Quality Improvement

Who is the Quality Improvement Team?

Contexture’s Quality Improvement (QI) Team consists of highly qualified professionals with expertise supporting healthcare organizations in advancing health and wellness through:

  • Practice Transformation and Technical Assistance supporting healthcare providers in making measurable improvements in healthcare data quality and the delivery of care.
  • Providing expertise and guidance on advanced payment models and clinical coding for better health outcomes and reimbursements.
  • Helping providers navigate new regulations in healthcare and changes in clinical guidelines and compliance.
  • Supporting healthcare providers to drive engagement and change to improve healthcare quality and delivery to advance health and wellness.

How We Help

Support:

The quality improvement team supports participants and organizations participating in various programs including:

  • Colorado Medicaid Alternative Payment Model (APM)
  • AHCCCS Differential Adjusted Payment Activity (DAP)
  • Grant Programs
  • Primary Care First
  • Hospital Transformation Program
  • Medication Consistency
  • OeHI Demographics

Services:

The quality improvement team provides expertise and guidance through the following methodologies:

  • Practice Transformation
  • Technical Assistance
  • Process Improvement
  • Quality Reporting

Consulting:

  • Paid consulting services are available for participants to choose from including:
  • Hierarchical Condition Category Risk Coding
  • Process Improvement Coaching Services
  • Quality Payment Program Reporting Support
  • Electronic Clinical Quality Measures Reporting

Practice Transformation

Since 2010, the Quality Improvement Team has provided practice transformation, coaching, and clinical advising to healthcare organizations to help implement changes and become examples of excellence in advanced patient-centered care and transform clinical practices to meet the quintuple aim: improved patient experience, population health, reducing costs, care team well-being and advancing health equity. Practice transformation includes the implementation of continuous quality improvement, engaged leadership, empanelment, team–based care, care coordination, enhanced access and more.

Technical Assistance

Technical Assistance for Data Quality

  • HIE participants access and input a wealth of data, but the quality and usefulness of the data is only as good as what you and other participants provide. Contexture’s Quality Improvement team offers technical assistance to help participants put their HIE and EHR to optimal use. Technical assistance services include training and feedback to help users properly report and analyze Hierarchical Condition Category risk coding and Electronic Clinical Quality Measures coding, assistance in improving data entry so other HIE participants can access reliable information and helping you use data for patient follow-up and direct outreach.

Process Improvement

Process Improvement Coaching

  • Contexture offers Process Improvement Coaching to optimize the benefits of value-based payer models which offer an innovative payment structure to support the delivery of advanced healthcare by rewarding value and quality. Value-based models require organizations to meet certain standards to be eligible for positive performance-based payment adjustments. The Quality Improvement team can help organizations use process improvement methodologies to analyze current processes, define challenges, and redesign processes to implement change and support value-based care.

Quality Reporting

Our Quality Improvement team can help you with reviewing, selecting and reporting your clinical quality measures to avoid negative payment adjustments.

We assist with:

  • Training staff on how to document quality measures accurately to ensure the best quality scores possible.
  • Reviewing, selecting and reporting clinical quality measures to earn incentives and avoid negative payment adjustments.
  • Assessing your patient volume and determining the number of incentives you can earn and/or penalties you may incur.
  • Reviewing your EHR reports and measures to optimize for quality reporting.
  • Optimizing health information exchange for improved provider communications and referrals, clinical decision-making and participation in reimbursement programs

Grant Programs

The Colorado Health Extension System (CHES), through the Practice Innovation Program at the University of Colorado, is a statewide infrastructure to support and coordinate practice transformation to achieve community health improvement goals. 
 
Contexture’s Quality Improvement team can assist your organization in providing practice facilitation and technical assistance for multiple grant programs. 

Differential Adjusted Payment Program

The Arizona Health Care Cost Containment (AHCCCS) Differential Adjusted Payment (DAP) program aims to distinguish providers that have committed to supporting designated actions that improve patients’ care experiences, improve members’ health and reduce cost of care growth. An integral part of the DAP program includes participation in and meeting milestones related to a qualifying HIE organization such as Contexture.

Hierarchical Condition Category Risk Coding

Current payment models are underscoring the importance of risk adjustment and offering compensation for practices able to make up for the extra costs associated with high-risk enrollees. Hierarchical Condition Category coding is a risk-adjusted model originally designed to estimate future healthcare costs for patients. Risk adjustment could positively impact your overall cost measure score. Contexture can help you code correctly to increase reimbursements and ensure adequate documentation to support coding.

Process Improvement Coaching Services

Contexture offers Process Improvement Coaching Services to optimize the benefits of value-based models, such as CMS’s Primary Care First (PCF) program, which offers an innovative payment structure to support the delivery of advanced primary care by rewarding value and quality. A PCF practice must meet certain standards to be eligible for a positive performance-based adjustment to their primary care model payments.

Quality Payment Program Reporting Support

The Quality Payment Program (QPP) is one of several programs that intends to change the way Medicare reimburses healthcare providers by moving toward value over volume. Our QPP Reporting Support service is aimed at quality improvement support and guidance on reporting specifications.

Electronic Clinical Quality Measures Reporting

eCQMs help measure and track the quality of healthcare services that eligible professionals and hospitals provide — as generated by a provider’s electronic health record. Contexture can help practices meet the ever-changing criteria in eCQM reporting to improve reimbursements and patient care.

Questions?

To learn more about our Quality Improvement services, contact us at qi@contexture.org.