We're not reinventing the wheel. We're just changing the tires.
Managed Care Solutions
With Vanguard Healthcare Partners
What We Do
Vanguard analyzes your Quality Payment Program performance and finds you the resources you need to earn your bonus and avoid penalties.
Vanguard offers turn-key QPP data automation and ancillary care solutions
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Evaluate the measures you participate in
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Assess your data collection methods
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Confirm your visit notes reflect the data being collected by providers
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Recommend practice solutions, technology solutions, and/or ancillary solutions based on discovered gaps in recommended patient services, service access, data collection, data reporting, and data auditing
How We Do It
Take a deep dive into the your data collection systems and benchmark your scores and opportunities against same and similar providers in your market.
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Assess technology stack to discover ability to immediately execute to engage the patient based on surfaced gaps in identified intervention opportunities
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Identify technologies operate in concert or in the background in order to prevent provider workflow disruption
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Identify clinical and operational partnerships that can fill care and coverage gaps so that you don’t miss any bonus money or incur penalties
Our budgeting and financial planning tools will give you the closest and most realistic outlook for your program. The data will give your practice the best idea on your true return on your investment and inform you of the likely financial reality.
Protecting Your Investment
Understanding how the government incentive programs work is critical to your success. Implementing an automated clinical and order decision supported workflow that medically justifies your orders is invaluable.
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Earning new revenue is the goal. Keeping it is the expectation, but it doesn't happen without the right solution and people behind it. Vanguard is highly skilled at implementing clinical data solutions.
Full Customer Service and Support
Vanguard is a turn-key solution. That means it's all inclusive and fully supported at all times. Your success is our job always.
About Quality Payment Programs
Quality Payment Programs (QPP) are being used by more than 90% of health plans in the United States to assess and compare the quality of healthcare services provided to their members. QPPs evaluate performance based on CMS driven categories and Alternative Payment Models (APM). Vanguard Healthcare Partners can help your organization optimize your QPP strategy with intelligent automation, clinical practice support, and best practices consultation.
About HEDIS
HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures used by more than 90% of health plans in the United States to assess and compare the quality of healthcare services provided to their members. These measures are used to evaluate the effectiveness, accessibility, and quality of care provided by healthcare providers.
HEDIS measures cover a wide range of topics, including preventive care, chronic disease management, and patient satisfaction. Some examples of HEDIS measures include:
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Immunization rates for children and adults
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Cancer screening rates (such as mammography and colon cancer screening)
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Control of blood pressure and cholesterol levels in patients with hypertension and hyperlipidemia
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Medication management for patients with asthma and diabetes
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Patient satisfaction with the healthcare experience
For insurers, HEDIS measures provide valuable information about the quality of care provided by healthcare providers. This information can be used to identify areas of improvement and to negotiate contracts with providers. Insurers can also use HEDIS measures to promote quality healthcare and to market their plans to employers and consumers.
For healthcare providers, HEDIS measures can be a valuable tool for evaluating and improving the quality of care they provide. By understanding their performance on HEDIS measures, providers can identify areas where they need to improve and take steps to address any shortcomings. Additionally, high performance on HEDIS measures can help providers to attract and retain patients and to negotiate contracts with insurers.
About MACRA
MACRA (Medicare Access and CHIP Reauthorization Act) is a law passed by the United States Congress in 2015 that aims to improve the quality and value of healthcare for Medicare beneficiaries. It replaces the previous reimbursement system for physicians that was based on the number of services provided with a new system that emphasizes value over volume.
Under MACRA, physicians are required to participate in one of two payment tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). MIPS is a performance-based track that combines four categories of measures: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost. The scores on these categories are used to determine the amount of reimbursement that physicians will receive from Medicare. APMs, on the other hand, are payment models that incentivize providers to deliver high-quality, coordinated care by linking reimbursement to quality performance.
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For insurers, MACRA can affect reimbursement rates for physicians, which may impact the cost of healthcare for beneficiaries. Additionally, insurers may need to adapt their networks to include physicians participating in advanced payment models.
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For healthcare providers, MACRA can have a significant impact on how they are reimbursed by Medicare. Providers participating in MIPS will be evaluated on their performance on various measures, and those who perform well will receive higher reimbursement rates. Providers participating in APMs will be reimbursed based on the quality of care they deliver, rather than the volume of services provided. As a result, healthcare providers will need to focus on delivering high-quality, coordinated care in order to be reimbursed at a higher rate.
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Some providers have expressed concerns about the administrative burden of reporting and the lack of clear guidance on how to participate in the APMs. Additionally, some providers have raised concerns about the fairness of the MIPS program, as it may disproportionately affect small and rural practices. Vanguard Healthcare Partners can help providers implement systems that optimize processes and automate many data input functions that simplify the reporting and coding burdens that determine success.
About MIPS
MIPS (Merit-based Incentive Payment System) is a program established by the Centers for Medicare and Medicaid Services (CMS) to incentivize healthcare providers to improve the quality and efficiency of care they deliver to Medicare beneficiaries. It is one of two tracks under the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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Under MIPS, providers are evaluated based on four performance categories: Quality, Advancing Care Information, Improvement Activities, and Cost. Providers can earn points in each category, and their total score determines their reimbursement adjustment for the following year.
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For insurers, MIPS can affect reimbursement rates for providers participating in the program. If a provider performs well on the MIPS evaluation, their reimbursement rates may increase, which can impact the overall cost of care for the insurer. On the other hand, if a provider performs poorly, their reimbursement rates may decrease, which could lead to lower costs for the insurer.
For healthcare providers, MIPS can affect their reimbursement rates and financial performance. Providers who perform well on the MIPS evaluation may see an increase in reimbursement rates, which can lead to increased revenue. However, providers who perform poorly may see a decrease in reimbursement rates, which could negatively impact their financial performance. Additionally, providers are required to report quality measures and other data to CMS, which can be time-consuming and costly.
Although MIPS provides a roadmap for quality outcomes and provider rewards, the program also requires providers to expend great amounts of time, cost, and effort for practices that are less health data-integrated and health data-automated. Vanguard Healthcare Partners can help practices optimize data and reporting capabilities.