Tag: coding

10 year-end activities to optimize performance in value-based care

By Vatica Health | November 1, 2021 | Provider, Value-Based Care

2021 has been a challenging year for primary care physicians nationwide. They’ve risen to the challenge by remaining committed to providing value-based patient care during times of intense operational transformation and financial uncertainty. However, it hasn’t been without sacrifice. Sixty-six percent of primary care physicians say they often experience feelings of burnout. This isn’t surprising given the risks associated with COVID-19 exposure as well as the significant burden of non-clinical work that requires their time and attention. Internists, for example, spend nearly 20 hours per week on paperwork and administrative tasks. Nearly a quarter of physicians (23%) say the most challenging part of their job is navigating ever-changing managed care and regulatory compliance requirements. The silver lining is that COVID-19 cases are declining and there are solutions to help you improve clinical and financial performance.

With only a couple of months remaining in 2021, there are several steps you can take to ensure that your practice meets all performance targets and that your patients receive the highest quality of care. The good news is that most of these actions are often supported by payer-sponsored risk adjustment and quality programs that provide vital clinical and administrative support to practices. This support helps providers close care gaps, enhance coding and documentation, identify and assess social determinants, and perform patient outreach. To enhance performance under value-based care contracts, consider these 10 tips:

1. Review 2021 performance reports from payers. These reports are a treasure trove of information and identify opportunities for improvement. Common examples include patients without primary care office visits, patients for whom chronic conditions were coded in 2020 but not recaptured in 2021, patients with incomplete preventive screenings, and patients with open gaps in care. Gather internal resources and put action plans in place.

Keep in mind that data latency may result in delayed reporting. Consequently, best practice is to compare external reports with your patients’ medical records for confirmation. Your practice’s EMR may include information that has not yet been reported to managed care plans. This information may impact your performance in value-based care programs. Perform a thorough reconciliation of all data sources to ensure consistency, alignment, and accurate performance reporting for all patients.

2. Ensure all eligible patients have completed an annual preventive care office visit. Schedule annual wellness visits (AWV) and other preventive care visit types for eligible patients. These visits provide opportunities for each patient to complete their personal prevention plan and Health Risk Assessment. Annual physical exams allow physicians to address care gaps as well as proactively identify potential chronic conditions. Check patients’ records when they present for a sick visit and schedule applicable preventive visits. For patients who have not visited the office, proactive patient outreach signals that you care about their well-being and that your office is there to help. Remind them they’re due for a visit and assist with scheduling. These actions foster trust and build stronger patient-physician relationships.

3. Follow up with patients who miss scheduled appointments. Consider whether any of your patients are missing appointments or not accessing routine care due to socioeconomic barriers?

Social determinants have a significant impact on health outcomes. As such, it is important to proactively reach out to vulnerable patients and address those barriers? The American Academy of Family Physicians provides some helpful advice.

4. Follow up with patients who were referred for preventive screening but did not comply. Patients’ needs and challenges vary. While some may have forgotten about the recommended screening, others may be experiencing difficulty scheduling the appointment due to long call wait times or limited appointment availability. Others may have unanswered questions that prevent them from taking action. The best practice is to call patients directly, assess the barrier, and determine what the practice can do to help. Oftentimes, a reminder call is all that’s needed.

5. ‘Close the loop’ with specialists. Communication between primary care physicians and specialists is important to avoid fragmented care delivery and ensure patient satisfaction. Ensure care continuity by following up with any specialists to whom patients are referred. Request findings and recommended treatment plans, as applicable, an update your EMR with relevant clinical information.

6. Keep close tabs on patients with multiple chronic conditions or who are on multiple medications. Do patients take medications as prescribed? Are their chronic conditions controlled, or are they at risk of acute exacerbations? The goal is to keep patients healthy and out of the hospital. If your practice hasn’t yet started a chronic care management program, now is the time to do it. For elderly patients who are on high-risk medication regimens, conduct a thorough evaluation, and consider lower-risk alternatives.

7. Conduct patient outreach after an acute event or hospitalization. Schedule appointments to review aftercare plans and make sure patients understand and can implement these plans. Do patients understand the specialists with whom they must follow up? Do they know what medications they must take? Do they know who to contact if they have questions? Can they recognize signs and symptoms that would warrant a phone call to their doctor? These are important questions to review with your patients.

8. Evaluate office workflows. Focus on preventive care, prioritization of high-risk patients, coordination of care, and strong communication with other members of each patient’s care team. Where are the deficiencies and how can the team improve processes? Research and evaluate technology solutions that can seamlessly integrate with your office’s existing systems and improve workflows while reducing operating costs.

9. Improve documentation and coding accuracy. Schedule dedicated time for role-specific training and education that includes front office staff, medical coders, and providers. Individuals serving in each of these roles must understand how their actions (or inactions) impact the accuracy and specificity of medical record documentation and coding. This information directly impacts performance calculations, care delivery, and potential payments.

10. Leverage free external resources. External resources such as local community programs can often provide support for patients and serve as an extension of your practice through their focus on improving quality of life. For example, there are programs that can help address social determinants of health. Additionally, health plans sponsor risk adjustment and quality programs that provide clinical and administrative resources to support primary care practices. Leveraging these programs improves quality of care and patient satisfaction while reducing the burden on physicians. This, in turn, reduces the risk of burnout and attrition.

