Recent care delivery models have focused on providing value-based care to patients. The changes provide opportunity for APNs to take a leadership role in implementing models and systems to effectively deliver that care. Here’s what APNs need to know about the new models.

IHI Triple Aim

The Institute for Healthcare Improvement (IHI) Triple Aim requires healthcare professionals to approach care delivery with an emphasis on performance that:

  • Improves the patient experience of care (including quality and satisfaction)
  • Improves overall population health
  • Reduces the cost of health care. 

To progress toward meeting the IHI Triple Aim, healthcare providers must reduce healthcare waste while accessing cutting-edge knowledge.   

MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is bipartisan legislation that created quality payment programs for health care. MACRA has two arms: 

  • Merit-based incentive payments (MIPS)
  • Advanced alternative payment models 

Participation in MIPS allows providers to earn performance-based payment adjustments for care delivered to Medicare beneficiaries. 

Oncology Care Model

As an alternative, the Centers for Medicare and Medicaid Services (CMS) designed several specialty care delivery models to improve the effectiveness and efficiency of care. The oncology-specific model is the Oncology Care Model (OCM). The 190 practices participating in the OCM engage in payment for performance accountability that encompasses data from quality measures, claims data, and patient satisfaction surveys. It’s important to note that although CMS designed this program for Medicare beneficiaries, 14 payers are also participating in the OCM. 

MIPS and OCM require the measurement of quality of care delivered. Practices participating in MIPS can select measures for reporting and improvement. Practices should choose measures most appropriate for their practice and patient population. OCM defines measures for reporting, with the understanding that the measures may change during the course of the multi-year agreement. 

The intent of MIPS and OCM is not solely to report. Quality payment programs emphasize improving care delivery in an effort to reduce waste and cost of care while improving efficiency, effectiveness, and patient satisfaction. Demonstrating improvement activities increases points awarded toward reimbursement. Examples of MIPS and OCM measure categories include care coordination, symptom management, and cancer survivorship. These measure focal areas that are all within the area of expertise of oncology APNs. 

The APN’s Role

Leading the dissemination and implementation of evidence for clinical practice and the measurement of quality with improvement activities is an important leadership opportunity for oncology APNs. Oncology APNs must become familiar with and establish leadership roles in their institution’s participation in MIPS or OCM.

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