What Independent Practices Need to Thrive Under Value-Based Care

April 11, 2019 - Providers and owners of independent practices often view value-based care as a trojan horse.

Value-based care promises to improve care quality and lower costs compared to fee-for-service, but providers must overhaul their financial and clinical processes to realize success under the model. Unlike the straightforward fee-for-service model, providers must now fulfill quality reporting tasks, monitor patient outcomes inside and outside of the practice, track financial outcomes, and more.

The clinical and financial changes are pushing aging physicians into retirement and practice owners into merging with larger organizations.

Michael Supino, the CEO of Midland Medical, a mid-sized private practice in Oakland, Florida, is no stranger to the challenges of implementing value-based care as an independent provider.

“We see about 8,000 patients a year. So, that's close to about 130 patients a day, and with that kind of volume and activity, unless you are doing an annual wellness visit, it's tough to address chief complaints and then, find any and all opportunities to do some of the quality measures,” he recently told RevCycleIntelligence.com.

READ MORE: Pay-for-Performance Strategies for Independent Physicians, Small Practices

Even partnering with a local accountable care organization (ACO) did not solve the practice’s issues with value-based care.

“Most EHRs – and some are better than others – have business intelligence tools, but we were at the mercy of whatever format, reporting system, or delivery schedule our ACO or Medicare Advantage partners use to give us information about our patients. That was another thorn in the side,” he stated.

“We are sending claims data out and they are receiving it. But we don’t have a ton of control over the data or the reporting systems. The systems are also cumbersome and not intuitive, which creates more issues,” he added.

Challenges like the ones experienced by Midland Medical are commonplace, and practices are worried they will not survive in the new healthcare landscape.

According to a 2018 survey from the medical malpractice insurer, the Doctors Company, 61 percent of physicians feel value-based care will have a negative impact on their practice and 63 percent say the new model will take a toll on their earnings.

READ MORE: GAO Finds Value-Based Care Issues for Small, Rural Practices

“For a lot of physicians, value-based care is still intangible. Value-based care seems like it's morphing all the time, and it's tough to grab a hold of,” Supino explained.

To help providers at Midland Medical grab ahold of value-based care, Supino recently invested in a web-based tool that enables providers to integrate value-based care practices into their daily workflows and understand the financial incentives of completing value-based tasks.

Making value-based care tangible for providers

With value-based care comes an abundance of data. Midland Medical was sorting through clinical documentation, claims, and other data sources to run reports and glean insights into how the practice can successfully deliver higher value care. The practice was also receiving reports from its ACO and Medicare Advantage partners.

The reports were key to identifying care gaps that were impacting the practice’s performance in value-based care contracts.

However, the care gaps and other critical information being conveyed through the reports wasn’t reaching the frontline when they needed it the most – in the exam room.

READ MORE: Collaboration Key to Independent Physicians in Value-Based Care

To give providers the right information at the right time, Midland Medical partnered with Stellar Health, a technology software provider that provides a web-based tool to help independent practices achieve value-based care success.

The tool combines financial and clinical data from various sources to give providers an easy-to-follow checklist of actions that will close care gaps. The tool also allocates incentive payments from participating payers to providers who close gaps, making value-based care more tangible to providers.

For example, if a diabetic patient comes into the office, providers can log into the tool, select the patient’s record, and see a checklist of items the provider needs to complete for a value-based care contract. The tool also highlights missing actions, like a missing diabetic eye exam.

“The tool created real time opportunity, rather than forcing physicians to dig through stacks of papers to try to find the report I gave him a week ago while he's sitting in front of a Medicare patient,” Supino said.

Showing providers the money they will receive for closing care gaps also motivated the providers to ensure each task was done for value-based care success.

“You're in control of giving yourself a ten percent raise every year through the actions, and a lot of doctors were excited to be getting it up front,” Supino stated. “Stellar has built a financial incentive to be executed in real time, rather than telling a doctor or an owner of a doctor's office that they will receive a check at the end of the year for a certain star or HEDIS rating. It takes out some of the uncertainty surrounding value-based care, and it's a big driver of behavioral change.”

Since putting value-based care into the hands of providers, Midland Medical has noticed fewer care gaps and even an uptick in coding accuracy, resulting in more accurate hierarchical condition category (HCC) scores. Payers like Medicare Advantage use HCC scores to determine payment rates for providers.

“We saw a dramatic increase in the amount of diagnoses that we were able to incorporate into new care plans for our patients,” he said. “We were able to confirm with specialists, an ER, a lab, or any provider that input a new diagnosis into a patient’s chart. We were truly identifying the sickness level and the costs to treat those patients.”

Providers at Midland Medical are also more comfortable engaging in value-based care contracts now that they have access to the information they need to understand value-based care. And Supino anticipates signing the dotted line on more advanced contracts in the near future.

“The tool helps to make us feel more comfortable with engaging in risk-based contracts,” he said. “That’s the future for us now that we've built a value-based care workflow and we've got great teams helping physicians execute it.”