Houston-based Nobilis Health launched Concertis, a technology platform that creates new payment and delivery methodologies.
Starting 2016, CMS's Medicare Access & CHIP Reauthorization Act of 2015 will replace the current Meaningful Use, Physician Quality Reporting System and Value-Based Payment Modifier. MACRA will reward physicians based on their ability to enhance patient outcomes while reducing costs.
Physicians have the option to participate in the Merit-Based Incentive Payment System or the Alternative Payment Models under MACRA. Most physicians will initially operate under MIPS, which consists of a weighted score of quality, resource use, meaningful use and practice improvement scores.
As part of APMs, CMS estimates between 31,000 clinicians and 90,000 clinicians will qualify for bonuses between $146 million and $429 million. CMS maintains only those APMs deemed "advanced" will qualify for such payments.
Under the Medicare Access and CHIP Reauthorization Act, an estimated 340,000 practices, mostly composed of practices between one member and 24 members, may endure penalties in 2019.
CMS will provide an estimated 412,000 physicians and clinicians bonuses as high as 4 percent in 2019. CMS set a goal of 30 percent of its 2016 payments to be value-based rather than fee-for service. The agency plans to increase that figure to 85 percent by 2018.
Here are five insights into Concertis:
1. A 100 percent Nobilis-owned entity, Concertis technology's new payment mythologies will include bundled payment networks to provide patients superior healthcare.
2. Through their bundled payment platform, Nobilis aims to significantly reduce the financial and administrative burdens providers encounter.
3. Marissa W. Arreola will serve as Concertis' president. Ms. Arreola is a former health law partner at Baker Donelson.
4. The company will work with payers to combine reimbursement for different providers and facilities into a single compressive bundled payment, which will cover a patient's entire episode of care. Concertis' bundled payment will provide users a warranty for surgical services.
5. Concertis will track data and its care navigation team will work with patients until 30 days to 60 days after their procedure.
"Bundled payments and performance based healthcare are going to be the driving force of healthcare as the industry moves to more efficient and cost effective delivery of healthcare services," said Harry Fleming, Nobilis' CEO. "Nobilis is positioning itself to be at the forefront of this movement by investing in the talent and technology today."
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