Value Based Care 1
In the Aledade model, this term refers to the money returned to primary care practices when they successfully lower the total cost of care while maintaining high quality.
What are Shared Savings?
This specific Medicare program (abbreviated as MSSP) is the most common value-based contract type that Aledade practices participate in.
What is the Medicare Shared Savings Program?
To meet billing requirements for Transitional Care Management, the initial interactive contact with the patient or caregiver must occur within this many business days after discharge.
What is two business days?
To be eligible for an Annual Wellness Visit, a Medicare patient must have been enrolled in Part B for at least this many months.
What is 12 months?
This healthcare delivery model rewards providers for the quality of care they give to patients, rather than the volume of services.
What is Value-Based Care (VBC)?
This strategy involves using data to identify high-risk patients within a group so that providers can intervene before a health crisis occurs.
What is Population Health Management (or Risk Stratification)?
For "High Complexity" TCM (CPT code 99496), the face-to-face visit must take place within this many calendar days of discharge.
What is seven calendar days?
This specific type of visit, often confused with the AWV, is a one-time benefit available only within the first 12 months of a patient's Medicare Part B enrollment.
What is the "Welcome to Medicare" visit (or Initial Preventive Physical Examination - IPPE)?
This traditional payment model, which VBC aims to replace, pays doctors based on the number of procedures and tests performed.
What is Fee-for-Service (FFS)?
In the Value-Based Care equation, Value is defined as Quality divided by this.
What is Cost?
This critical clinical process, which involves comparing the patient's pre-admission medications with those prescribed at discharge, must be performed no later than the date of the face-to-face visit.
What is Medication Reconciliation?
A mandatory component of the AWV, this assessment tool is used to identify a patient’s self-reported health status, frailty, and behavioral risks.
What is the Health Risk Assessment (HRA)?
This term describes standardized measurements used to track clinical performance, such as ensuring diabetic patients receive regular A1c testing.
What are Quality Metrics (or HEDIS scores)?
This three-letter acronym refers to the score used to adjust payments based on the health status and complexity of a patient; a higher score typically indicates a sicker patient.
What is RAF (Risk Adjustment Factor)?
The TCM service period begins on the date of the patient's discharge and continues for this many total days.
What is 30 days?
Unlike a standard physical exam, the Annual Wellness Visit is unique for Medicare patients because it has $0 cost-sharing, meaning the patient does not have to pay these two common types of fees.
What are the deductible and coinsurance?
Unlike process measures, these measures track the actual results of care, such as a reduction in hospital readmission rates.
What are Outcome Measures?
This performance-based payment system, part of the Quality Payment Program (QPP), adjusts a provider's Medicare Part B payments based on scores in quality, cost, and improvement activities.
What is MIPS (Merit-based Incentive Payment System)?
This specific type of "non-face-to-face" service involves the clinical staff coordinating with community service providers to help a patient after they leave the hospital.
What are discharge planning/care coordination services?
After the "Initial" AWV is completed, patients are eligible for a "Subsequent" AWV once every this many months.
What is 12 months (or once per year)?