Close this search box.

TRIARQ Health: Medical Billing Made Easy and Reliable

Mike Sappington | CEO | TRIARQ Health

Managing a modern independent healthcare practice is a complex challenge. Physicians and practice managers face stiff competition from consolidating hospital networks, payment models are growing ever-more intricate, and technology continues to advance at breakneck speed. Since its founding in 2005, TRIARQ Health has worked tirelessly to simplify the technology and financial management aspects of healthcare to give independent practice the strength they need to thrive. TRIARQ offers physicians a wide range of services on a partnership level so that they can run modern, patient-centered practices while rewarding them for delivering high-value care. TRIARQ is led by experienced healthcare leaders who help doctors participate in Value-Based Care through their proprietary, cloud-based, care management platform, and innovative patient engagement services. These tools help doctors and patients realize better outcomes.

The TRIARQ promise revolves around “The Tree Ones:” One Expert Partner, One Complete Solution, One Simple Fee. Through a unique combination of experience in clinical and technological aspects of the healthcare industry, TRIARQ plays the role of a one-stop solution that can help its customers make the most of both care and financial management.

Their proprietary technology tools, performance managers, and billing experts are all under one roof, providing One Complete Solution, which means that practices work with the industry’s most comprehensive team. Their services are available for one simple fee, whether that’s a flat dollar amount or a share of the revenue; no add ons and no extras.

The Igneous Mind Behind TRIARQ Health

Mike Sappington, the CEO of TRAIRQ Health, is at the help of this nationwide family of independent medical practice in the changing world of modern healthcare. From identifying new opportunities to help practices get involved in value-based contracts to pioneering new practice management technologies, his focus has always been on strengthening the viability of independent physician practices.

In 2016, he combined technology services and billing services into one simple package called “TRIARQ Complete.” Within a year, it was offering the marketplace a revolutionary Revenue Guarantee based on cutting-edge technology. And in 2018, he led TRIARQ into the exciting nationwide program called BPCI-Advanced by pioneering a new approach to care management that he calls “Clinically Integrated Networks.”

The Extraordinary Journey of TRIARQ Health

TRIARQ Health’s roots run back to 2005 when the current managing director, Milind Ghyar, and SVP of client support and cloud, Yaw Kwakye, found gloStream, an Electronic Medical Records (EMR) company. After several years of rapid growth, gloStream found the EMR market maturing. Most doctors now had an EMR. They found, however, that there was a significant opportunity on the revenue management side of the business.

So, in 2013, they started offering Revenue Cycle Management (RCM) services. Since medical billing necessarily flows from the charting and coding process, they were in a prime position to help doctors increase the accuracy and effectiveness of their billing. Their businesses were also capable of providing an expert, full-time billing team for practices who could not afford their own.

Building on a history of practice management support, combined with growing RCM expertise, they launched a new level of support services as performance management in 2014. It was no longer enough just to help practices use their EMR effectively. TRAIRQ hired experienced practice management professionals to proactively monitor practice data and records to uncover hidden revenue opportunities and maximize growth.

With growing momentum, gloStream affiliated with a company called TRIARQ Health in 2015 and began doing business as TRIARQ Practice Services. The bi-partisan MACRA bill also passed into law and the government started to move the industry toward Value-Based Care. In response, TRIARQ launched the quality payment program to start helping practices make the most of this new opportunity.

In 2016, TRIARQ made a bold move to combine and simplify its practice management services into TRIARQ Pro and TRIARQ Complete. TRIARQ Pro is a fixed cost package of practice management services and tools including the EMR and Performance Management. TRIARQ Complete is built on RCM services and includes all TRIARQ Pro services and software for free. In the same year, TRIARQ also launched its Alliance partnerships to help orthopedic surgeons get involved in value-based hip & knee joint replacement programs.

Since then, TRIARQ has continued to develop and expand its Alliance programs. It, now, includes national scale value-based programs like BPCI-Advanced in multiple states, built on a framework the company calls “Clinically Integrated Networks.” These networks are a closely coordinated team of care providers from surgeons to physical therapists and home health providers to hospital case managers.

