An inforMD by Privia blog series, “Population Health & You,” brought to you by Rick Foerster (VP, Population Health, Privia Health)
The system of reimbursement is slowly but surely shifting away from fee-for-service and closer to value-based care, making preventative medicine with its low-cost and high-quality care critical to long-term financial success for independent physicians. So, how does an office manager begin to contribute to population health in addition to overseeing daily operations of the practice? Similar to how we laid out a game plan for primary care providers to operationalize population health, the first step is understanding the goals of population health and what your data says about you.
Goodbye, Fee-For-Service … Hello, Value-Based Care!
The shift to value-based care is not going to slow down and office managers play a huge role in this transformation to population health. Capturing different levels of reimbursement over time, such as shared savings deals, downside risk deals, and bundled care payments, lead to an increase in the percentage of total revenue based on value-based care contracts.
While value-based care may not be fully implemented today, there are a number of fee-for-service “bridges” that allow practices to improve quality and cost, while still being reimbursed. These tactics exist in both fee-for-service and value-based worlds and therefore are a natural starting place. Ways to build these bridges from fee-for-service to value-based care contracts include:
- Provide better access – When patients don’t have access to their providers, they still need to seek care, usually resulting in an expensive emergency-room visit or with another practice. Creating greater access—through same- or next-day appointments, longer hours, virtual visits, after-hours phone lines—not only ensures providers stay in the loop on their patients’ care, but also reduces the cost of care by avoiding higher cost settings.
- Schedule annual wellness visits consistently – Proactively identify which patients aren’t coming into your office at least once a year to get them in for a comprehensive exam. This allows you to attest to quality measures and complete risk-adjustment documentation. That’s a win-win.
- Manage chronic care patient appointments – Medicare reimburses care managers who provide monthly services to patients who have more than two chronic conditions through Chronic Care Management (CCM) billing codes.
- Coordinate advance directives – End-of-life conversations can be hard to broach, but setting your patients up with a plan when they need it most can help ensure their wishes are met so unnecessary test and procedures are not performed. Similar to CCM, Medicare started to reimburse providers for setting up advance directives with their patients.
Shape the Workflow
As an office manager, you play a critical role in shaping the workflow of your office. The question here is: How does improving these workflows contribute to successful population health? Population health is not just one specific activity that a provider can offer, but rather a whole system of operations that need to work effectively in order to be successful. The provider needs to interact seamlessly with the medical staff, front desk, billing team, scheduling team, and office operations. You, as the office manager, are the conductor of the operation and are critical to ensuring the smooth coordination of activity across the team.
In order to maximize your efficiency and effectiveness, here are a few questions to ask yourself as you begin to operationalize these changes: Some things to consider when beginning to operationalize these changes include:
- How can you reduce the amount of administration that your provider has to complete in order to increase their time delivering patient care?
- How can your clinical staff (e.g. medical assistants) help complete quality measures for patients during the intake process? How can they ensure patients receive their referrals or prescriptions and understand the next steps?
- If a patient has an urgent issue and needs to speak with the provider, do you have a workflow to get them that access or do you tell them to seek emergency care?
- How do you tackle revenue-cycle issues? How effectively are you following up with patients on these topics?
- Do you delegate functions across the whole office staff to ensure everyone is working at the top of their license?
A fully operational population health team requires the participation of all team members. A common mistake is overwhelming the doctor with the whole population health to-do list when you have a capable team who can contribute.
Some ways for you to use your team to the fullest include:
- Allowing nurses to conduct follow up care management to high-risk or chronic patients to ensure they’re adhering to their care plan.
- Giving medical assistants the opportunity to close care gaps by ensuring documentation in the electronic health record (EHR) is clear, ordering lab tests, and making sure patient referrals are clear.
- Tasking front desk with patient communication to help with financial questions, follow up calls, and support questions.
- Taking administrative work off the shoulders of providers so they can focus on patient care.
To tie it all together, office managers are capable of funneling the information, questions, and workflows through to the appropriate person so that everyone—not just the doctor—is working to their full potential. They are the conductor of the symphony, responsible for pulling together and coordinating a team of experts to deliver great patient care from all angles.
If you’re an office manager and have any tips on how to improve office workflow, we’d love to hear from you in the comments below.
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