Proving Your Worth: Value-Based Care Drives Data Demands

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Clunky technology and administrative hassles force providers to exert herculean energy to discover basic data about their practices. How many diabetics do you treat at your practice? How many non-smokers? What about patients with more than one chronic illness?

Understanding the nuances of your patient population is important to you because you care about the people whose lives you impact. And as government and commercial payments rapidly shift from fee-for-service compensation to value-based arrangements, this knowledge is essential to your practice’s survival.
Three things are clear in the current healthcare landscape:

  1. MACRA is changing the way physicians are paid, and commercial payers are also moving to more value-based arrangements; these require significant qualitative proof points for reimbursement.
  2. Electronic Health Records (EHR) aren’t going anywhere; you need technology to be successful under value-based shifts. Your EHR needs to be an ally, not a hindrance.
  3. Data is a first step to succeed in value-based care. You also need ways to support your patients outside the office and data helps identify specific patient populations to target, as an example.

Do you have the technology and support to ensure your practice can navigate these changes?

Performance and Payments: MACRA Changes the Game

MACRA is altering the practice of medicine, the collection/reporting of patient data, and the structure of payment models, all in the name of lowering healthcare costs. If you don’t believe this, look at where healthcare dollars are flocking. As of 2018, Medicare is tying 90 percent of payments to quality and Cigna is aiming for 90 percent value-based arrangements. Blue Cross Blue Shield is directing $71 billion to value-based care, and United Health is directing $65 billion. Anthem, Aetna, Medicare Advantage … all the major reimbursement methods are switching to payments based on performance.
This means the government and commercial insurers will base your payments on the data you provide them, and how well you can support patients both inside and outside the office. You need to equip yourself with the technology and resources to accurately represent and support your patient population. If you don’t, you’ll lose out on reimbursement opportunities.
Whether you like it or not, there is now a bar that you need to be able to clear in quality and outcomes. If you fall below the threshold, you could see significant economic damages. But, with the right resources, there is also a huge opportunity to be rewarded for all the value you do create.
How do you make sure you can prove your hard work to payers and the government? That’s where data collection and accessibility come into play.

Demand for Data: Make Your EHR Your Ally

Because of the reality of MACRA and other such programs, EHRs are “increasingly important…and there is no question they are here to stay,” said Dr. Barbara McAneny, president-elect of the American Medical Association (AMA).
Rand Corporation published a study looking at the effects of healthcare payment models on physician practices. “One of the main takeaways was that as payment models shift from fee-for-service to other kinds of payments, the importance of having a data infrastructure and performance data that can be used in actionable ways increases dramatically,” said Mark Friedberg, the study’s lead author. “You have to know who your patients are, who are your high utilizers, and the reasons that make them high users so you can target appropriate interventions. And you just don’t do that without an EHR coupled with some pretty hefty in-house analytics.”
Most EHRs focus on inputs, not outputs. What you need in this new value-based reality is a system that can easily produce insights to reduce costs, improve referral selections, optimize workflow, streamline coding, and deliver other actionable items.  In addition, if your EHR cannot produce customized reports (or you don’t have the tools to do so), your life is going to be a whole lot harder. Look for a platform that supports you, not one that forces you to act by its rules.
The key to a good EHR relationship is having a system that utilizes workflows. This is the “secret sauce” of successful, efficient practices. AMA notes that the average physician spends 5.9 hours (out of an 11.4-hour workday) in their EHR. Efficient workflows based on a “whole-team” approach let you spend more time with patients and less time acting as an expensive data-entry clerk.  
Success under MACRA and value-based payments is more than just a good tech setup. You also need methods to proactively provide care when patients aren’t in your office.

Out of Sight Can’t be Out of Mind

Gone are the days when you could wait for sick patients to book an appointment. Now, particularly under MACRA and value-based care, you need to have the tools and programs in place to support your patients outside the office and proactively manage care.  
Besides meaningful data and a stellar EHR, using tools to engage with your patients is critical in achieving better outcomes. One example is using a patient portal where you can communicate with patients, share educational materials, and enable patients to help manage data (such as their medical history). Patient engagement truly is a core pillar of success in today’s landscape.
In addition, you need to be more prescriptive in how you spend your day. Practices can use data to identify high-risk patients and also use that information to establish care programs to co-manage care. Do you have methods to identify the 5 percent of patients that account for 50 percent of costs? If runny noses are keeping you occupied, you are quickly going to find yourself in tight economic straits. You need ways to identify the patients most likely to have high costs and additional needs. Then you can make sure their needs are being monitored and they are receiving extra care.

That’s What We Know, Now Find out What We Believe in This Video

Doing these things is difficult to accomplish as an independent provider, but you have probably made the decision to remain autonomous for a reason. Luckily, there is a way to get the best of both worlds. Privia Medical Group provides the resources, expertise, and technology that you need to provide higher quality care at lower costs, all while you maintain your practice ownership.
Independent physicians have a massive impact on the healthcare of millions of patients across the country. It is time you are given access to the technology, resources, and support that you deserve. Privia can help. Watch this two-minute video and hear why physicians are taking this step to help their practices, their patients, and themselves.



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