Want to realign fee-for-service physicians to value-based care? Act on your data

In a healthcare landscape where 70 percent of physicians prefer fee-for-service payment models¹, tying physician payment to outcomes requires realigning entrenched clinical processes with new value-based methods.

This article is sponsored by Cigna

Actionable data is a requisite for physicians wondering why they should don a value-over-volume mindset. However, actionable data is different than aggregate patient data stored in siloed EHRs; it is retrieved from EHRs and translated across medical groups and systems. It considers care across the continuum, and connects the dots between quality augmentation and cost.

But as medical experts discussed during a workshop sponsored by Cigna® at the Becker's Hospital Review 9th Annual Meeting in Chicago, April 11, using actionable information to change clinical behavior requires a top-down commitment to transparent cost and quality data.

A commitment to clear cost data

Most physicians agree they have a responsibility to control costs, but more than a third don't know the costs of tests and procedures, according to a 2016 study from The Dartmouth Institute for Health Policy and Clinical Practice. Cost obscurity challenges providers like Ritesh Shah, MD, an orthopedic surgeon at Chicago-based Illinois Bone and Joint Institute, especially as his organization began transitioning to Medicare and Cigna-administered total knee replacement bundled payment models in 2014.

IBJI spent about 4 ½ years collecting enough data to uncover how clinicians performed under the value-based model in terms of cost and quality. Afterward, the 20-location practice decided to unblind cost and outcomes information for its physicians, a controversial move that Dr. Shah said at first emboldened many IBJI physicians to examine quality and cost metrics very personally and objectively.

"We had multiple meetings over the course of a couple of years to get to the point where everyone was comfortable with [the process]," said Dr. Shah. Now, nearly every quarter, IBJI holds meetings with its membership to discuss an unblinded document describing the standing of each surgeon in regard to cost and outcomes metrics.

"In surgery, every surgeon feels that they take care of the sickest patients. But if you look at the data and you're open about it, you realize there's a spectrum. When you look at why outcomes are variable, it often has to do with systematic processes."

Transparent data helped IBJI surgeons recognize inefficient, systematic processes and redirect their clinical actions toward improving outcomes and lowering costs. Dr. Shah said a majority of IBJI surgeons now believe the transparency helped reduce four poor outcomes: surgical site infections, blood clots, readmissions and resurgery.

EHRs and analytics' role in advancing data transparency

Albeit controversial in any clinical setting, lifting the curtains on physician outcomes and cost data requires different approaches when adopted at a multihospital health system.

Consider Northwestern Medicine, a seven-hospital system based in Chicago. In 2014, Northwestern began its value-based payment transition after acquiring Winfield, Ill.-based Cadence Health and its 3,000 patients under a Blue Cross Blue Shield health maintenance organization product. Gary Wainer, DO, medical director of Chicago-based Northwestern Medicine Physician Partners, helped lead Northwestern's shift to value-based care, spurred by the Cadence acquisition. Northwestern physicians now care for about 200,000 patients under value-based contracts, like bundled payments as well as Medicare and Cigna Collaborative Care® arrangements.

For Northwestern, ensuring transparent data required a broader reach than quarterly meetings on cost data. The system, which is live on Epic, spent more than four years building out the EHR's Healthy Planet accountable care and population health module to grow its usable data reservoir. Northwestern also created a tool to collate patient information from multiple platforms: Epic, Cigna claims and physician enterprise warehouses.

"Obviously from a physician standpoint, while it may be important to know Cigna data, it's really important to know my patient population of my practice, and that may not be reflected in individual physician data," Dr. Wainer said.

Northwestern Medicine also accesses translatable data through its Cigna Collaborative Care arrangement. Peter McCauley, MD, national medical executive for clinical provider engagement and value-based relationships at Cigna, explained how providers in Cigna Collaborative Care arrangements can access a tool called Cigna iCollaborate®. Cigna iCollaborate allows clinicians within a Cigna Collaborative Care arrangement to monitor patient health, evaluate risks and engage on a daily basis with a patient population covered by Cigna.

"Clearly, having as much information about a patient as possible can impact and make a difference for physicians," Dr. McCauley said. "Whether it's reducing unnecessary or duplicative care, or being able to identify patients who are heading toward a worsening condition or diagnosis."

Cigna also provides periodic reports to its Cigna Collaborative Care participating providers that address quality outcomes like readmission rates. Dr. Wainer emphasized making actionable data transparent and relatable to Northwestern physicians, through an EHR and payer tools, has been key to realigning clinical processes with value-based incentives.

Any initiative aimed at changing physician behavior rooted in fee-for-service processes requires a commitment to clear data. Hospital executives, frontline staff and payers can no longer work separately on generating data that is only helpful to their respective institutions. A collaborative, systemwide approach to making sure all parties can act on shared data is necessary.

¹ http://www.bain.com/publications/articles/front-line-of-healthcare-report-2017.aspx

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