CCMS Medicine Winter 2017 - 17

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- called the Practice Options Initiative - will create clinically
integrated networks (CINs) as well as a Management Services
Organization (MSO) to help Pennsylvania physicians succeed in
value-based care, while maintaining leadership roles and clinical
autonomy.
The MSO will initially provide services within the general
categories of revenue cycle, practice operations, and finance and
business operations. It will include services such as front end
management as well as back end management of the practice,
staff payroll, reimbursement, charge capture, appeals, coding,
practice management, etc., as well as Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) readiness and Merit-Based
Incentive Payment System (MIPS) reporting. These services will be
available to any physician practicing in Pennsylvania or elsewhere.
One way physicians can succeed in value-based care is through
CINs. A CIN is a group of separate practices - each with a unique
Tax Identification Number (TIN) - collaborating to demonstrate
value, meet quality metrics, and improve patient outcomes. This
is a direct response to the evolving health care delivery system,
which is moving rapidly toward value-based care led by passage
of MACRA and its accompanying regulations. This guidance
outlines the use of MIPS reporting and development of Alternative
Payment Models (APMs).
A well-led CIN provides the infrastructure to efficiently,
effectively, and comprehensively address the known issues in health
care for the foreseeable future, and an established physician-led,
physician-owned network to efficiently address the unknown
health care shifts of tomorrow.
In a physician-owned and physician-led CIN, physicians are
not only "at the table," but are creating and implementing the local
approach collectively. The more physicians understand the value
of physician-driven networks, the more successful and sustainable
they will be as health care leaders. It will also increase professional
satisfaction - a very important part of who physicians are, and
something that has recently been at an all-time low.
The ultimate goal is for CINs to serve as the high-performing,
local catalysts for greater value for the health care dollar, while

rewarding participating physicians for their work. PAMED
plans to advance these networks by providing physicians with
the knowledge, tools, and confidence that patients are receiving
the best, most appropriate care possible throughout the entire
continuum of care provided.
This means physician engagement must occur at a granular
level. Physician-created initiatives, with input and buy-in from the
entire network, and resulting in better overall coordination, is a
cornerstone of success. This will allow physicians to directly affect
health outcomes for large populations of patients while also being
able to bend the cost curve, as the market so desperately needs.
PAMED must and will support physicians during this
transition through use of services offered through the MSO or
CINs. PAMED is looking to engage Pennsylvania physicians;
provide the necessary education, clinical tools, and data; and offer
hands-on practice support to assure successful transitions. This
is the value of becoming part of a CIN, and of being a PAMED
member.
If you would like additional information about PAMED's
Practice Options Initiative, please contact Dennis Olmstead,
PAMED's senior advisor of health policy and economics, through
PAMED's Knowledge Center at 855-PAMED4U (855-726-3348)
or KnowledgeCenter@pamedsoc.org.
If you haven't already, check out PAMED's online, on-demand
CME series - "Addressing Physician Uncertainty about Payment
Reform: Skills for Success in Value-Based Delivery Systems."
Free to PAMED members, this series is facilitated by Ray Fabius,
MD, a PAMED member and a nationally respected expert in the
field of population health. It covers a variety of important topics,
including practical health informatics, using a data toolbox in
your practice, quality management, process improvement, lessons
learned from the managed care era, and population health. Access
the CME at www.pamedsoc.org/valuebasedcare.
A version of this article first appeared in the summer 2016 issue of
Pennsylvania Physician and was updated on Dec. 13, 2016.

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Table of Contents for the Digital Edition of CCMS Medicine Winter 2017
