Author: Julia Pulliam, PA-C (2026)
Primary advisor: Robert Murphy, MD
Committee members: Dean F. Sittig, PhD and Susan Clack, PhD
DHI Translational Project, McWilliams School of Biomedical Informatics at UTHealth Houston.
ABSTRACT
The transition to Value-Based Care (VBC) challenges independent rural primary care practices due to heavy administrative burdens, interoperability barriers, and a reliance on claims data that often undervalues care. This project aimed to improve clinical data reporting to Medicare Advantage Quality Incentive Programs (QIPs) at Oregon City Family Practice (OCFP). By focusing on colon cancer screening metrics, the project sought to demonstrate how automating semantic interoperability can accurately reflect care quality, reduce manual waste, and increase revenue. Guided by the Johns Hopkins Evidence-Based Practice (JHEBP) framework, Plan-Do-Study-Act (PDSA) cycles were used to design a transition from manual reporting to an automated workflow.
Planned interventions included integrating the Qvera Interface Engine (QIE) and the American Board of Family Medicine’s PRIME registry. When institutional barriers from the hosting health system delayed integration, a subsequent PDSA cycle focused on the project lead completing direct Epic database certification to bypass these roadblocks and establish independent data access. While full technical automation was delayed, the manual submission of clinical data during the project proved that actual clinical quality was consistently higher than payer assessments based on claims data.
OCFP’s overall quality rating increased from 2.11 to 4.0 stars. This improvement drove a 104% increase in QIP revenue, yielding $280,367 in incentive payments for 2024 and representing a 1,746% Return on Investment (ROI). Furthermore, the project lead successfully secured Direct Access Accreditation to independently manage OCFP's database. The project confirmed that healthcare value is hidden within clinical data, and semantic interoperability is essential to reveal it. Evaluating VBC quality solely through claims data places an unsustainable manual reporting burden on providers and misrepresents outcomes. Ultimately, applied clinical informatics and primary care leadership are critical to ensuring the long-term financial viability and survival of independent primary care and advancing VBC.
Keywords: Value Based Care, Primary Care, Interoperability