User-friendly Services 

To simplify the process of revenue management, TRIARQ Health has divided its services into two divisions: Practice Management and Value Services. The practice management division includes EMR software, performance management consulting, payer revenue cycle management, and patient revenue cycle management. The value services division organizes and manages the equity-based alliances that help orthopedic surgeons take on risk-bearing value-based contracts with payers like Blue Cross Blue Shield of Michigan and national CMS programs like BPCI-Advanced. It also develops and manages the Clinically Integrated Networks that allow alliances to succeed in their value-based programs.

With the help of its full-time support team, TRIARQ has been able to resolve all the issues with the software. On one hand, the robust billing team is ready to help solve any billing-related queries and on the other, along with the technical team, the sales team is in close contact with all the practices so as to ensure the needs of the partners are being met.

Overcoming the Obstacles 

TRIARQ has identified the problems in the existing systems and is focused on finding effective solutions for them. According to the company, there have been major shifts in the healthcare industry from both the provider and the payer side of the business. With respect to providers, there has been an increased consolidation under large health systems which are typically led by hospitals. This means, instead of thousands of independent physician practices, there are relatively few regional networks that directly employ most physicians. As per TRIARQ, these large systems gain a significant competitive advantage over independent physicians because their scale offers economic efficiency and can leverage big data for their own benefit.

“On the payer side, we have started seeing an aggressive implementation of Value-Based Payment models like MACRA/MIPS and BPCI-Advanced. These payment systems bundle together various types of healthcare, from general population health to specific treatment episodes, and give providers incentive to reduce the cost of care while maintaining or increasing quality measurements,” says Sappington. There’s a high cost to working within these Value-Based Care systems and most independent medical practices can’t afford to do it on their own which further hampers their ability to compete with large healthcare companies. Therefore, TRIARQ has come up with innovative solutions like the QPathways Care Management Platform and has created new systems like the Clinically Integrated Networks. 

Unique Approach to Healthcare Revenue Management 

What makes TRIARQ different from other RCM companies is the fact that the company concentrates on technology rather than billing. The billing flows through the technology and practice management foundation which makes the process beneficial for the customers. Sappington says, “We see RCM from a wide perspective, starting with the doctor-patient conversation. Our software and tools help doctors and other care providers capture accurate data that is translated into accurate billing codes. Coming at RCM from this perspective gives us greater confidence in the amounts we charge to payers. Our close partnerships with practices also help us understand the details of their payer contracts and our experience across hundreds of practices give us precise knowledge of how much each payer will pay. That’s why we’re able to offer the Revenue Guarantee.”

The billing services provided by TRIARQ Health offers tremendous value to Independent Medical Practices all over the nation with the help of its technology. “We work with physicians on a partnership level so that they can own their own practice while still benefiting from the power of large-scale data and analytics,” adds Sappington. With a nationwide network of medical practice partners, the company has access to the data that helps uncover unique insights into the healthcare business that it can then pass along to those practice partners. Small, one and two doctor practices get access to information when they join the TRIARQ family just the same as the large ones. The company’s performance managers usually share the insights of other leading companies and allow them to deliver better care. Sappington expresses “Our practice partners also gain the ability to participate in new value-based payment models, which strengthens their ability to compete. Value-based contracts require significant administrative investment. Recording data, analyzing data, reporting data. It all takes a lot of time. TRIARQ’s technology helps simplify that data collection and synthesis and our Performance Managers are experts in the reporting process. Many of our practices receive perfect scores in programs like MIPS that they could have never dreamed of achieving on their own.”

What’s Ahead?

The future of TRIARQ Health is extremely exciting and there’s a lot to offer. On the technology front, the team is working on two major projects that would enable the use of EMR on mobile devices and add video chat features for e-visits.

“The billing team is also hard at work on new, innovative features that make life easier for both doctors and their patients. New patient RCM will give patients more options for paying their share of healthcare costs. As high-deductible plans become more popular, patients are responsible for paying more for non-preventative visits. That puts a strain on the doctor-patient relationship because practices aren’t used to asking patients for money, and patients aren’t used to paying out of pocket. But by offering mobile payments, payment plans, and other features it will bring both patients and practices closer together,” says Sappington.

And lastly, TRIARQ is in the middle of developing a library of new resources called QCollege within the MyQOne partner portal. This library will contain educational and training materials that both help practices make the most of their EMR and keep them on top of other important information regarding changes in the healthcare landscape.



Copyright 2023 © Insightscare Magazine ( a Digital Ink brand ) All rights reserved.