PAYBACK CHART CLINICAL QUALITY MEASURES
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PAYBACK CHART CLINICAL QUALITY MEASURES Focusing on CQM improvement translates into an increase in services, more office visits, and a lift in FFS billings. For a healthcare organization with 50 providers, Enli CareManager can drive $2.2M in incremental revenue—an average increase of $3.7K per provider per month. CareManager also supports performance in value-based reimbursement contracts by helping providers avoid costly interventions, driving higher quality scores, and qualifying for payment adjustments and/or incentives. CQM IMPROVEMENT 1 TOTAL 2 BP Screenings Diabetic A1c Management Cervical Screenings Breast Screenings Renal Screening Colon Cancer Screening 1. CQM improvements based upon Enli customer data (leading regional health system) 2. Service rates for primary care office visits, lab tests, and screenings based upon industry averages and may vary significantly from site to site 3. Incremental MIPS revenue based on median performer and results from a 2% increase in fee schedule payout for physicians as a result of higher quality scores 4. Shared savings incremental revenue assumed for median performer in the Medicare Shared Savings Program (MSSP) program 8.5% 12.0% 20.0% 4.2% 8.0% 2.8% TOTAL $ 846,090 $ 95,280 $ 705,917 $ 74,808 $ 2,541 $ 46,946 $ 1,771,582 MIPS 3 $125,000 ORGANIZATION SIZE: 50 PROVIDERS SERVICE RATES: • OFFICE VISIT $150 • PAP SMEAR $150 • URINE ALBUMIN LAB TEST $50 • A1C LAB TEST $100 • MAMMOGRAPHY $100 • COLONOSCOPY $2,000 KEY ASSUMPTIONS SHARED SAVINGS 4 $190,095 CONTACT US TO MODEL YOUR FINANCIAL UPSIDE FFS $1,771,582 ENLI.NET
Transcript of PAYBACK CHART CLINICAL QUALITY MEASURES
PAYBACK CHART CLINICAL QUALITY MEASURES
Focusing on CQM improvement translates into an increase in services, more office visits, and a lift in FFS billings. For a healthcare organization with 50 providers, Enli CareManager can drive $2.2M in incremental revenue—an average increase of $3.7K per provider per month.
CareManager also supports performance in value-based reimbursement contracts by helping providers avoid costly interventions, driving higher quality scores, and qualifying for payment adjustments and/or incentives.
CQM IMPROVEMENT1 TOTAL2
BP Screenings
Diabetic A1c Management
Cervical Screenings
Breast Screenings
Renal Screening
Colon Cancer Screening
1. CQM improvements based upon Enli customer data (leading regional health system)
2. Service rates for primary care office visits, lab tests, and screenings based upon industry averages and may vary significantly from site to site
3. Incremental MIPS revenue based on median performer and results from a 2% increase in fee schedule payout for physicians as a result of higher quality scores
4. Shared savings incremental revenue assumed for median performer in the Medicare Shared Savings Program (MSSP) program
8.5%
12.0%
20.0%
4.2%
8.0%
2.8%
TOTAL
$ 846,090
$ 95,280
$ 705,917
$ 74,808
$ 2,541
$ 46,946
$ 1,771,582
MIPS3
$125,000ORGANIZATION SIZE:50 PROVIDERS
SERVICE RATES: • OFFICE VISIT $150
• PAP SMEAR $150
• URINE ALBUMIN LAB TEST $50
• A1C LAB TEST $100
• MAMMOGRAPHY $100
• COLONOSCOPY $2,000
KEY ASSUMPTIONS
SHAREDSAVINGS4
$190,095
CONTACT US TO MODEL YOUR FINANCIAL UPSIDE
FFS$1,771,582
ENLI.NET
