MSSP Survival Kit
Owner: Derek Sanz
Status: Outline complete · Waiting on payer quotes
Last updated: 2026‑02‑16
1. Program Pillars
- Attribution & Benchmark Hygiene — monthly prospective roster review, RAF refresh, AWV automation.
- Pharmacy Intervention Layer — deprescribing, GLP‑1/SGLT2 adoption, infusion and specialty spend oversight.
- Fast Escalation Infrastructure — 24/7 nurse line decision tree, community paramedicine partners, EMS + home care integration.
2. Required Infrastructure
| Asset |
Description |
Owner |
| MSSP command dashboard |
Real-time attribution, financial “leak” tracker, risk segmentation heat map |
Analytics |
| Pharmacy consult line |
SLA ≤2 business days, templated consult note in EHR |
Clinical pharmacy |
| Transitional care workflow |
48-hour TCM call, med-rec checklist, post-discharge pharmacist touch |
Nursing + pharmacy |
| Community resource spine |
Transportation, SNF/HHA roster, social support pathways |
Care coordination |
3. Pharmacy-Led Services
- 48-Hour Post-Discharge Call: Medication reconciliation, SDOH screen, follow-up scheduling.
- Polypharmacy review: ≥12 meds or ≥5 high-risk classes flagged in dashboard.
- Infusion site-of-care optimization: Biosimilar conversions, home vs. outpatient infusions, specialty pharmacy oversight.
4. Financial Guardrails
| Metric |
Target |
| SNF average length of stay |
≤20 days |
| ED visits per 1,000 |
<150 |
| Pharmacy PMPM variance |
±$90 vs. risk-adjusted benchmark |
| GLP-1/SGLT2 uptake (eligible cohort) |
≥40% |
| AWV completion |
≥75% |
5. Communication Toolkit
- Provider one-pager: Referral workflow, consult SLA, sample documentation.
- Patient FAQ: 24/7 support instructions, medication refill access, escalation ladder.
- Care coordinator script: Color-coded decision tree for triage and pharmacy consult triggers.
6. Metrics Dashboard Starter
| KPI |
Goal |
Data Source |
| 7-day post-discharge contact rate |
≥85% |
Care management platform |
| Medication reconciliation completion |
≥90% |
Pharmacy log |
| Avoidable ED per 1k |
<140 |
Claims/ADT |
| GLP-1 utilization (eligible) |
>40% |
EHR + Rx claims |
| AWV completion |
≥75% |
EHR |
7. Action Plan
- Payer engagement: finalize shared-savings advance arrangements (Humana, BCBS FL) — owner: biz dev.
- Documentation: deploy standardized pharmacist consult template in EHR — owner: informatics.
- Training: care coordinator refresher on escalation script by Feb 28 — owner: nursing education.
- Quality alignment: sync CMS Web Interface / eCQM needs with pharmacy measures — owner: quality team.
Contact: valuebased@sanzsolutions.com | 813‑XXX‑XXXX
