Value Based Care Notes Flashcards
What is the triple aim of value based care? (same as the pillars)
- Patient experience - Improve the patient experience of health care
- Outcomes/Quality - Improve the health of populations
- Cost/Value - Reduce the per capita cost of health care
What are the actions and results of value-based care? (Remember: triple aim)
Latonia Bradshaw
Precious McClendon - Career Coach background
Quality of Care
Action: close gaps in care.
Result: improved quality measures.
Action: Risk stratify patients for care management.
Result: Healthier patient population.
Reducing Cost
Action: analyze cost and utilization data.
Result: Increased shared savings.
Action: Identify patients for past due visits.
Result: Increased top line revenue
Improving Experience
Action: Combine data at the point of care.
Result: Informed decision making.
Action: Engage patients
Result: Increased patient participation.
What are the actions and results of quality of care?
Quality of Care
Action: close gaps in care.
Result: improved quality measures.
Action: Risk stratify patients for care management. Result: Healthier patient population.
What are the actions and results of reducing cost?
Reducing Cost
Action: analyze cost and utilization data.
Result: Increased shared savings.
Action: Identify patients for past due visits.
Result: Increased top line revenue
What are the actions and results of improving patient (and provider) experience?
Improving Experience
Action: Combine data at the point of care.
Result: Informed decision making.
Action: Engage patients
What is population health management?
VBC incentivizes providers to proactively manage their patients. Ideally, this is done by prioritizing patients with gaps in care or by risk level. Providers or care managers can engage those identified patients to drive them into the exam room while knowing exactly what needs to be done at the point of care.
This process, and the technology that supports it, is known as population health management.
o Goals
Keep patients healthier
Reduce unnecessary spending
Improve the total healthcare experience for all stakeholders
How is population health management done?
Aggregating data from a variety of sources
- Many organizations use an enterprise data warehouse (EDW)
- Cleansing claims, clinical, and social data to generate a comprehensive view of each patient.
o Transform disparate data into meaningful action so that providers can effectively use it to focus on the pillars of value-based care.
Improved participation in value-based contracts gives ability to negotiate future payer arrangements as they take on more risk.
Implementing PHM strategies ensures proactive care delivery with the right resources and data, enabling all stakeholders to enjoy clinical and financial success.
Where does improving quality of care begin?
Improving quality of care starts with putting the patient at the center of care.
Every method of improving quality will originate or evolved from either of these two critical actions:
- Identifying and closing gaps in care
- Using data to stratify patient populations by risk
What are the six steps to get started in improving quality of care?
- Close gaps in care
- Risk stratify patients for care management
- Analyze cost and utilization data
- Identify patients who are past due for screening or interventions
- Combine data at the point of care.
- Engage patients.
What are the problems, solutions, and outcomes associated with managing gaps in care?
Problem: a gap in care occurs when a patient is not compliant with a care standard required for measure reporting in various quality programs.
Solution: Use analytics to proactively drive the daily workflow that enables them to take immediate action on poorly performing quality measures.
- Quality measures and care gaps will vary depending on the contract and population size.
Outcome: Increased compliance and quality measure scores.
What are the problems, solutions, and outcomes associated with risk stratifying patients for care management?
Problem: 5% of patients account for 50% of spending, thus a small amount of patients make up a disproportionately large percentage of costs. These costs can be managed and reduced dramatically when appropriately care managing the right patients.
Solution: Use a risk stratification engine to identify the small percentage of high cost patients by segmenting the patient population into groups of risk. (e.g, John Hopkins ACG predictive model)
- This identifies patients who have historically had a high cost of healthcare and those who have a high likelihood of reducing future costs with appropriate care intervention.
- Helps providers and care managers focus on patient groups where they can make the biggest impact.
Outcome: Healthier patient population and reduced total costs.
What are the problems, solutions, and outcomes associated with analyzing cost and utilization data?
Problem: Without visibility, provider groups have a difficult time tracking performance against their value-based contracts
Solution: Analyze clinical and claims reports to understand how providers are performing across the board, from a financial and utilization standpoint.
- Look for cost drivers, such as out of network leakage or other unnecessary spending areas.
- Metrics can be used to evaluate total healthcare spend and performance to reduce spending.
- Financial: PPPM, total paid, Part A paid, Inpatient paid, SNF paid, and more
- Utilization: Total patient visits, ER visits, Inpatient admits, Inpatient readmits, and more
Outcome: Reduced unnecessary spending and increased share savings
What are the problems, solutions, and outcomes associated with identifying patients for past due services?
Problem: Healthcare reimbursement used to be encounter based, but providers now have to change the way they operate to include a focus on prevention to align with value-based contracts.
Solution: Implement CMS’ Annual Wellness Visit (AWV). No cost to patient, but provider can reap $172 in FFS revenue for a first-time visit, and $111 for subsequent visits.
- Can close up to eleven care gaps in one AWV visit.
- Use this visit to document pre-existing or new diagnosis codes (e.g, Hierarchical Condition Category Codes – HCC) that may have been overlooked.
Outcome: Increased top line revenue and quality outcomes.
What are the problems, solutions, and outcomes associated with combining data at the point of care?
Problem: Providers currently lack insight into their patient’s historical care encounters that take place outside the health network, thus hindering their ability to make the most informed decisions at the point of care.
Solution: Longitudinal medical profile displaying open gaps in care as well as complete view of past diagnoses, medications, labs, ER visits, re-admissions, and other utilization information.
- Providers can use clinical judgment informed by the patient’s past to determine the next step of care.
Outcome: Informed decision making.
What are the problems, solutions, and outcomes associated with engaging patients?
Problem: The average senior patient (65+) visits their PCP eight times a year, leaving roughly 8752 hours of little to no communication between the patient and provider. Chronically ill patients who remain out of touch end up taking a trip to the ER for avoidable reasons.
Solution: Use automated patient engagement tools that scale communication campaigns to proactively engage a defined group of patients.
- Texts, voicemails, secure email can all be used to send reminders for care plan steps, upcoming appointments, medication refills, etc.
- Even better if able to segment patients based on communication preferences and to deliver personalized communications.
Outcome: Increased patient participation and satisfaction.
