One participating clinic incorporated financial metrics across some of their 2020 QI initiatives like diabetes care, telehealth, and patient engagement/satisfaction. For their diabetes improvement initiative, their team met with their CFO to analyze how quality metrics impact clinic revenues. Through participating in the MVC Program, and working more closely with the Finance Department, this QI department gained a deeper understanding of the multiple factors impacting revenues (wrap around rate, CAP rate, PPS Rate, Total Payments received, etc.). Their analysis showed how the Clinical Practice Guidelines (quarterly visits for diabetes patients) also coincided with scenarios that generated the most revenues for the clinic. With a more holistic understanding of “value”, their QI team is now focusing their improvement efforts on diabetes patients with < 2 visits and >8 visits in the last 12 months.
The participating team also made new connections with local health plan and IPA representatives to understand the pay for performance and quality incentive payment targets – which can be directly linked back to a number of their current QI efforts around colorectal cancer screening. Overall, the team shared how their Quality department now has a deeper understanding of the financial metrics and drivers that should be monitored with their QI efforts, and are meeting with their finance department on a regular basis.