The U.S. healthcare system is rapidly moving from a volume driven, primarily fee-for-service model to multiple integrated care models that incorporate a variety of innovative payment structures. Clinicians are increasingly being held to higher levels of accountability for the quality and efficiency of the care they provide.

The Transforming Clinical Practice Initiative (TCPI) assists clinicians in changing the way they deliver care. By participating in TCPI, practices are able to receive technical assistance and peer-level support they need to deliver care in a patient-centric and efficient manner, which is increasingly being demanded by healthcare payers and purchasers as part of a transformed care delivery system.

Participating clinicians will be better positioned for success in one of the two Medicare Quality Payment Program (QPP) tracks, the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).

As part of TCPI, a Change Package was developed to organize transformation strategies surrounding three primary drivers in order to achieve the seven TCPI Aims:

  1. Support more than 140,000 clinicians
  2. Improve health outcomes for millions of patients
  3. Reduce unnecessary hospitalization for 5 million patients
  4. Generate $1 to $4 billion in savings
  5. Sustain efficient care by reducing unnecessary tests and procedures
  6. Transition 75% of practices completing the program to participate in Alternative Payment Models (APMs)
  7. Build evidence base on transformation

The three primary drivers of the TCPI Change Package are: (1) Patient and Family-Centered Care Design, (2) Continuous Data-Driven Quality Improvement, and (3) Sustainable Business Operations.

The QPP aligns with TCPI, and performance is measured by the data clinicians report in the four QPP areas; Quality (50%), Improvement Activities (15%), Promoting Interoperability -formerly Advancing Care Information (25%), and Cost (10%).

By integrating the TCPI Patient and Family Engagements (PFE) components and collaborating with patients and families, patients are more likely to follow the treatment plan agreed upon with their doctor – which can have an increase on the clinician’s MIPS Quality Measures performance.

Several of the Improvement Activities mirror the TCPI tactics such as 24/7 access, establishing Patient and Family Advisory Councils (PFACs), integration of behavioral health, etc. The implementation of e-tools (e.g. patient portal, e-Prescribing, etc.) is essential to achieve the MIPS Promoting Interoperability element of the MIPS scores, as well as the TCPI PFE components.

For more information on the significance of PFE Components to MIPS scores and the QPP visit the Linking the PFE Program to QPP MIPs document.

Beginning in 2018, the cost performance category will count towards your MIPS final score.This performance category replaces the value-based payment modifier (VBM) program. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay.

Learn more about TCPI

Learn more about the QPP

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Additional resources about Patient and Family Engagement (PFE):

Technical Assistance is available at 844-205-5540 Monday – Friday 8:30am – 5pm (Central Time) or by email. Visit our website for additional information.