How Vatica Health can help

Founded in 2011 as the first preventive services technology solution designed specifically for physicians, by physicians, Vatica Health remains a pioneer in physician-centric technology and support solutions that directly improve clinical outcomes, efficiency, and financial performance. Vatica Health deploys on-site or virtual licensed, clinical nurses that serve as extensions of your team at no cost to the practice. Vatica Health is accelerating the transformation to value-based care by helping providers, health plans, and patients work together to achieve better outcomes. To learn more, visit https://vaticahealth.com/.

Aligning incentives in healthcare to improve physician documentation

By Vatica Health | September 23, 2021 | Provider, Risk Adjustment

By Burke Burnett, Senior Director of Product Strategy

When you put effort into a task, it feels good to get rewarded for it. It’s the idea behind incentive theory. People are frequently motivated by a desire for positive reinforcement and gravitate toward behaviors that lead to incentives and away from those that might lead to negative consequences.

Sounds simple. It’s why we study to get good grades or work hard to get a promotion. However, in healthcare, it’s a bit more complex. Why? Payers and providers are paid differently, and when incentives aren’t aligned, that can lead to different priorities. While everyone in the healthcare ecosystem generally has the same goal-  to keep patients healthy and living a high quality of life – the way payments flow through the system can create misalignment.

For example, Medicare Advantage plans are paid based on predicted costs derived from patients’ severity of illness and risk of mortality. If the documentation and coding doesn’t accurately reflect risk, the health plan may not receive enough sufficient capitation to manage the patient’s active medical conditions. Physicians, on the other hand, are often paid based on the volume of services they provide. There’s no financial incentive to painstakingly capture and code a patient’s risk because it doesn’t directly impact revenue in fee-for-service payment models.

The irony is that treating PCPs and their staff—are best suited to conduct a comprehensive risk assessment. Given their relationship with the patient and access to all clinical information in their EMR, they are the most appropriate clinician to accurately document and code clinical conditions and close care gaps leading to more accurate HCCs and better outcomes which benefits both health plans and providers.

To help promote better collaboration and alignment between health plans and physicians, consider the following talk tracks.

1. The Inevitable Transition to Value-Based Care. One third of all U.S. healthcare payments already flow through alternative payment models. By 2025, it is anticipated that all Medicare Advantage and traditional Medicare plans will adopt two-sided risk alternative payment models. Fifty percent of Medicaid and commercial plans will adopt these models.

How will we get there and make the seismic shift from fee-for-service to value based care payment models? One recent roadmap from the University of Pennsylvania’s Leonard Davis Institute of Health Economics says the Centers for Medicare & Medicaid Services (CMS) must take these steps:

  • Articulate a clear vision for the future of value-based payment that aligns across all publicly-financed healthcare, Medicare, and Medicaid.
  • Dramatically simplify the current value-based payment landscape and engage late-adopting providers.
  • Accelerate the movement from upside-only shared savings to risk-bearing, population-based alternative payment models while curtailing the ability of providers to opt out of value-based payment altogether.
  • Pull providers toward advanced alternative payment models while also structuring incentives to push providers away from fee-for-service payment.
  • Achieve health equity to promote value-based care.

What’s the takeaway here?  Financial performance and quality of care are inextricably linked, and success in value-based care depends on accurately assessing the needs of your population so that your payments will be sufficient to deliver appropriate care. Physicians can’t afford to wait until 2025 for value-based care arrangements to be forced upon them, it will be too late. The key is to strike a balance so that physicians and their staff are not inundated with more administrative tasks and receive appropriate compensation for any additional work which is performed.

2. Annual comprehensive risk assessments pay off. Many payers offer providers a financial incentive for each comprehensive risk assessment they complete. This means direct revenue for the practice. The annual wellness visit (AWV) is a perfect time to conduct this assessment and be paid separately for it. A payer-sponsored risk adjustment program even helps physicians conduct these assessments with ease as they supply physicians with turnkey solutions that include free clinical and administrative resources, and easy to use technology.

3. Physicians earn more money when they help payers improve quality measures. When physicians document more thoroughly and close clinical care gaps, health plans benefit by being rated more favorably. Thus, many plans provide financial incentives for physicians to improve quality measures and close gaps in care.

4. Driving the utilization of preventive services can generate additional revenue for the practice. Engaging patients in an AWV or comprehensive annual physical not only helps keep patients healthy, it also can lead to additional revenue opportunities for the practice. For example, a patient who presents for an AWV might also need immunizations, colorectal cancer screening or advanced care planning. A payer-sponsored risk adjustment program provides physicians with easy-to-use software and services that surface clinically appropriate preventive services and better address all chronic conditions.

5. Comprehensive documentation is the right thing to do. All financial incentives aside, comprehensive documentation is what promotes high-quality patient care. An overwhelming majority of physicians go into medicine to help patients, and that’s exactly what comprehensive documentation does. It captures severity and risk and tells the patient’s entire story. That story is the foundation for the clinical care they receive. Without it, patient care could be compromised.  In the end, better alignment not only leads to better financial performance for health plans and providers – but the efficient delivery of the highest quality of care.  

How Vatica Health can help

Founded in 2011, Vatica Health is the leading provider-centric risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge technology at the point of care, Vatica increases patient engagement and wellness, improves coding accuracy and completeness, identifies and closes gaps in care, and enhances communication and collaboration between providers and health plans. Vatica Health is trusted by many of the leading health plans and thousands of providers nationwide

The best part?

It’s a health-plan sponsored initiative. That means there are no direct costs for practices to participate.

As practices continue to seek point-of-care solutions to better tell each patient’s story, they need look no further than Vatica Health. Vatica Health is accelerating the transformation to value-based care by helping providers, health plans, and patients work together to achieve better outcomes. To learn more, visit https://vaticahealth.com/.