QPP APM Entity Solution

Health Endeavors quality metric solution is an automated consistent, repeatable and easily sustainable process.

Whether your organization stays in or leaves the ACO program, your organization will have integrated a comprehensive MIPS solution for the future that provides year-round gap analysis and performance scoring using data import automation to the greatest extent available.

In addition, the solution will minimize the need for the allocation of internal resources.

Health Endeavors QPP APM Entity Onboarding Steps

Step 1: Assign Security Official for My Team

Security Official is the top level in the hierarchy of user roles and permissions. This is an ACO administrator that will manage other user accounts, set up priorities for data imports and  maintain ACO network configuration in Health Endeavors. ACO company account can have multiple users with Security Official role.

Training: 1 hour

Step 2: Setup SFTP File Transfer

SFTP account is set up by Health Endeavors for clients to securely  transfer quality measure data. 

Return the completed SFTP Connection Worksheet to your Health Endeavors Account Manager.

Training: 1 hour

Step 3: Network Manager Setup (Security Official Only)

 

Network Manager is administrative component of Health Endeavors platform that is used to configure:

  • Divisions, Facilities, Locations, Providers

  • Assignment for patients on ACO Attribution List - HALR (Historical Assignment) and QALR (Quarterly Assignment List Report) files.

  • Assignment for patients on Commercial Membership Rosters.

Security Official Training: 2 hours

Step 4: Understand Data Sources

Year-Round Quality Measures Data Sources:

  • ​Payer Claims (QCD Codes per MIPS CQM specs)​ - CPT Category II codes and HCPCS Level II codes. 

  • QRDA Category I Files (Single Patient Report) Individual patient-level report that contains data defined in the measure.

  • SMART on FHIR (Cerner, Epic or Allscripts)

  • Manual Key

End-of-Year Submission (Commercial Patient Rosters not Available):

  • QRDA Category III (Calculated Report) - Aggregate quality report with a result for a given population and period of time.

Review the 2021 Data Sources Overview sheet on the Measures Overview Document

Training: 1 hour

Step 5: Import Chart (Security Official Only)

QM Import Chart is administrative component of QM Import Chart that is used to configure priority levels for data sources on individual quality measures.

Training: 30 minutes

Step 6: Educate your clinical staff on quality measure requirements

ACOs participating in the Medicare Shared Saving s Program are required to report through the APP for purposes of assessing their quality performance for that program. You must collect measure data for the 12-month performance period (January 1 - December 31, 2021) on the following sets of pre-determined quality measures:

See details on Measures Overview Document.

Measures must be reported for at least of 70% of all patients (Medicare and non-Medicare) that qualify for the measure.

Step 7: Year-Round Solution Training

  • Year-Round Gaps in Care Analysis - Proactive, year-round strategy for identifying, disease and wellness gaps in care significantly improves your quality performance

  • Year-Round Performance Scoring - Track year-round performance using CPT II codes, QRDA I and SMART on FHIR to avoid poor performance surprises at the end of the year.

  • On-Demand Provider Scorecard - Quickly and consistently deliver electronic provider scorecards on performance and progress to help your team meet metric goals

Step 8: Solution Support and Data Review Status Calls 

  • First 3 months weekly status calls (30 minutes)

  • After 3 months, monthly status calls (30 minutes)

  • Book appointments with Health Endeavors' team member using the links on Home Page.

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