Delivering Value-Based Care Through Patient Portals and EHR Incentives

Founder, Topflight Apps

February 28, 2018

Wouldn’t healthcare be better if your healthcare organization could deliver care efficiently and optimize value by emphasizing patient engagement? Our healthcare team certainly thinks so. So do the Centers for Medicare & Medicaid Services (CMS), the agency that oversees the majority of federal healthcare programs.

The CMS has taken to incentivize high quality of care over service volume by replacing the Medicaid Incentive Program with the Medicare Quality Payment Program effective January 1, 2017. Through the new value-based care approach, healthcare organizations that intend to receive payments from CMS will have to combine Electronic Healthcare Records (EHR) and secure patient portal websites to deliver care and communicate with patients.

What is EHR?

An electronic health record (EHR) is a digital version of a patient file with a medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results.

It is often referred to as the cornerstone for laboratories, medical imaging facilities, pharmacies, emergency facilities, and clinics to thrive in the digital age and effectively meet patient needs.

The EHR term may, in some contexts, encompass such practice management functions as billing and patient scheduling. Physicians and staff benefit greatly from EHR because it aids their decision making, and it allows more accessible preventive care and chronic disease management. Patients, in their turn, don’t need to provide their health details over and over again to different providers if the latter use the same EHR platform.

Key features of EHR:

Authorized users get real-time access to secured patient health data
Patient health data can be managed by authorized providers from different health care organizations
Less time is spent on follow-up calls, so patients get med refills faster
EHR allows access to evidence-based tools that providers can use to come up with more efficient treatment plans
EHR automates and streamlines providers’ workflows
Improved continuity of care and delivery of patient education materials

The CMS will apply incentives by scoring eligible provider performance based on a prescribed Merit-based Incentive Payment System (MIPS).

Read Our Guide on How to Create an EMR/EHR Software and How to Integrate a Health App with Epic EHR/EMR

EHR Incentives Payment Adjustments and Patient Portals

MACRA is the 2015 law that defines Stage 3 Meaningful Use and the Medicare Quality Payment Program (QPP), the framework that CMS can use to drive advances in care information systems. Stage 3 puts providers on track to reform healthcare priorities through payment adjustments, incentives, and penalties by shifting the focus to service delivery and EHR adoption.

EHR Incentives

In the transition to the new system, Stages 1 and 2 have now expired. Stage 3 incentivizes providers to make what it terms as meaningful use of electronic health record technology for all of their interactions with patients and CMS.

Under MACRA, the QPP defines how eligible providers should implement or upgrade their EHR systems and MIPS scores their progress. As of 2018, healthcare providers must apply the rules in Stage 3 to qualify as having made meaningful use of EHR technology.

MACRA defines new incentives for EHR adoption with a more integrated program than before, the Merit-based Incentive Payment System (MIPS). CMS will use MIPS to score quality for eligible providers to determine the adjustments or penalties that the agency will apply to payments for services delivered in the preceding year.

Patient Portals

As an eligible provider, your web-based patient portal will be your online communication channel centered on patients, but also with clinicians and CMS. It’s a platform where your patients can interact with their healthcare information via the Internet.

Under MACRA, CMS is betting that patient portals are critical to making quality care achievable and measurable, and by which MIPS will score the EHR incentives, adjustments, and penalties for your organization.

Value based care emphasizes better patient engagement. CMS expects eligible providers to deliver improved coordination and communication. Patient portals are the key ingredients that capture patient feedback and facilitate non-face-to-face care.

4 Ways MIPS Scores Quality

Patient portals improve the transparency and ease of care; they capture timely information and eliminate the need for patients to visit practices. In practical terms, your organization’s patient portal has to fulfill four categories of QPP reporting requirements to achieve high scores under MIPS and optimize your payment incentives:

Advancing Care Information

The way that your patient portal manages information accounts for 25 percent of its MIPS score. A portal that captures the full list of measures and objectives will get the maximum score in this section.

All MIPS eligible clinicians can participate in the ACI category. The measures and objectives that give you the scoring for this category promote patient engagement and the use of certified EHR technology that exchanges information electronically.

The ACI objectives: Protecting patient information, prescribing medication electronically, giving patients electronic access to their information, and health information exchange. ACI scores improvement provided by your patient portal based on how well you implement measures to achieve these objectives.

Quality Performance

In 2018 quality accounts for half of the score, from 2019 onward it will be 30 percent. A patient portal that can demonstrate increased patient engagement and improved outcomes will score higher in this category.

Clinical Practice Improvement Activities

Eligible providers get fifteen percent of their MIPS Final Score from activities that deliver measurable improvements in practice performance. Providers select four activities to measure from a long list of options. The patient portal plays a vital role in this category because the options focus on activities related to patient engagement.

Cost Performance

Your patient portal can help fulfill all of the Meaningful Use Stage 3 requirements. From 2019, this will account for thirty percent of your MIPS score and will measure how well your organization uses EHR based on Medicare claims. Your patient portal will assist here by providing all of the data that comes from EHRs and patient engagement with your organization.

Building A Meaningful Use Stage 3 Patient Portal

Developing patient portal systems present significant adaptive challenges to any healthcare providers who earn payments through CMS. However once implemented, a patient portal that conforms to the best practices of meaningful use it will deliver vastly improved patient care.

It is not too late to achieve Stage 3 of meaningful for your organization. Implementing a patient portal that serves CMS, your organization and the best interests of patients is a significant but finite task. With the right development partner, your organization can make the transition with the least disruption and the maximum benefit to all stakeholders.

Conclusions

The transition to value-based care under the QPP, as defined by MACRA, is a strong incentive to drive the meaningful use of EHRs and patient portals for all Medicare and Medicaid healthcare providers.

Patient portals are changing the way that patients engage with healthcare providers at a fundamental level. Patient-facing websites make true value-based care possible for organizations that deliver care and integrate them with EHR systems.

The additional EHR incentives such as payment adjustments and penalties that arise from your MIPS scores make it imperative that you design and develop a portal that delivers the best value-based care solution for your patients.

What Can Topflight Apps Do for You?

The team at Topflight Apps is a group of talented and passionate healthcare app developers with expertise in value-based healthcare initiatives. We specialize in UX/UI, healthcare domain knowledge, and compliance, making us the right partners to build your certified patient portal. Connect with Topflight Apps to discuss the right patient portal to deliver value-based care on behalf of your organization.

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Joe Tuan