On June 17, 2022, the Centers for Medicare and Medicaid Services Innovation Center (CMMI) published a blog sharing insights on necessary steps in specialist engagement in APMs – primarily increasing access to coordinated and integrated specialty care. The authors suggested that greater performance data transparency between primary care physicians (PCPs) and specialists can drive high-value referrals and reduce low-value care. To fully integrate specialty care into population-based models, PCPs need basic data on specialist performance to make informed decisions about the care patients may need while ensuring quality and cost-effectiveness.
The Provider Performance Insights (PPI) tool at Forvis Mazars models Merit-Based Incentive Payment System (MIPS) Episodes of Care and Total Per Capita Cost (TPCC), providing metrics at a physician-specific level using Medicare claims. This provides timely and transparent data, benchmarked against national cohorts, with clinical themes to help with performance improvement. The PPI tool measures the exact data sets that the CMMI indicated physicians are looking for.
Medicare’s June blog post is right about needing transparent specialist data – and Forvis Mazars’ PPI tool delivers just that with utilization, cost, and clinical opportunities to help real-time improvement.