What MIPS Can Do For You!

How AdM Coaching® Can Help You…

Behavioral Education and Research Services, Inc. (BEARS) is pleased to provide an applied behavioral approach to helping providers achieve their goals for the 2017 release of the Merit-Based Incentive Payment System (MIPS).

MIPS can be seen in terms of

Quality (60%) – “Did you do the right thing for your patient?”
Advancing Care Information (ACI) (25%) – “Are you using electronic medical records and data management systems?”
Clinical Practice Improvement Activities (CPIA) (15%) – “How are you improving your operations and clinical services?”

Without a roadmap, MIPS can be a maze to traverse.

For more information on AdM Coaching®, the B-MAAS, B-PAAS, Consequence Analysis and the Adherence Improvement Plan please contact us at info@bearstherapy.com or call us at 321-439-5949.

How BEARS can fulfill your MIPS requirements

BEARS uses a proprietary applied behavioral approach (Adherence Management Coaching®) that first identifies at-risk patients and then specifically examines factors that both physically and cognitively contribute to non-adherence.

We take a patient-centered behavioral approach with our Consequence Analysis™ and review the discharge plan or care plan with patients and their families. We identify high risk areas that may be “punishing” to the patient. This information is shared with the provider; and where possible, accommodations are made to personalize the plan. The “modified” plan is then shared with the patient and an Adherence Improvement Plan (AIP) is completed.

Adherence Management Coaching® is a skill that can be taught to staff members (e.g., nurses, social workers, pharmacists, clinicians, etc.) and provides these professionals with a tool kit beyond Teach Back and Motivational Interviewing.

In the following pages, BEARS’ looked at each of the 94 CPIA areas and selected 27 in which Adherence Management Coaching® can make a difference in the outcomes for patients.

For more information on AdM Coaching®, the B-MAAS, B-PAAS, Consequence Analysis and the Adherence Improvement Plan please contact us at info@bearstherapy.com or call us at 321-439-5949.

IDENTIFY THE "AT-RISK" PATIENT

Improvement Activities is a new performance category for 2017 MIPS

Clinicians are rewarded when care is focused on “…coordination, beneficiary engagement, and patient safety.”

Within the Selected Improvement Activities, CMS has described a number of activities that can use Adherence Management Coaching to fulfill these requirements. 

Expanded Care Access (IA_EPA_4) is a Medium weighted activity stating, “As a result of Quality Innovation Network-Quality Improvement Organization technical assistance, performance of additional activities that improve access to services (e.g., investment of an on-site diabetes educator)."

Adherence Management Coaching® provides an applied behavioral skill set that can augment the diabetic educator or serve as a stand-alone investment in an AdM Coach.

Anticoagulant Management Improvements (IA_PM_2) AdM Coaches incorporate a behavior based patient education system that includes adherence tracking, improved patient communication and dosing adherence tracking.  The AdM Coaching Tool kit provides the B-MAAS for identifying at-risk patients, the B-PAAS for identifying physical or cognitive handicaps that could contribute to non-adherence, the Consequence Analysis® to identify areas in the plan of care the patient finds too aggravating to follow, and the Adherence Improvement Plan (AIP) for directing better adherence.  This Tool Kit meets the requirements described in IA_PM_2.

Care coordination agreements that promote improvements in patient tracing across settings (IA_CC_12) BEARS’ Adherence Improvement Plan provides behavior based information across settings to other clinicians.  When followed across the care continuum, the patient is reinforced within practice settings and between clinical environments.

BEARS health services professionals have reviewed the 2017 MIPS Performance Activities in each of the three categories and is prepared to share how we can work with your practice to integrate AdM Coaching® into your MIPS required activities. 

For more information on AdM Coaching®, the B-MAAS, B-PAAS, Consequence Analysis and the Adherence Improvement Plan please contact us at info@bearstherapy.com or call us at 321-439-5949.

Quality Measures (QM)

Quality Measures, as described by CMS, provides a check-list consisting of 271 clinical tasks that, when done correctly, can improve the patient’s clinical outcome.  In any interpersonal transaction, there are always at least two participants in the exchange. 

If clinicians order the appropriate test, procedure or medication, but the patient does not follow their plan of care, is the outcome the result of the clinician’s fault or the patients?

