What readiness looks like in the office
Value-based care readiness for independent practices is usually discussed as a contract question. In the office it is a list question. Can the practice say who its patients are, which quality measures apply to them, who is due for what, and who on staff is working on it?
Accountable care organizations, Medicare Advantage quality programs and commercial quality contracts tie part of a practice’s payment to quality measures and sometimes to total cost of care. Each rewards a practice that can find its care gaps and close them. Gateway supports that work: quality measure tracking and care-gap follow-up.
Start with a measure inventory
Most practices answer to more than one measure set, and the sets do not match. We start by writing down what the practice is being measured on. For each program or contract, the inventory records:
- The measures that apply, in the program’s own wording
- Which patients count toward each measure and which are excluded
- What closes the measure: a visit, a test, a result in a stated range or a documented screening
- Where the program gets its data: claims, fields in the record or files the practice submits
- The measurement period and the reporting deadlines
Measure definitions change from year to year. The practice confirms the current version with the program, and we keep the inventory matched to it.
Building the care-gap list
The care-gap list works patient by patient. Each line names the patient, the measure, the status and the next step with its owner. We build it from the practice’s records and from the gap reports that payers and accountable care organizations send.
Those sources rarely agree, and the disagreement is useful. Some gaps are care gaps: the patient has not had the screening or the follow-up visit. Others are record gaps: the service happened, but the result sits in a scanned document, another office’s chart or a field the report does not read. The list keeps the two apart, because they call for different work.
Working the gaps between visits
Under the practice’s direction, we take on the follow-up that does not need a clinician.
- Pre-visit preparation. Before an appointment, the patient’s open gaps go on a short list for the clinician.
- Preventive visits. Patients due for a wellness visit are booked through the practice’s annual wellness visit program.
- Records requests. When a screening was done elsewhere, we request the report so the result can be entered where the measure reads it.
- Outreach. Patients with open gaps and no visit scheduled get a call or message in wording the practice approved.
- Results routing. Results go to the clinician for review, and the line is updated.
What to order is the clinician’s decision at every step.
Seeing progress through the measurement period
Many measures are scored over a calendar year, and gaps left until the last quarter are hard to close. We give the practice a regular snapshot: open gaps by measure and by clinician, and what closed since the last review.
The snapshot describes work done and work remaining. It is not a forecast of a quality score, a bonus or shared savings.
How care programs support the same goals
Many gaps close inside programs the practice may already run. The regular contacts in chronic care management and advanced primary care management are a natural point to ask about overdue tests. Transitional care management organizes the contact and visit after a hospital stay, where many follow-up measures are decided.
Practices with larger panels can ask about AI-assisted care program follow-up, which surfaces upcoming contacts for staff to review.
What stays with the practice
- Every clinical decision, including which screenings and targets suit a patient
- Whether a patient meets a measure exclusion, as documented by the clinician
- Whether to join an accountable care organization or sign a value-based contract, decided with the practice’s own legal and financial advisers
- Submitting or attesting to quality data under the program’s rules
- Final coding decisions and responsibility for claims
This service does not include contract negotiation or legal or actuarial advice.
How an engagement starts
Send a practice support inquiry or call 314-325-0126. The form takes contact details only. We will ask which arrangements the practice is in or considering, what gap reports it receives and who works them today.
A sensible first scope is small: two or three measures for one clinician’s panel, or one payer’s gap report reconciled against the chart. The practice decides what to add after that.
Common questions
We are not in a value-based contract yet. Is it too early to prepare?
No. The groundwork is the same with or without a contract: an accurate panel, a habit of tracking preventive care, and records that hold results where they can be found. A practice that already works a gap list can see more clearly what a proposed arrangement would ask of it.
Can you work from the gap reports our payers already send?
Yes. They are usually the starting point. We reconcile each one against the practice’s records, mark gaps already closed in the chart and combine reports from different payers into one list. A patient who appears on three reports should get one call, not three.
A patient had the screening somewhere else. How does that gap get closed?
It depends on the program. Some accept a documented result in the practice’s record, some need the outside report on file and some take supplemental data the practice submits. We request the report and note what the program requires. The practice decides how it is entered.
Does Gateway submit our quality data?
No. Submission and attestation stay with the practice, or with the organization or registry that reports for it. We organize the underlying work: the measure inventory, the gap list, outside records and the status of each item, so whoever submits has current information.