurement in health care:
- Breast Cancer Screening
- Colorectal Cancer Screening
- Adult BMI Assessment
- Pain Assessment for Older Adults
- Diabetic Eye Exam
- Diabetic Kidney Disease Monitoring
- Rheumatoid Arthritis Management
"These improved outcomes, clinical recognitions and incentive payments are a direct result of ACPNY's interdepartmental collaboration and dedication to providing a collaborative, comprehensive care model," said Dr. Navarra Rodriguez, ACPNY's President and Chief Medical Officer. "Looking forward, we will continue to go above and beyond to manage chronic conditions and engage patients in their care plan, while enhancing our data capture and sharing capabilities to streamline advanced clinical processes. Our entire organization is united by the goal of maximizing opportunities for better care and performance results, rooted in our emphasis on care coordination, population health, and evidence-based guidelines."
About AdvantageCare Physicians
AdvantageCare Physicians, one of the largest primary and specialty care practice in the New York area, provides quality, personalized care that is focused on the whole patient. With medical offices across the five boroughs and Long Island, AdvantageCare Physicians takes a team-based approach to care where physicians work with nurses, social workers, nutritionists, behavioral health specialists and other professionals. www.ACPNY.com.
National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA's HEDIS® is the most widely used performance measurement tool in health care. NCQA's Web site (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.
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SOURCE AdvantageCare Physicians