Louisiana success stories

LA Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

Partnership Boosts Louisiana Health Group’s Knowledge of the Quality Payment Program

3/4/2019

photo of Kristi JonesAffinity Health Group is a wholly-owned subsidiary of Vantage Health Plan based out of Monroe, Louisiana and consists of 26 clinics in the Northeast Louisiana region. Affinity’s sites include primary care, industrial medicine, population health and specialty offerings; walk-in clinics; pharmacies and a health management center. Of these, 19 clinics have received National Committee for Quality Assurance (NCQA) recognitions, including ten Patient Centered Medical Homes, seven Level 3 Patient Centered Specialty Practice, and two Patient Centered Connected Care.
 
According to Kristi Jones, RN, CPHQ, Performance Analytics Management Quality Improvement Specialist for Affinity Health Group (pictured on the right), “Our leadership understands the importance of quality patient outcomes and has invested in it. We have departments and teams dedicated to quality within our organization and our clinics.”

 

Although Affinity had been very successful with its Merit-based Incentive Payment System (MIPS) score in the 2017 transitional year, staffing changes and departmental restructuring caused delays in the team’s ability to focus on MIPS requirements for Year 2 of the Quality Payment Program (QPP). In September of 2018, Affinity realized MIPS reporting was quickly approaching and an action plan was needed to ensure successful reporting. A high level MIPS oversight team was assembled to sift through the 2018 requirements and develop a plan of attack. One of the team’s biggest concerns was how to gather and disseminate targeted information “up the ladder and down the ladder” with key players within the organization. Although resources were available, the team found it daunting to break down a 100-page document into the essentials for each role within the organization. This is where Quality Insights QIN-QIO was able to help. 
 
When Lisa Sherman, RN, the CMS Technical Assistance Contractor for Louisiana, heard of the staffing changes and need for a fast-paced review of the QPP, she scheduled a virtual meeting with the Affinity MIPS Oversight Team. She reviewed the four categories of MIPS and their scoring complexities, as well as discussed how an organization’s MIPS score can affect Medicare reimbursement. Sherman also reviewed the wide array of resources Quality Insights offers through its Learning and Action Network (LAN) and explained that assistance and education is provided at no-cost to the organization. 
 
Once a communication plan was in place to get all practices on the same page, the MIPS Team began using the MACRA/MIPS e-newsletter provided by Quality Insights to keep its key stakeholders apprised of changing Medicare regulations, upcoming webinars and educational events for staff. In addition to the regular e-newsletters, the Affinity team has taken advantage of Quality Insights’ monthly QPPLive! Q&A forum. Affinity staff have found this live, interactive, online event to be beneficial as it provides them with the opportunity to not only listen and learn from others in the field, but these sessions also keep them abreast of breaking news regarding the QPP.
 
Affinity staff also regularly attend Quality Insights’ educational webinars featuring various MIPS categories and topics. A team member facilitates this by registering, reserving a conference room and inviting others to attend together. Cohesive team-based engagement efforts have resulted in improved and streamlined communication activities, which have ultimately lead staff to a better understanding of MIPS requirements and opportunities for improvement.
 
Once the Affinity team solidified their communication and educational efforts, the next step was to estimate their MIPS score for the year and work to improve that score, if needed. When Sherman provided a demonstration of a MIPS Calculator to staff, they realized it was just what they needed.  
 
“This tool was so helpful. It calculated benchmark scores for quality measures, bonus points and estimated the Cost category (new for 2018) score. The estimated score was extremely close to the score received upon completion of reporting on the QPP portal,” said Jones.
 
“We learned that MIPS is much bigger than one person. The responsibility must be shared and adequately communicated with process owners across the entire organization to be successful. Our end goal is to demonstrate the best possible quality care and outcomes to our patient population,” shared Jones. “Quality Insights has the expertise and resources to validate our progress with MIPS and assure success.”
 
Affinity credits Sherman with helping them find success along their continued MIPS journey. “Lisa is a wonderful resource for us. She has been available to answer questions and guide us to a positive outcome which has allowed us to increase our Medicare reimbursement by receiving a positive payment adjustment starting in 2020.”