As provider groups struggle with increasing demands and staffing challenges, two physician leaders presented solutions to both. During a webinar sponsored by the RISE Association, Richard Charles, MD, chief medical officer of General Physician, PC, and Jagraj Rai, MD, president of Guthrie Lourdes Medical Group, spoke about payer-sponsored programs that have helped both their patients and their practice.
You can watch the webinar here or read on for highlights.
Dr. Charles noted that he and his colleagues had criteria for an in-office program to support risk adjustment and quality requests from payers. It had to be quick and easy for physicians and integrate with their current workflow. It needed to help the physician before and after the visit, with incentives for the treating PCP.
According to Dr. Charles, a payer-sponsored solution from Vatica helped his group identify the true burden of illness for their patients to accurately stratify them and deliver appropriate care. Vatica’s pre-visit notification identified gaps in care to help the practice improve HEDIS scores as shown in the graph. General Physician also increased risk score accuracy by about 10% per patient.
Vatica gap closure rate
Compared to 4-star rating; claims paid through 1/31/23
More accurate coding and documentation, along with the incentive offered by the payer, allowed the practice to add support services such as care management and enhanced pharmacy programs. Both are valuable resources to help PCPs address conditions and close care gaps, resulting in increased patient satisfaction, improved outcomes and additional practice revenue.
Dr. Charles shared tips for the webinar’s payer audience. He recommended sharing data with PCPs so they can understand how coding and documentation affects the practice’s financial performance. Provide a payer-agnostic solution that’s easy and efficient. General Physician’s average time to complete a review is only 2 minutes/patient.
Dr. Rai’s practice has similar requirements for a risk adjustment program. He stressed the importance of sharing incentives with treating PCPs. While it took six months of work with several departments in the practice, he found that passing along the incentive to PCPs has a major impact. In the first five months of 2024, the practice has more than doubled the number of completed visits during the same period in 2023.
Dr. Rai lauded the pre-visit summary that lists conditions to address, open care caps and prescriptions to reconcile. The ideal time to address those issues is when the PCP is face to face with the patient. The summary saves the PCP significant time, requiring less chart review.
“I continue to marvel about our team at Vatica because they are there at every step,” he adds. “They provide education. Sometimes our clinicians may forget to complete the chart. The Vatica team reminds them. We may need a little more education, and they’re always there.”
Moderator Whitney Chernoff, senior VP of client engagement at Vatica Health, summarized the key takeaways. She noted that tech-only solutions often create more work for the PCP. Having trained clinicians in the process helps ensure that PCPs are looking at the most accurate data. All three speakers highlighted the importance of sharing incentives with treating providers and hiring needed staff with the funds. In the end, addressing chronic conditions and closing care gaps makes patients healthier and supports lower overall healthcare spend, which is everyone’s goal.
