Leveraging technology to simplify value-based care – Tracking submissions and measuring performance at Oaklawn Medical Group

By Chris Hayhurst | October 2, 2023

Simplify value-based care

Value-based care models come with high complexity and few guarantees. For healthcare organizations to do well and maximize returns, they must excel in everything from collaborating with other providers to integrating the systems required for reporting. Without a good roadmap for navigating this landscape, it’s easy for practices to wind up lost. Across the athenahealth network, healthcare organizations are using tools and technology to help them achieve their value-based care goals.

Here is one of them.

A department of Oaklawn Hospital in Marshall, MI, Oaklawn Medical Group offers internal and family medicine services at eight locations in and around the city. The practice includes 34 providers who participate in Primary Care First (PCF), a CMS-administered alternative payment model (APM) designed to reduce Medicare spending while improving care quality and access for patients.

According to Oaklawn’s Cody Zeithammel, assistant director of quality, outcomes, and analytics, the organization had previously participated in CMS’s Comprehensive Primary Care Plus (CPC+) program. They transitioned to PCF just one month after CPC+ ended in late 2021.

“We performed so well in CPC+, and we wanted to continue the value-based and elevated-care-management approach,” Zeithammel said, noting that PCF rewards providers for preventing avoidable inpatient hospital admissions. “We decided it made sense for us, especially since we have a hospital attached to our system.”

Oaklawn leverages athenahealth’s unified quality submission dashboard to prepare the files they submit to CMS. The process involves using a built-in utility to create Quality Reporting Document Architecture III (QRDA 3) files of electronic clinical quality measures (eCQM) data captured from the EHR. “It’s pretty flawless and straightforward,” said Zeithammel. “We download the QRDA 3 file and store it on our network drive, and then we go out to the Quality Payment Program site and do our uploads.”

In addition to the support it offers around submissions, the athenahealth platform gives Oaklawn’s providers an easy way to track and measure performance. PCF’s three eCQMs include a measure for patients who’ve received colorectal screenings and two others for patients with diabetes (HbA1c) or high blood pressure. “You just go to the provider’s name and hit ‘run,’ and you get numerator-denominator criteria with hyperlinks to a detailed report” that can be used to make clinical decisions, Zeithammel explained.

While Zeithammel noted that PCF has “paid a little bit less” than CPC+ to date, he expects that trend will change soon. “I think the program is leading us in the right direction to improve patient care while increasing our reimbursements.”