Quality Measures are a function of provider’s clinical skills in both diagnosing and make the correct clinical decisions.  With 80% of patients choosing not to follow their plan of care, medication adherence, providing a correct diagnosis and plan of care needs to be augmented with

1. A determination of risk for non-adherence, and;

2. An Adherence Improvement Plan for those identified as "At-Risk" populations.

BEARS’ identified particular QMs where Adherence Management Coaching® may be of great benefit in improving outcomes.  Of the 271 measures identified by CMS, there are 27 where patient behavior, and specifically non-adherence to their plan of care, may contribute to increased morbidity and mortality.

  Quality Measures NQS Domain NQF Quality ID Priority Measure Risk Factor
1. Adherence to Antipsychotic Medications for Individuals with Schizophrenia Patient safety 1879 383 High Non-adherence
2. Adult kidney disease: Blood pressure management Effective Clinical Care (ECC) N/A 122 High Non-adherence
3. Adult major depressive disorder: Coordination of Care Communication and Care coordination (CCC) N/A 325 High Non-adherence
4. All-cause hospital readmission CCC 1789 458 No Non-adherence
5. Anti-depressant medication management ECC 0105 009 No Non-adherence
6. Care Plan CCC 0326 047 Yes Non-adherence
7. Controlling high blood pressure ECC 0018 236 Yes Non-adherence
8. Coronary artery disease (CAD) ACE/ARB, diabetes ECC 0066 118 No Non-adherence
9. CAD antiplatelet therapy ECC 0067 006 No Non-adherence
10. CAD Beta blocker ECC 0070 007 No Non-adherence
11. Diabetes: Hemoglobin A1c ECC 0059 001 Yes Non-adherence
12. Function outcome assessment CCC 2624 182 Yes Non-adherence
13. Heart failure (HF) ACE/ARB therapy ECC 0081 005 No Non-adherence
14. HF Beta blocker therapy ECC 0083 008 No Non-adherence
15. HIV Viral load suppression ECC 2082 338 Yes Non-adherence
16. Hypertension: Improvement in blood pressure ECC N/A 373 Yes Non-adherence
17. Ischemic vascular disease (IVD) All or none ECC N/A 441 Yes Non-adherence
18. IVD use of aspirin or another antiplatelet ECC 0068 204 N0 Non-adherence
19. Medication management/Asthma Efficiency and cost reduction (ECR) 1799 444 Yes Non-adherence
20. Medication reconciliation post discharge CCC 0097 046 Yes Non-adherence
21. Optimal asthma control ECC N/A 398 Yes Non-adherence
22. Persistence of Beta blocker treatment post AMI ECC 0071 442 No Non-adherence
23. Statin therapy after Low extremity bypass ECC 1519 257 No Non-adherence
24. Statin therapy for prevention and Rx of CVD ECC N/A 438 No Non-adherence
25. Stroke and stroke rehab: Thrombolytic therapy ECC N/A 187 No Non-adherence
26. Unplanned readmission within 30-days post procedure ECC N/A 356 Yes Non-adherence
27. Weight assessment and counseling for nutrition Community/Population Health 0024 239 No Non-adherence

 

BEARS addresses non-adherence and can be used in all 27 of the above categories. For more information on AdM Coaching®, the B-MAAS, B-PAAS, Consequence Analysis and the Adherence Improvement Plan please contact us at info@bearstherapy.com or call us at 321-439-5949.

Care Coordination (CC)

Implementation of documentation improvements for practice/process improvements (CC-8)

Implementation of practices/processes that document care coordination activities (e.g., a documented care coordination encounter that tracks all clinical staff involved and communications from date patient is scheduled for outpatient procedure through day of procedure).

Activity ID

Subcategory Name

Activity Weighting

IA_CC_8 Care Coordination Medium

 

BEARS Approach B-MAAS B-PASS Consequence Analysis (CA) Adherence Improvement Plan (AIP) AdM Coaching
  X X X X X
BEARS Approach Logic:

 

 

Care transition documentation practice improvement (CC-10)

Implementation of practices/processes for care transition that include documentation of how a MIPS eligible clinician or group carried out a patient-centered action plan for first 30 days following a discharge (e.g., staff involved, phone calls conducted in support of transition, accompaniments, navigation actions, home visits, patient information access, etc.).

