We’re concluding our “Peak Practice Performance” series with an in-depth look into population health.
One way to generate additional revenue is to partner with payers on risk agreements that can provide your practice with incentive dollars for improved quality and reduced cost. That can be intimidating, especially since CMS Administrator Seema Verma emphasized the need to move away from upside-only contracts to focus on downside risk.
These changes are coming, so how can you future-proof your practice and seize this shift to help your patients, make money, and advance healthcare?
Increased Quality — What are your current quality metrics?
Do you shop at Costco? If so, you’re aware the wholesale retailer is known for three things: low prices, bulk items, and high-quality products, all wrapped into a one-stop-shopping experience.
That’s the gist of patient-centered population health-focused experience. You save money by ensuring they receive high-quality, evidence-backed, coordinated care that cuts down on costly emergency visits. Similarly, this structure leads to a win-win for patients and providers alike; patients maintain good health while providers receive an incentive payment for providing effective care-management services.
However, it’s not quite as easy as signing up for a Costco membership. Taking on risk-based incentives involves closely monitoring patient quality while disincentivizing patients from seeking high-cost healthcare. Increasing the number and proportion of risk agreements you participate in can boost your incentive earnings and in order to do so, you must first be enrolled in a payer contract that allows for incentive payments.
Are you currently under a risk agreement? If so, what are the annual quality metrics and are you meeting the targets?
[perfectpullquote align=”left” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Taking on risk-based incentives involves closely monitoring patient quality while disincentivizing patients from seeking high-cost healthcare. [/perfectpullquote]
For example, Medicare Advantage plans are currently in open enrollment and this time period runs through December 7. During this time, you’ll want to check to make sure you accommodate Medicare and Medicare Advantage plans with extended benefits. Your quality metrics, such as medication and colorectal screening adherence, will assist in determining whether or not you’re eligible for per-patient, per-month stipends, which can range anywhere from $2 to $30, depending upon your plan.
One tool that you can wield is a powerful electronic health record (EHR). Sort your patient population to know which of your existing patients will be aging into eligibility and decide where to direct patients so they can do their research, consult with a representative, and have their questions answered.
Also related to Medicare and Medicare Advantage plans are annual wellness visits. These visits carry clout when it comes to establishing you as a patient’s primary care provider. These visits are heavily weighted and can give you the upper hand over providers who treat the same patient and want payer assignment. In order to leverage annual wellness visits in your favor, first ensure that patients are making and meeting their appointments. You can also use this visit as a way to account for any quality metrics that are listed as outstanding. Online scheduling tools make keeping this appointment easier for patients, and your practice can adopt multiple strategies to reduce patient no-shows.
Lower Cost of Care — What is your per member per month cost?
Defining your cost consists of a number of factors. One item to consider is a matter of calculating the number of referrals you make to high-cost or low-cost providers. Of course, especially if your Medicare population is significant, you’ll need to make referrals to specialties. The key is again a referral system built into your EHR system that can reliably direct patients to reasonably priced, high-quality providers.
Emergency department visits are another way to cause your cost of care to skyrocket. This high-deductible visit is expensive for patients and payers — and therefore for providers, too. A great example of a condition that too often ends up in a redundant emergency visit is dizziness, which can be addressed by a primary care provider immediately through telehealth. This diverts patients from both emergency departments and urgent care centers while also keeping them in your practice, helping you retain attribution.
Telehealth can help to avoid these costly external visits while acting as a cost-containment resource than you can share with payers to demonstrate your commitment to low-cost, high-quality patient solutions.
There will be certain cases when an urgent care visit is necessary. However, it’s imperative to encourage patients to follow up these visits by seeing their primary care provider who can assist them through recovery, whether that entails prescriptions, physical therapy, or other forms of care.
Resources to Start Building Your Plan
A robust, risk-based incentive plan, coupled with low-cost and high-quality metrics not only helps your patients, but also helps you stay ahead of healthcare’s shift toward value-based contracts while being rewarded for your excellent patient care.
Now that we’ve rounded out the “Peak Practice Performance” blog series, take a minute to go back and read our posts on the following topics: