Value-based payment arrangements in government and commercial payer environments require external data reporting for nearly all practices. Practices should be able to measure, analyze and report data in a timely and complete manner based on payer requirements to be successful in value-based payment arrangements. The Reporting and Analytics category outlines key considerations for practices to explore their reporting and analytics infrastructure, including integrating electronic health record (EHR), claims and payer supplied data. Review the following questions and responses to determine the strength of your reporting and analytics systems.
Does your practice optimize its use of certified EHR technology?
|If yes||Your practice meets the necessary criteria for structured data in a certified EHR for APM participation.|
|If no||Your practice may not meet certified EHR technology conditions required for many APMs and all Advanced APMs under the Quality Payment Program. Consider solutions prior to APM participation.|
|If unsure||There are established certified EHR requirements for Advancing Care Information under the Quality Payment Program that may apply to other payer APMs as well. Investigate the status of your practice’s EHR prior to APM participation.|
Review Advancing Care Information EHR requirements through the CMS Advancing Care Information fact sheet.
Does your practice understand how it will aggregate data and be assessed by payers?
|If yes||Aggregate data so that it may be compared to performance benchmarks and forecast clinical and financial outcomes in an APM.|
|If no||It is critical to understand how performance is compared so specific targets can be met. Consider solutions prior to APM participation.|
|If unsure||Determine your practice’s plan to aggregate data across providers and evaluate whether it will be compared to geographic or specialty level benchmarks prior to APM participation.|
Data Analytics and Capabilities
Does your practice utilize or develop disease registries from the EHR, claims or other sources such as the National Cardiovascular Data Registry (NCDR)?
|If yes||Proactively manage disease state(s) by determining gaps in care to achieve APM success.|
|If no||If your practice does not utilize disease registries it can be more difficult to determine which patients are in the denominator for metrics. Consider solutions prior to APM participation.|
|If unsure||Determine if your practice can identify which of your patients have diabetes, CHF, CAD and other cardiovascular conditions using the data sources prior to APM participation.|
Review data through ACC's NCDR Portal.
Can your practice bring EHR, claims and other payer provided data points together for quality and cost insights?
|If yes||Integrate data points from available sources to create the most complete picture possible of quality and cost opportunities for your practice’s patients in an APM setting.|
|If no||Perform a cost/benefit analysis for insights on the cost and value of integrating these data points. Consider solutions prior to APM participation.|
|If unsure||Determine what data points your practice may have access to and discuss other available data with your commercial payers prior to APM participation.|
Can your practice access and analyze data from the EHR to identify areas for quality performance improvement?
|If yes||Quality data from the EHR should be structured in easy-to-read reports to monitor performance and drive improvement, i.e. dashboards, for ease of use in an APM.|
|If no||Without quality data to analyze, your practice is dependent on payer-provided information that may not be timely or complete. Consider solutions prior to APM participation.|
|If unsure||Assess the reporting capabilities of your practice’s EHR or determine if you need to create or invest in an analytical tool prior to APM participation.|
Can your practice access and analyze claims data to identify quality and cost opportunities?
|If yes||Claims data that comes from payers should be analyzed to identify and prioritize quality and cost opportunities. For additional insights, merge claims data with EHR data for a complete picture of opportunities in an APM.|
|If no||Your practice may be missing insights on where to focus efforts and resources to pursue potential quality and cost opportunities. Consider solutions prior to APM participation.|
|If unsure||Medicare data is largely available through Federal Government websites, but it may be dated and not reflect current practice patterns. It is critical to understand the commercial payers’ capacity and willingness to share information prior to APM participation, if applicable.|
If your practice has multiple EHRs, do you have interoperable capabilities that can aggregate data to fulfill external reporting requirements?
|If yes||An analytical tool that can aggregate data from multiple EHRs helps ensure complete reporting is fulfilled and performance measures are calculated appropriately in an APM.|
|If no||Partial reporting from a subset of EHRs may not reflect accurate care management and could result in poor performance scores. Consider solutions prior to APM participation.|
|If unsure||Work with the practice’s Health Information Technology vendors to determine what information could be excluded if certain EHRs feed reporting requirements.|
Can your practice measure and report data in a timely and complete fashion, as required per different APM payer requirements, i.e. claims, quality, etc.?
|If yes||Your practice can share data with payers, which is an APM requirement.|
|If no||Suggest postponing participation in a value-based arrangement if your practice cannot collect and submit data. Consider solutions prior to APM participation.|
|If unsure||Certainty is needed in collecting and submitting data in the specific format required because it will be a prerequisite in any value-based arrangement. Investigate practice options prior to APM participation.|