Welcome to Keep Well ACO

On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule which implemented the Quality Payment Program that was part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The new Quality Payment Program (QPP) replaces previous quality related initiatives (i.e. PQRS) while combining other programs (i.e. Meaningful Use) into a comprehensive reporting and performance system. Medicare reimbursement will be significantly impacted by performance scores. The QPP has two tracks for practitioners: Advanced Alternative Payment Models (APMs) and The Merit-based Incentive Payment System (MIPs). Unless providers elect to participate in one of the APM innovative payament models they will be subject to the criteria of MIPs.

Practitioners meeting the requirements of APMs receive a 5% incentive payment from Medicare and are exempt from the requirements of MIPs. However, there are separate requirements in the APM models, each requiring some degree of risk sharing.

MIPs is a system of performance-based payment adjustments to the traditional Medicare payment system. Beginning in 2017, performance results will result in a positive or negative payment adjustment of up to 4% for 2019 services. Each year this adjustment increases up to 9% in 2022. There are four categories of performance measures in MIPs: Quality , Improvement Activities, Advancing Care Information, and Cost.

The new QPP offers both opportunities and challenges for physician practices. Unfortunately for many practices the challenges outweigh the benefits, however, participation is not optional. Not participating will result in receiving the maximum negative adjustment to your Medicare payments. APMs sound attractive, but include significant risks that providers need to understand to properly evaluate. The MIPs track is an easier transition for most practices, but is also complicated and requires practice administration that many providershave not yet developed. 

Keep Well ACO was formed to provide a support infrastructure for physician practices. We have the tools and can provide the assistance your practice needs to be successful in meeting the challenges of MACRA. We work directly with practice management to set up the systems, protocols, and reporting mechanisms to be successful. 

In 2015 Medicare began paying physicians separately for Chronic Care Management (CCM) Services. Likewise, many other payers have followed suit and also offer reimbursement for these services that are now recognized as a critcal component of primary care that contributes to better health and care for individuals.

While providing care management services contributes to optimal outcomes for patients with chronic conditions, meeting the complex requirements for reimbursement can be challenging for practitioners. Keep Well ACO simplifies the process with a proven technology platform, structured service model, and staffing services to meet your practice's unique specific needs.