Our Results

Quality Improvement Program Restructuring — Multi-Payer Primary Care Practice 

A large multi-payer primary care organization participating in a Medicare ACO and Commercial payer programs was consistently falling short of quality thresholds needed to earn quarterly incentive payments and annual shared savings. Their Medicaid Prepaid Health Plan metrics were also underperforming. Internal data systems were reporting inaccurately, providers were not coding visits correctly for risk adjustment, and the QI team lacked workflows to close care gaps across payer lines. 

The Net Effect: a practice leaving significant money on the table — missing quarterly incentive payments, at risk of losing annual shared savings, and underperforming across all payer quality programs. 

6 Weeks

From engagement to all metrics at threshold

30%+

Projected year-over-year improvement

+10%

Monthly increase in AWV completions

The Challenge

This multi-payer primary care practice was participating in a large ACO for both Medicare and Commercial payers but was consistently falling short of the quality thresholds needed to earn quarterly incentive payments and annual shared savings. Their Medicaid Prepaid Health Plan metrics were also underperforming. Internal data systems were reporting metrics inaccurately, providers were not coding visits or documenting diagnoses correctly for risk adjustment, and the QI team lacked the workflows and structure to close care gaps efficiently across payer lines.

What We Did

MyVitaLink embedded with the practice's internal QI team and took a phased approach—starting with the most time-sensitive priority: reaching metric thresholds for the current Medicare ACO quarter to recover the incentive payment. From there, we reorganized the QI team's priorities and built out sustainable infrastructure:

• Restructured QI team workflows, priorities, and accountability

• Created and updated policies, procedures, and care-gap closure workflows for providers and staff across all payer lines

• Trained providers on proper visit coding and diagnosis documentation for risk adjustment

• Identified and corrected data system issues so metrics report accurately—both internally and for Medicare QRDA file submission

• Drove Annual Wellness Visit scheduling and completion to support preventive quality measures

The Results

All Medicare ACO quality metrics brought to threshold within 6 weeks, securing the quarterly incentive payment that had previously been at risk.

Annual Wellness Visit completion rates increasing 10% month over month, building a strong foundation for preventive care and quality measure performance.

Providers now accurately coding visits and applying proper diagnosis codes for risk adjustment, improving both quality scores and appropriate reimbursement.

Data systems corrected and validated to ensure accurate internal reporting and clean QRDA file submissions to Medicare at year end.

On track for 30%+ improvement over prior year performance and projected to earn full annual shared savings if the current trajectory holds.

"Within six weeks of engaging MyVitaLink, this practice went from missing quality thresholds to meeting every one—and they're now positioned to earn their full shared savings for the year."