How the Quality of Your Data Affects Patient Care and Profitability

As a private primary care practice owner or business manager, how many sleepless nights have you spent worrying about how to keep your practice profitable? In today’s value-based healthcare environment, clinicians face extreme pressure to improve patient experience and outcomes with a dwindling amount of face-to-face contact. In order to survive the changing climate, independent practices need a way to use scarce resources more efficiently and maintain the quality of their patients’ care.

Technology provides the key. It can actually be a life saver by minimizing the administrative burden and helping you manage your patient populations. But to help you enhance care and not detract from it, the right technology solution requires two critical components:

1. Meaningful data

2. A way to share that data throughout the care continuum

Better Data Translates to Profitable Practices.

While some clinicians believe that technology takes away from patient care, too often the data, not the system, is letting them down. Few independent PCPs have access to data outside their own EMR system, and they can’t depend on their patients to fill in the gaps.

In an effort to eliminate disjointed care for patients with chronic or serious illnesses, Acclivity Health has developed a platform that integrates with the EMR to give PCPs a 360-degree view of their patients’ care. The platform collects data from multiple sources — from Medicare and payer claims to pharmacy records, lab reports and scheduling data. It then analyzes that data and reports it in a way that enhances population and care management. The benefits are significant. But optimum results depend on the willingness of providers to share their own data.

In order for the healthcare industry to operate with better data, providers need to understand the value of shared data and be willing to share the data they collect themselves. By sharing the data, every member of the care team can collaborate and ensure the best outcomes possible.

Sharing data can eliminate the ineffective or unnecessary treatments that increase healthcare spending. And it can enable practices not only to meet the terms of their value-based care contracts but also earn significant bonuses payments.

Meaningful Data Benefits Independent Primary Care Practices

Primary care providers can allocate their resources most effectively when they know exactly which patients need to be seen now. High risk patients don’t come with a built-in timeline for

care management. Not all patients with the same chronic illness need to be seen with the same frequency. People’s healthcare runs in bursts. Ideally, you want a way to tailor your care management and your support for these people according to when statistics indicate they are about to come into a high utilization period. You need a way to anticipate those bursts and manage them.

Data is truly meaningful when it can provide every PCP with the full complexity of their patients’ medical journeys in real time, including:

· When they need their annual wellness exams

· How many doctors and/or specialists they’re seeing

· Knowing about all new conditions and/or diagnoses

· The number of medications they’re taking

· If they’ve filled their prescriptions

· Having the results of all screenings and lab tests

· If they’ve been hospitalized or moved to a SNF or into palliative care

The right solution will provide a full range of benefits for your practice, which in turn will provide better quality care, better outcomes and better patient experience — all metrics that affect your bottom line when it comes to value-based care.

1. Predict medical challenges before they occur

Improve your understanding of your patient populations with insights into cost and utilization risk, medication compliance, mortality risk, and psychosocial issues. Predict what resources somebody will need in the next 12 months.

2. Optimize care management

Guide clinical decision making with data that enables you to target those patients who will receive the maximum benefit from the care management resources you have. For example, identify patients with new diagnoses that will require you to ramp up your level of support, see them more often, ensure you have their medications under control and manage their care so that, if they do require hospitalization or have an acute encounter, it will be shorter and they won’t require readmission. In this way you mitigate their actual costs and improve your opportunity for bonus payments.

3. Get Patient Referral Support

Eliminate the guesswork and determine which high-risk, high utilization patients qualify for the various benefits associated with palliative care or hospice. Additionally, with data regarding the entire care network, you can create network analysis reports and evaluate which specialists you should refer to, based on the quality of their care and their ability to manage patients well.

4. Improve transition management

Get notified, in near real-time, of your patients’ hospital admissions, discharges and transfers so you can set up Transitional Care Management (TCM) visits for discharged

patients. This adds another source of revenue for your practice, while reducing readmission rates.

5. Improve coding & increase reimbursements

Keep your risk scores up to date so you get the reimbursements you deserve, with greater opportunities for earning shared savings and avoiding shared loss. Use your data platform to ensure that all patients’ chronic conditions are carried over from one year to the next, and that your practice’s risk score accurately reflects the level of high-risk patients you serve.

6. Analyze prospective capitated payment models

Make intelligent decisions about whether proposed contracts will be lucrative and aligned with your goals. Once a contract is signed, having the right data allows you to monitor and manage the success criteria for your specific contracts.

7. Track value-based metrics

Use your data to gauge the quality and outcome of your services. For instance, if reducing readmissions provides shared savings, set up alerts so you can connect with patients immediately after discharge and make sure you provide appropriate post-acute care. Or you can get notified when patients haven’t refilled medications on time and determine whether they have compliance issues or can’t afford what you have prescribed.

Health Information Technology is evolving rapidly. It shouldn’t be a hindrance, but an enhancement that can transform your practice. Acclivity Health has a very specific mission to improve the care and outcomes of patients with advanced illness. If you serve this patient population, we believe we can help you determine the best solution for your practice and meet your success criteria from your contracts. To learn more, please contact us at info@AcclivityHealth.com.