Clinical Quality Solution
Medical groups are participating in an array of quality data reporting and pay-for performance initiatives while taking on more risk-sharing with payers. Expanding and changing program rules and procedures are straining provider resources. Physicians are expected to support these initiatives, but lack tools that would make them efficient.
To eliminate the strain of this trend on physicians, the Allscripts Clinical Quality Solution (CQS) Powered by Team Praxis was developed. The Allscripts CQS features a modular framework with add-on content channels that support specific payer initiatives. Physicians need only document appropriate information within Allscripts Enterprise EHR to support these initiatives and bring additional revenue to the group.
Content Channels include:
The Allscripts CQS PQRI Channel extracts clinical information recorded in Allscripts Enterprise EHR and practice management systems and then generates results ready for reporting to CMS. Using accurate, up-to-date PQRI rules in its algorithms, the channel ensures the highest possible CMS bonus payment. In many cases the solution pays for itself and helps defray EHR costs by providing a new revenue stream.
The HCC Diagnosis Recapture Channel provides medical groups with a tool to proactively manage Medicare Advantage risk. It alerts physicians at the point of care to code appropriately, eliminating the need to correct charts after the fact. Medical groups are not only able to better manage their current risk contracts, but can explore increasing their risk sharing percentage or enter into full-risk arrangements.
The CQS e-Prescribing Channel is available as an add-on to the Allscripts CQS Framework. The framework supports other add-on content channels including a PQRI Channel which automates Medicare fee for service reporting and a HCC Diagnosis Recapture Channel which automates Medicare Advantage risk adjustment.
A Population Health Management Channel is currently being developed to solve the general problem of applying clinical decision support to improve quality. This solution will tap the collective wisdom of clinical champions and quality leaders in the organization to improve patient outcomes from the bottom up. The CQS framework allows both provider innovationas well as relieving burdensome payer reporting. Both are important to providers and are compared in the following table.
The CQS framework enables each content channel to present physicians with an up-to-date display of their patient information at the point of care. This patient dashboard provides actionable information for complying with one or more channel initiatives. Tools are also provided for quality and case management teams to quickly and easily identify patients needing follow-up care and then schedule appropriate interventions, assisting the physician with improving clinical outcomes and payer reimbursements.
- Modular framework supports multiple initiatives including CMS, PQRI and Medicare Advantage HCC
- Content channels provide new revenue streams, effectively defraying the cost of an EHR. Rules-driven framework cuts through program complexity to display only relevant information and to generate results ready for transmission to P4P.
- Patient dashboard provides actionable information for physicians at the point of care.
- Physicians able to “drill-down” on individual patients and results, building confidence in data and providing decision support
- Aggregate patient dashboard for case managers identifies patients needing interventions, improving clinical outcomes and maximizing payer reimbursements