A dedicated roster of 12,152 physicians from New Jersey, Maryland, and Puerto Rico taking part in NJII’s Garden Practice Transformation Network (GPTN) were able to improve the health of more than 13.7 million patients by employing evidence-based best practices. We prepared them for the switch from fee-for-service to value-based care, which resulted in efficiency driven cost savings totaling $179 million through the fall of 2019.
The GPTN is one of 29 Practice Transformation Networks (PTN) in the country. The networks were created in 2015 by the Transforming Clinical Practices Initiative (TCPI), established by the Centers for Medicare and Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI). The PTNs were given four-year assignments to improve health, lower costs and increase access to care by helping medical practices strengthen their core competency in value-based care through extensive coaching and mentoring. GPTN and its peers are wrapping up operations at the end of the year.
Primary care and specialist practices managing chronic patients that participated in the Physicians Quality Reporting System (PQRS) were able to take part in the PTN program. PTNs were tasked with submitting PQRS data of their enrolled practices. The PTNs also sought to increase practice revenue with Transitional Care Management (TCM), which compensated practices for managing chronic patients as outpatients rather than inpatients. Our own GPTN delivered exemplary results – the $179 million in savings that participating practices realized far exceeding the initial goal of $155 million in savings we established with CMS.
“Data improves the quality of care,” noted Senior Director of Payer and Provider Services Sarah Balzano. “Preparing practices to succeed in the value-based model saves lives and money.”
One client, family physician Saleem Mahmood from Jersey City, N.J., saw a substantial improvement in 30-day readmissions. We trained his staff in managing transitions of care effectively and incorporating best practices in organizing care-coordination workflow, post-discharge appointments and follow-up calls, and ensuring consistency in admissions, discharges and transfers (ADT) from local hospitals. Based on this intervention, Dr. Mahmood potentially avoided readmissions for 72 patients, accounting for $970,098 in savings. His practice’s readmission rate fell to only 6.04%, about a third of the national rate of 15.32%.
Another Jersey City practice, Quality Medical Care, benefited from participation in many ways. GPTN professionals trained the facility’s staff in Transitional Care Management workflows, Quality Measure monitoring, and proper Electronic Health Record (EHR) monitoring. Quality Medical Care was able to improve colorectal screenings from 64.87% to 94.74%. The metrics for controlling blood pressure improved from 64.92% to 96.06% and tobacco screening results improved from 86.91% to 97.92%. In total, the practice saved nearly $402,000.
We also helped Dr. Anna Korkis, a gastroenterologist and liver specialist in Ridgewood, N.J., control high blood pressure amongst her patients. Her office improved at measuring risk stratification and identifying those most at risk so that they could be engaged in the creation of care plans and self-monitoring best-practices. Dr. Korkis was able to reach 75.54% performance in her Controlling High Blood Pressure Measure, up 7.44% from the national average of 68.1%.
The GPTN’s performance has been well recognized. It was one of four PTNs earning a Pioneer Award from CMS in 2018 for successfully implementing TCPI’s Data Support and Feedback Reports (DSFR). And, this August, we were one of five PTNs CMS recognized for successfully meeting the goals of the TCPI – supporting clinicians in their practice transformations, improving health outcomes, reducing unnecessary hospitalizations, generating savings, sustaining efficient care delivery by reducing unnecessary testing and procedures, transitioning practices to Alternative Payment Models, and building the evidence base on practice transformation so that effective solutions can be scaled.
The CMS viewed our work with the GPTN so favorably it recognized the Healthcare Division as one of the Prime Awardees of the Network of Quality Improvement and Innovation Contractors, (NQIIC) in June. This prestigious designation is only given to organizations demonstrating healthcare quality improvement expertise. It allows us to bid on task orders through the summer of 2024.
We have bid on the second task order issued to NQIIC. Should we win the bid, NJII will once again work with providers to help improve behavioral outcomes, patient safety, quality of care transitions, and increase the self-management of chronic disease. If you are interested in participating in these programs please contact us.
The GPTN team will continue to serve the network of physicians it has established. Going forward into 2020, they will support the Healthcare Division’s value-based program, helping practices understand and improve on quality measures, such as the Healthcare Effectiveness Data and Information Set (HEDIS). “Incentivized contracts increase quality and lower cost,” said Hernandez. “We look forward to continuing to engage with, and advising clients.”