Activity ID

Subcategory Name

Activity Weighting

IA_CC_10 Care Coordination Medium

 

BEARS Approach B-MAAS B-PASS Consequence Analysis (CA) Adherence Improvement Plan (AIP) AdM Coaching
  X X X X X
BEARS Approach Logic:  BEARS’ AdM Coaching program begins with identified patients while they are in hospital.  The Consequence Analysis® and AIP® are developed prior to discharge and shared with appropriate in-home supports, including family and outside agencies.  A sample time-line for the first 30-days follows.

 

Care transition standard operational improvements (CC-11)

Establish standard operations to manage transitions of care that could include one or more of the following:  Establish formalized lines of communication with local settings in which empaneled patients receive care to ensure documented flow of information and seamless transitions in care; and/or Partner with community or hospital-based transitional care services.

Activity ID

Subcategory Name

Activity Weighting

IA_CC_11 Care Coordination Medium

 

BEARS Approach B-MAAS B-PASS Consequence Analysis (CA) Adherence Improvement Plan (AIP) AdM Coaching
  X X X X X
BEARS Approach Logic:

The common denominator across all lines of communication, within and between providers, patients and families, is behavior.  Seamless transitions are a function of each clinician understanding and reinforcing behaviors from the patient’s perspective.  At-risk (for non-adherence or non-persistence) patients can develop adherent behaviors when their Adherence Improvement Plan is supported by all members of the transitional care team.  The B-MAAS and B-PAAS identify which patients are at greater risk for non-adherence and physical disabilities that may contribute to non-adherence.  The Consequence Analysis (CA) identifies specific elements in the discharge/care plan (e.g., dietary restrictions, exercise programs, self-injurious habits and medication requirements) that patients find to be punishing and likely to be rejected.  The Adherence Improvement Plan is the resulting document that represents the clinician’s and patient’s agreement with what may be a modified plan of care and the behaviors necessary to achieve the outcomes/results that clinicians and patients want.

 

 

Care coordination agreements that promote improvements in patient tracking across settings (CC-12)

Establish effective care coordination and active referral management that could include one or more of the following:  Establish care coordination agreements with frequently used consultants that set expectations for documented flow of information and MIPS eligible clinician or MIPS eligible clinician group expectations between settings.  Provide patients with information that sets their expectations consistently with the care coordination agreements; Track patients referred to specialist through the entire process; and/or systematically integrate information from referrals into the plan of care.

Activity ID

Subcategory Name

Activity Weighting

IA_CC_12 Care Coordination Medium

 

BEARS Approach B-MAAS B-PASS Consequence Analysis (CA) Adherence Improvement Plan (AIP) AdM Coaching
  X X X X X
BEARS Approach Logic:

Care coordination agreements with frequently used consultants: AdM Coaching provides consistency with the AIP as all clinicians know the patient’s perspective on their care plan.  Knowing what other clinicians have ordered is important.  Knowing how patients respond to those orders and what may contribute to non-adherence is equally or more important.

Provide patients with information that sets their expectations consistently with the care coordination agreements: Inconsistent information between providers and information available on the internet lead to one of the primary reasons for non-adherence, distrust.  The CA and AIP are work products developed with patients that allow their input into what they need to do to improve their condition.

Systematically integrate information from referrals into the plan of care: Integrated information within the CA and AIP, through the efforts of an AdM Coach, ensures that each change is reviewed through the patient’s perspective and that consequences which may reduce adherence are considered and integrated into the AIP.  AdM Coaches share this information with all clinicians on the team to ensure there is consistent reinforcement of target behaviors.  New habits are a function of reinforcing target behaviors as they become a part of patient’s routine.  The more members of the team that are aware of what behavior is being reinforced and how to reinforce them, increases the likelihood of new habits developing.  Many of the behaviors patients are asked to do (e.g., long term medication therapy) have no positive reinforcers built in.  In fact, many behaviors are surrounded by “punishers” (e.g., cost, inconvenience, side effects).

 

 

For more information on AdM Coaching®, the B-MAAS, B-PAAS, Consequence Analysis and the Adherence Improvement Plan please contact us at info@bearstherapy.com or call us at 321-439-5949.