Healthmonix Advisor

Transforming care through collaboration: Lessons from the frontlines of value-based healthcare

Posted by Paul Grant on May 21, 2025

One theme emerged loud and clear at the NAACOS Spring 2025 Conference: transformation isn’t just about systems. It’s about people, collaboration, and actionable workflows. 

Healthcare organizations nationwide are navigating the complexities of value-based care (VBC). VBC success is measured in procedures performed and outcomes achieved. It requires coordination between technology, teams, and providers. 

Many organizations are struggling to close the gaps.

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Topics: Quality Performance Category

Redesigning the system: A narrative from Becker’s 2025 annual meeting

Posted by Lauren Patrick on May 15, 2025

Last week, I had the opportunity to join healthcare executives, clinical leaders, and innovators from across the country at the Becker’s Hospital Review 15th Annual Meeting. Every year, this event captures the current temperature of healthcare transformation — but this year felt different. There was a sharpened urgency in the air and a deeper willingness to challenge long-standing norms. 

Across sessions, one question echoed consistently: How do we design a healthcare system that truly delivers value — to patients, providers, employers, and communities? 

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Topics: Quality Performance Category

The Transforming Episode Accountability Model (TEAM): A new era in healthcare

Posted by Lauren Patrick on May 1, 2025

The Transforming Episode Accountability Model (TEAM) is set to revolutionize how hospitals coordinate care for Medicare beneficiaries undergoing high-risk, high-volume surgical procedures. Slated to start in January 2026, this 5-year, mandatory model will focus on improving patient care quality while controlling costs.  

Here’s an in-depth look at what TEAM entails and its potential to transform the healthcare landscape. 

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Topics: Quality Performance Category

What primary care providers must know about billing, compliance, and MIPS MVPs in 2025

Posted by Lauren Patrick on April 24, 2025

In 2025, CMS launched a significant evolution in its commitment to primary care: the Advanced Primary Care Management (APCM) codes. These codes — G0556, G0557, and G0558 — are designed to simplify billing, support patient-centered care, and advance health equity for patients with chronic conditions. 

But there’s a catch. These codes come with new requirements, including participation in the Value in Primary Care MIPS Value Pathway (MVP) for eligible clinicians. 

In this post, we’ll break down: 

  • What APCM codes are 
  • Who can bill them 
  • How they differ from existing care management codes 
  • What’s required for MIPS compliance 
  • What happens if you don’t report 
  • What steps your practice should take next 
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Topics: Quality Performance Category

Healthmonix has done it: Quality reporting success for MSSP ACOs at scale

Posted by Lauren Patrick on April 15, 2025

As value-based care matures, MSSP ACOs face mounting complexity in quality reporting — across EHRs, payers, and evolving CMS requirements. At Healthmonix, we don’t just promise solutions. We’ve already delivered them — at scale, across diverse ACOs, and in direct partnership with forward-thinking healthcare leaders. 

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Topics: ACO, Quality Performance Category

Further thoughts on the 2024 Final Rule and the Quality Payment Program

Posted by Lauren Patrick on November 16, 2023

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.

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Topics: Quality Performance Category, MIPS Reporting

7 initial takeaways from the 2024 PFS Final Rule

Posted by Lauren Patrick on November 3, 2023

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. 

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Topics: Quality Performance Category, MIPS Reporting

Why You'll Be in For a MIPS Shock - No More Bonus Points or Loopholes

Posted by Lauren Patrick on December 6, 2021

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Physician Fee Schedule (PFS) Final Rule which governs MIPS and other quality payment programs. Anticipated changes were made to MIPS, making the program more challenging in 2022 and signaling additional changes to the program in coming years.

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Topics: MACRA & MIPS, Quality Performance Category, IA Performance Category, Cost Performance Category, PI Performance Category, MIPS Value Pathways, 2022 PFS Final Rule

This Could Be Your First Year to Receive a MIPS Penalty. Here's Why.

Posted by Lauren Patrick on November 18, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Final Rule, CMS has demonstrated that MIPS will be both financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.

   

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Topics: Quality Performance Category, IA Performance Category, Cost Performance Category, PI Performance Category, 2022 PFS Final Rule

New Challenges Brought on by Changes to MIPS Threshold & Performance Categories

Posted by Lauren Patrick on September 24, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Proposed Rule, MIPS participants find themselves wrestling with lingering disappointment from participation in the program in previous years, and resistance to the idea that MIPS will be financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.    

This is the second in a series of blog posts on the 2020 payment adjustment and the 2022 Proposed Rule, that will address this sense of disappointment and show how the future of MIPS will contain much more rigorous program requirements and create greater financial rewards.  To see financial and program success, you will need to be prepared to meet the new challenges.  We have the guidance you need to succeed in 2021 and beyond.    

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Topics: MACRA & MIPS, Quality Performance Category, Cost Performance Category, 2022 PFS Proposed Rule