Focus on improving quality with tailored analytics
In part, BIDCO reduces complexity for physicians by tailoring analytics and strategies at the local pod level and working with each pod to help them understand how to drive performance. With tailored analytics, quality metrics are likely to differ among pods. For example, a pod that has a large number of pediatric patients might focus on well-child visits, making sure to perform more outreach to raise quality scores in this area. Another hypothetical example might be a pod that has relatively low mammography rates. Here the quality metrics might be focused on improving mammography compliance.
“Sometimes, certain outcome measures carry more weight in the contract,” Carney said. “And when providers perceive that these metrics are driving greater value and improved patient outcomes, they are more likely to view the metrics as an area of opportunity.”
Strategies to educate physicians
Carney emphasizes that educating clinicians on the value-based models starts with convening the right stakeholders at the table on a regular basis.
BIDCO does three things to promote focus and prioritization with this group:
- Meets at least quarterly to review and discuss performance.
- Monitors and measures performance on a regular basis.
- Creates dashboards for each provider pod so physicians can see how they’re performing against these metrics.
These actions not only help demystify the value-based model but also bring needed resources to help physicians understand where to focus their efforts under the model. BIDCO also reviews performance on each risk-based contract and on its financial incentive models quarterly to assess the metrics and make course corrections if needed. Meetings with physicians are both face-to-face and by phone, and sometimes they involve webinars.
“We work constantly with the individual pods,” Carney said. “Then, on a monthly basis, we have a meeting of the Primary Care Physician (PCP) Advisory Committee that gets those physician champions together, whether by a webinar or in person, to promote knowledge exchange through brainstorming, education and questions.”
BIDCO gains input from the physician champions by running ideas through the meeting and soliciting their feedback.
Use actionable data to give physicians direction
BIDCO has made a commitment to developing the resources to provide actionable data to clinicians to engage them in performance improvement.
“We provide physicians with actionable data through focused reporting using a population health tool,” Carney said. “Physicians can access the tool themselves and pull their care gap reports or other reports that identify for them who the actionable patients are.”
The reporting is focused to avoid overwhelming physicians with too much information, and it’s actionable and directive to allow them to focus on the next step.
“Physicians are provided with lists of patients we would like them to reach out to,” Carney said. “Then we monitor the outcomes of those patient interactions against our targets to see if there’s improvement or a need for a course correction.”
And the focus is not limited to the highest-cost patients.
“We also focus on patients who present an opportunity for managing their health going forward,” Carney said. “We have a program we call our Rising-Risk Management Program that focuses on that middle tier of patients who don’t show up as your highest-cost patients. But if they’re not managed, they very well could end up in that high-cost category.”
Carney describes it as moving beyond predictive analytics to prescriptive analytics, driving outcomes for rising-risk patients by prescribing the outcomes to be avoided, including costly hospitalizations, and instead keeping patients in their homes to receive the care they need.
“To see improvement, there could be some areas where reaching out to only a handful of patients is all that’s needed to get you to the next gate, which drives your performance and your incentives score,” she said. “So that’s a good opportunity.”
Carney also notes there might be areas where an ACO has not even hit the minimum gate yet, which can have a big impact on its overall score.
“If you are still short of the minimum gate, you might want to focus on at least getting there,” she advises. “It’s our job to urge physicians to focus on those areas and let them know which patients they should reach out to. Our population health tool also allows physicians to drill down and get care gap reports to help them in their everyday practice.”