Pathway to Value for 1.1 million FFS Providers

There are 1.1 million Providers that received reimbursements via Medicare’s reimbursement  Fee-For-Service (FFS)model.  The CMS objective is to ensureall Medicare and a vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.  

Currently, non-adherence to medication therapy accounts forup to 50% of treatment failures, and up to 25% of hospitalizations each year inthe United States; 69% of re-hospitalizations are due to non-adherence – up to $300B in costs each year.  

GenieMD Unified VIrtual Care Platform

With this as one of many challenges, the question for a Medicare FFS provider is how they transform their delivery model to meet CMS objectives.  One plausible approach is toadvance FFS based virtual care programs such as Remote Patient Monitoring (RPM),Chronic Care Management (CCM), Remote Therapeutic Monitoring (RTM)  and/or others. While the use of Telehealth is transforming the location ofcare delivery a vast majority of care is still delivered in the provider’s office; however, wellness is achieved at home. Mentioned virtual care programs extend the delivery of care to the home– maximizing patient engagement, care plan compliance, education, behavioral change and overall experience.

It’s accurate that RPM gives emphasis on collecting the patient’s physiological measures; however, so much more is learned in the process about a patient’s current state of wellness.  Virtual care programs create early intervention opportunities to mitigate escalation of clinical conditions.  This leads to enhanced medication compliance, reduced use of the emergency room and any hospitalization or re-hospitalization– in the end facilitating greater quality of care while reducing costs.  These FFS programs establish the necessary experienceand pathway for the provider to migrate to value-based reimbursement.  Moving forward with greater knowledge and confidence reduces their risks.  

Achieving said value-based objectives as a small or large practice is critical; however, greater value can be achieved if Independent Physician Organizations (IPAs) scale such a program to maximize their clinical integration objectives.   This will provide a common tool set patients to engage each physician as well as facilitate the ability for all stakeholders to securely collaborate across the community of care further enhances the quality of care.