The Medicare Shared Savings Program (MSSP) is a leading driver of value-based care. According to the Centers for Medicare and Medicaid Services (CMS), the MSSP aims to improve Medicare beneficiaries’ health outcomes, advance population health, and lower costs. The Program works by empowering accountable care organizations (ACOs) to generate savings for participating physicians through high-quality, cost-effective care delivery.
The MSSP and other value-based arrangements offer a promising alternative to fee-for-service arrangements. However, the U.S. healthcare system still operates primarily under a fee-for-service structure. A recent study found that volume — not value — drives physician pay. Despite growing participation in the MSSP, some experts speculate that ACOs have “plateaued.”
To counter and challenge this belief, we’ve gathered and gleaned insights from a diverse group of thought leaders working in the world of value-based. Creating consistent success in the MSSP — or any value-based model — depends greatly on teamwork. Collaboration and expertise have helped Privia Quality Network (PQN) generate tremendous savings since PQN entered the MSSP in 2014. By sharing our hard-earned lessons, we hope to elevate providers’ performance in the MSSP and accelerate the volume-to-value transformation.
Lesson #1: Start With the Right Physicians
Keith Fernandez, MD, Chief Clinical Officer, Privia Health
When creating a physician network, culture and alignment are critical. “Culture” has many facets, but a key component is a shared, clear desire to improve care quality and cost-effectiveness. A second, closely related component is an agreement to collaborate in order to achieve those results. To develop this culture, it’s important to recognize that not all physicians are ready for new models from the get-go. To bring these physicians up to speed, first focus on trust-building and then move quickly to focus on specific actions, such as quality and risk adjustment.
Many believe that an engaged physician leader guarantees success, but the reality is much more complicated. Physician engagement and education are crucial. However, engagement and education for staff — including office managers, medical assistants, clinical providers, and billing teams — is equally important. Success in the MSSP requires a deep knowledge of patients, and every member of the team can provide insight into when, where, and how patients want to receive care.
Lesson #2: Access, Access, Access
Rick Foerster, Senior Vice President of Value-Based Operations, Privia Health
Patient access is a foundation of value-based care. It’s the rising tide that lifts all the ships of value-based care. And no amount of care management or ancillary support can overcome a lack of primary care access.
How does access support value-based care? In almost every dimension possible:
- Attribution. Access allows you to engage patients proactively and ensure they continue to get attributed to you every year.
- Quality. Access provides you the opportunity to address open quality gaps (such as preventive care), manage ongoing chronic conditions, and ensure patients have a high satisfaction rate.
- Network. Access allows you to influence where patients seek care, particularly as it relates to finding the highest-value specialists and facilities in the area.
- Care Management. Access creates opportunities to refer patients into care management or clinical programs.
- Cost of Care. Primary care offers one of the lowest-cost care options while helping maintain care quality and continuity.
You can support patient access by offering every dimension of access possible. There is no silver bullet; patient needs and preferences vary widely, so you can’t rely on just one strategy. Cover all of your bases, including: practice website, online scheduling, patient portals, email, text/chat, mobile apps, 24/7 nurse triage, and — of course — telehealth. These access strategies can help significantly lower average emergency room utilization, outpatient facility spend, total annual expenditures, and other key metrics.
[Deep Dive: Want more tips for creating consistent success in value-based care? Click here to tune in to our recent podcast!]
Lesson #3: Don’t Skip the Annual Wellness Visit (AWV)
Glenn Abrahamsen, Ph.D., Senior Vice President of Business Analytics, Privia Health
Your Medicare patients’ AWVs serve a variety of purposes. During these visits, you can proactively engage these patients in preventive care, assess risks, and close documentation gaps. Unlike routine exams, AWVs take an expansive look into patients’ emotional, psychological, and physical well-being while developing and reviewing personalized plans to improve health. According to the American Academy of Family Physicians (AAFP): “The AWV provides an opportunity for physicians to improve the quality of care, assist in patient engagement, and optimize payment opportunities.”
Optimizing payment opportunities is especially relevant when discussing risk- or value-based arrangements such as the MSSP. A proven way to increase your patient attribution base — and, with it, your potential earnings via shared savings — is through your AWVs. AWVs also provide you with opportunities to examine your patients’ health in greater depth, which can help identify care needs and avoid more costly care episodes. Our research and data show that patients who follow through with their AWVs have 61 percent fewer hospitalizations and 47 percent fewer emergency room visits. Patients who have an AWV combined with other high-quality care measures have a risk-adjusted total cost of care 25 percent lower than their peers.
So how can you leverage the power of AWVs to improve your patients’ health and your savings in the MSSP? First, ensure that you satisfy all documentation requirements for your AWVs. Implement workflows to fulfill all components, from medical and family history to measurements, cognitive function assessments to screening schedules, and more.
Another way to improve AWV adherence is through continual, targeted patient outreach and engagement. Patients’ preferences vary widely, so deploy a variety of methods. Automated outreach and call centers can help you connect with high-risk or hard-to-reach patients. Notifications sent through the patient portal can remind more tech-forward patients. Text and email campaigns can get through to busy patients. Office staff can call and educate patients about AWVs’ costs and importance.
Finally, your encouragement as a physician is critical. The AAFP found that “90 percent of patients who had received an AWV said they did so at the recommendation of their physician.” At the same time, “61 percent of patients who had not received an AWV said they had never heard of it.” As a trusted physician, use your voice to boost AWV adherence, engage patients, and nurture the valuable relationship that lies at the heart of healthcare.
Lesson #4: Integrate Data-Driven Actions at the Point of Care
Chris Voigt, Chief Technology Officer, Privia Health
There’s a tremendous amount of data available in the healthcare ecosystem. The problem is that this data is far too often inaccessible when it’s most needed: during patient visits. Unstructured, unorganized data doesn’t help providers make decisions.
That’s why it’s important to seamlessly integrate data into practices’ day-to-day workflows. Proper integration enables you to view meaningful information without clicking between apps and PDFs, which can distract from patients and their care. A tech-forward, data-informed environment is ideal for success in the MSSP and other value-based programs.
So what data analytics should you look for to help you in the MSSP?
- Intelligent aggregation. While your electronic health record (EHR) may be a frustrating fact of life, it’s also an absolute goldmine of health data. Explore your EHR’s ability to leverage existing data while incorporating further data from external sources like local hospitals, health information exchanges (HIEs), and the Centers for Medicare and Medicaid Services (CMS).
- Data mining and sharing. Mine your EHR for charts that contain data around historical or suspect conditions, such as unstructured discharge summaries to help you better identify patient risks. Be sure to check whether your patient data is properly available so that anyone treating your patients has the necessary information readily accessible.
- Built-in referral networks. How does your EHR support your referral decisions? When searching for specialists, what quality and cost metrics does your EHR display? How does your EHR support your expertise, intuition, and decision-making when it comes to referrals? Asking these questions of your EHR can help inform and optimize your referrals to lower costs and improve quality.
- Helpful reminders. Look into how your EHR syncs with your patient portal. Are your patients receiving updates related to their AWVs, which can grow your attribution and empower patients? Explore whether your EHR can send messages to patients about open care gaps. These seemingly small reminders can make a huge difference by closing gaps, improving patient health outcomes, and fulfilling criteria to generate more savings in the MSSP.
We’ve found that continually adding and refining integrations enables physicians to focus on patients while freeing up time and bandwidth. This added freedom and flexibility are essential to understanding and thriving in the MSSP and other value-based models.