Supporting Medicare’s Quality Payment Program


Nuna is proud to announce that we are beginning new work with the Centers for Medicare and Medicaid Services (CMS) to support the introduction of value-based healthcare. This month, Nuna was awarded a two-year subcontract to TISTA Science and Technology to support the implementation of the Medicare Quality Payment Program (QPP), which rewards clinicians treating Medicare patients based on their performance on cost and quality metrics.  

TISTA and Nuna will implement the QPP Cost Scoring system as part of the Merit Based Incentive Payments System (MIPS), in which over 400,000 clinicians will participate in 2017. This project focuses on building the claims-based scoring engine used to calculate the cost portion of the MIPS performance score. The performance score is then used to determine whether a clinician receives a bonus or penalty on their Medicare payments and the size of the payment adjustment. When fully implemented, a clinician’s MIPS performance score can result in bonuses or penalties on their Medicare reimbursements of up to 9 percent.  

“It has been one of our greatest honors as a company to support CMS as they move toward greater transparency and accountability in Medicare and Medicaid,” said Nuna CEO Jini Kim. “The Medicaid data platform we built will help CMS to better understand quality and cost in the Medicaid program, and Medicare’s QPP seeks to reward providers who do the most to achieve good outcomes for patients at a reasonable cost.”

Alongside TISTA, Nuna will be developing the pipeline that develops individual cost scores for clinicians based on extracted claims information. To succeed, this engine requires scalability in order to process hundreds of millions of claims, and parallelism so that multiple processes can occur at the same time without sacrificing speed. We will be using agile development techniques and open source software and technologies to create a high performing, accurate processing and analytics platform for this important healthcare program.

Nuna Health