The data physicians need to succeed with value-based care

Today's physicians are experiencing unprecedented burnout, financial pressures and workplace uncertainty. Some are retiring or closing their practices to become employed or have had their practices acquired by private equity firms. At the same time, physicians and practices are navigating the challenges of operating in a fee-for-service world while beginning value-based care arrangements. 

During a roundtable discussion sponsored by CareAllies at the Becker's Hospital Review 12th Annual Meeting, CareAllies President Rob Cetti and Chief Medical Officer Joe Nicholson, DO, described the current physician landscape and benefits of physician-led value-based care.

Four key takeaways:

1. The market for physicians is being disrupted. The pandemic accelerated existing physician shortages and prompted physicians to reevaluate their work and their lives. The number of new physicians hasn't offset the shortages. 

Against this backdrop, "private equity is coming in with almost unlimited resources" to cherry pick and acquire high-performing practices and physicians, Mr. Cetti said. He described an independent physician in Texas making $300,000 per year who was offered $5 million from a private equity firm to acquire his practice. Roundtable participants from across the country agreed they are seeing similar actions from private equity as well as competitors. Hospitals are often constrained in how they can compete for physicians and practices by "limitations around how we compensate physicians."

2. Physicians understand the need to move to value-based care but don't know how. Some physicians remain locked into a fee-for-service model, seeing as many patients as they can for 15-minute appointments. But increasingly, physicians and practices understand the importance of value-based care; the challenge is how to get there. For example, physicians know that stratification can help identify those patients with chronic illnesses, but are challenged in building a sustainable model that balances revenue for the additional time dedicated to these patients. And many practices don't know which patients to reach out to.

When done right, successful value-based care can reduce waste and improve efficiency by managing key events like the handoff at discharge. Another key component of value-based care is focusing on quality performance and star ratings and managing the customer service journey throughout. Understanding that no organization is the same, CareAllies helps radically simplify and improve the effectiveness of value-based care to set physicians up for success.

3. Accurate documentation is vital to a financially successful physician practice. Without accurate documentation, coding for chronic conditions may be missed, and patients’ true level of risk cannot be captured.

Practices need to ensure accurate coding, as well as accurate risk adjustment. While proper risk adjustment may lead to increased revenue, "the clinical message is where it has to start," Mr. Cetti said. Accurate documentation of conditions is clinically important because it provides history and information to enable a patient’s physician and care team to provide the best care. Additionally, risk adjustment is clinically important because it provides the resources physicians need to best manage their most frail patients.

4. Point-of-care insights help address these challenges. Data insights can enable proactive patient prioritization and shape a new care-delivery model. Advancing risk stratification can improve both health outcomes and financials. It allows providers to answer the question of who to outreach first. When organizations "leverage data analytics to support patients" they can identify the most fragile, at-risk patients for who need increased attention, Dr. Nicholson said. 

CareAllies helps simplify value-based care through physician engagement, quality performance improvement, and population health data, and technology. CareAllies works with hospitals, health systems and provider groups to help them deliver more accessible and affordable care and make health care more rewarding for all.


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