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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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In my last two blog
posts, I have written about the potential to significantly reduce healthcare
costs and identified 20 factors driving the growth of healthcare spending.
In our recent work with
HFMA on its Value Project, we had the opportunity to visit 10 organizations
ranging in size from Partners in Boston to Franklin Memorial in Farmington,
Maine. For the American Hospital Association, we recently prepared four case
studies of organizations moving toward accountable care.
With one exception, all
the hospitals and health systems we studied for HFMA and AHA were giving a high
priority to developing their primary care network. Many were acquiring primary
care practices or employing primary care physicians. Most also were moving
aggressively to get their primary care physicians on an electronic health record
and accredited for patient-centered medical homes. Several had developed chronic
disease registries and were working to improve the quality and reduce the costs
of care for patients with chronic disease.
In our view, these
strategies make sense. However, in only one case—New West Physicians in the
Denver Area —did we see what a physician-led, tightly managed primary care group
with proper incentives can accomplish. New West has 84 providers in 16
locations; it has a specialty panel of 500 physicians but regularly uses 250 of
these physicians as preferred.
All New West physicians
are on an electronic health record (EHR), thereby making it possible to conduct
three major studies each year of the quality of care provided by individual
physicians. New West also has a software program that analyzes, on a real time
basis, claims submitted to its major health customer, a Medicare Advantage plan.
(New West takes financial risk for primary and specialty care, but not hospital
care.) The combination of using its EHR to analyze patterns of care and using
the analytics package on claims data (supplemented by its own matrices) allows
New West to evaluate the performance of its specialists as well as its own
primary care physicians. Specialists who are outliers in their care patterns are
required to either shape up or be eliminated from the panel. Because New West
referrals can amount to as much as half of the business for some specialists,
this is a requirement they cannot afford to take lightly.
New West also employs
hospitalists at its five major hospitals, and these physicians manage the care
of the 25 to 30 New West patients who are likely to be in a hospital at any
given time. The hospitalists have access to the New West EHR from the hospitals,
and pick up the patients in the emergency department (ED), supervise their
treatment in the hospital, and ensure a smooth handoff of patients discharged to
post-acute care facilities and back to their primary care physicians. The
result? A readmission rate of 8 percent for the same diagnosis within 30
New West’s approach
allows it to make money on Medicare Advantage, and thereby increase the income
of its primary care physicians to well above the regional average. The
organization can deliver care to Medicare Advantage patients at rates
substantially lower than regular Medicare rates.
Relative to quality and
access, the two other legs of the Triple Aim, New West has outstanding patient
satisfaction scores from both its major health plans and its internal surveys. A
limited number of its 16 conveniently-located clinics maintain after-hours and
weekend services, thus mitigating the need to go to a hospital ED.
So are hospitals and
health systems that own primary care practices willing to take tough approaches
in their dealing with specialists? Are they willing to give primary care
physicians incentives to truly manage the care of their patients? In my view,
the changes needed in the delivery of care exemplified by New West Physicians
are where our nation’s healthcare system needs to go if it is to bend the cost
is a senior consultant, McManis Consulting, Denver, and a member of
HFMA’s Colorado Chapter.
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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