Healthmonix Advisor

The Centers for Medicare and Medicaid Innovation (CMMI) have introduced the Making Care Primary (MCP) model, a new initiative aimed at transforming primary care delivery through value-based care.  

 The MCP model, announced June 8, 2023, is a 10.5-year multi-payer partnership launched July 1, 2024. This voluntary model aims to improve care management and care coordination while addressing patients' health-related social needs. 

This year’s HLTH 2024 conference delivered on its promise to push the boundaries of what’s possible in healthcare. It was a chance to connect with peers, challenge the status quo, and dig into the trends that will reshape our industry. From the innovative — but so needed — concept of socially prescribed care to the potential ripple effects of the upcoming election, HLTH 2024 was a window into a rapidly changing landscape.

Here’s what stood out to me.

2024 stands as a pivotal year for healthcare providers, marking the end of leniency granted since the COVID-19 Public Health Emergency began. Participation in the Quality Payment Program (QPP) and the Merit-based Incentive Payment System (MIPS) is no longer optional — if providers fail to engage, they’ll face penalties.  

For the first time since the COVID-19 Public Health Emergency (PHE), all eligible clinicians must engage with the MIPS program or face a stark 9% cut in Medicare Part B claim reimbursements. With the stakes raised this year, scores have become pivotal. Additionally, the threshold for avoiding penalties has jumped in recent years, making high scores a coveted achievement. 

Within MIPS, the quality component demands each clinician or group to report on 6 quality measures. The scoring landscape, however, has shifted: 

• Bonus points for eCQM and additional high-priority measures have been eliminated. 
• The baseline score for measures has been reduced from 3 points to 0 for non-small practices, adding to the competitive tension. 

In the dynamic landscape of healthcare technology, data security and compliance are paramount. As we witness the rapid evolution of digital health solutions, patients and healthcare providers alike demand robust safeguards to ensure the confidentiality, integrity, and availability of sensitive information.

We're thrilled to announce that Healthmonix, a leading value-base care organization in healthcare technology, has achieved the prestigious HITRUST certification, reinforcing our commitment to excellence in data security. 

Background: Under the Quality Payment Program (QPP), eligible clinicians face payment adjustments determined by their performance in the Merit-Based Incentive Payment System (MIPS) or choose to participate in the Advanced Alternative Payment Model (APM) track. Those in MIPS see their payments increased, maintained, or decreased based on relative performance in four categories: Quality, Cost, Promoting Interoperability, and Improvement Activities.  

Clinicians participating in an Advanced APM are exempt from MIPS and were initially qualified for a 5% bonus payment. However, after the expiration of the 5% bonus, Congress reauthorized the bonus at a reduced rate of 3.5% for the year 2023. Additionally, the Centers for Medicare & Medicaid Services (CMS) has introduced a new alternative to traditional MIPS known as the MIPS Value Pathways (MVPs), which is a voluntary option for eligible clinicians.

The program continues to evolve at a macro level, as CMS has a vision to move providers out of ‘traditional MIPS’ and into other reporting options such as APP for Shared Savings participants, MVPs for those still in fee for service, and APMs for other provider programs. In addition, CMS continues to pursue the Universal Foundation. Providers need to be prepared for bigger shifts in their quality reporting strategies as CMS aligns programs under the National Quality Strategy.

Below we explore some of the key takeaways from the 2024 PFS Final Rule impacting the QPP program.

In the 2024 Medicare Physician Fee Schedule (PFS) Final Rule released yesterday, CMS is emphasizing getting the Quality Payment Program (QPP) “back on track with the trajectory we had planned before the public health emergency (PHE)”. They’re focused on ensuring that the program resumes its intended progress, which was interrupted during the PHE over the last few years. 

Here's an initial breakdown of what this means.