Traditionally, hospitals encounter and respond to a number of incentives to undertake QI activities. Given the financing and structure of primary care, building interest and motivation to participate in QI activities has been difficult. Recently, however, the same mechanisms for promoting accountability in inpatient care are being tested in primary care, with a rapid increase in the number of practices pursuing patient-centered medical home recognition or accreditation processes. Health plans and payers are beginning to incentivize primary care practices for demonstrating improvement in health outcomes and clinical processes, such as providing a per member per month (pm/pm) payment when a practice meets certain requirements or clinical outcomes. As the reimbursement landscape is changing, practice administrators and physician leaders will need support in determining future reimbursements from health plans and federal incentives associated with NCQA-PCMH and federal initiatives such as Meaningful Use.
Used as a marketing and educational tool to encourage new practices to join a formal QI initiative, Western New York (W NY) alliance developed the Return on Investment (ROI) Calculator. The ROI calculator allows practice managers to load patient profiles and staffing in order to determine future cash flow associated with specific quality improvement initiatives in their region. This calculator has been particularly useful when developing a business rationale for a potential practice to join a formal QI initiative. t attempts to answer the question, “What’s in it for our practice financially to work on a quality improvement initiative?”
The calculator can be used to determine investments needed (time and resources) to meet requirements of the quality initiatives and be eligible for higher reimbursements. As the practice manager identifies potential financial gains, it can potentially create an opening for practice coaches to work with practices that might be resistant to joining a QI initiative or using a practice coach.
Modifications of the ROI calculator would be needed based on the variables and incentives in your region. It has been open sourced so others can modify and test the calculator to their particular circumstances.
Compiled by Jen Powell, an AF4Q technical advisor working with the Improving Performance in Practice (IPIP) Technical Support Team.
How can practice coaches assist practice leaders in identifying potential future reimbursement and incentives associated with QI initiatives?
One Alliance developed a tool to address this.
Does practice coaching improve practice performance?
Evidence reveals improvement in the quality of primary care.
How do practice coaches work with patient partners (patients who are engaged in QI efforts) to improve ambulatory care?
Learn from AF4Q Alliances’ pioneering work.
How does a practice coach assess a practice to determine areas of need and focus?
Focus on the practice’s ability to undertake improvement efforts, for starters.
What is a practice coach?
Making meaningful change to improve outcomes.
How do you develop a business model to sustain your practice coaching program?
Three AF4Q Alliances are figuring out how.
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