The Role of Technology in Primary Care First: Higher Revenue, Better Outcomes

Primary Care First (PCF) Practices have emerged as pioneers in transforming healthcare delivery – in essence becoming an Accountable Care Organization (ACO) at the practice level. They are resourcefully tackling collaboration, transforming models of care, and focusing on improved patient outcomes. At the center of their work, PCF Practices must consider harnessing technology to drive optimal clinical and financial outcomes.

Strategic attention must be given to PCF Leakage:
At the heart of a high-performing PCF Technology lies a set of foundational pillars: Leakage management and Care-Delivery improvements.

Strategic attention must be given to PCF Leakage:

High-performing PCF practices are led by visionary leaders, who align organizational goals with the regulations within PCF’s model and mission. One of these regulations governs capitation payment and claw back features: Leakage. It’s important for PCF leadership to recognize and invest in containing leakage, because the revenue impact is sizeable. Many organizations are seeing 20-40 percent revenue impacts based upon PCF claw backs. Given this outsized impact, technology solutions can build chase list and prioritize your efforts to address the problem. Here are a few examples of leakage types:

• Patient Churn – Leakage caused by patients leaving the practice for another PCP but remaining attributed. 
• Multiple PCPs – Leakage caused by your patients splitting time with another primary care provider/practice (e.g., snowbird).
• Internal – Leakage caused by your patient visiting one of your other locations, or an internal provider not listed on your PCF roster. 
• Incorrect Taxonomy/Specialty – Leakage caused by a patient’s visit to an outside physician (usually a specialist) with a primary care taxonomy. Physicians will occasionally have their primary and secondary specialties reversed in the NPPES system.
• Retail Clinic/Urgent Care – Leakage caused by your patient visiting a convenience clinic
• Specialty NPs – Leakage caused by your patient visiting a specialty provider and being seen by a Nurse Practitioner. NPs have very few taxonomies to choose from and most options are considered primary care.

Real-Robust Care Coordination and Integration should be forged:

Seamless care coordination is critical. High-performing PCF Practices prioritize integration among care providers, leveraging technology and collaborative models of care to ensure that patients receive comprehensive and continuous care. These culminate in robust coordination practices such as the following: 

• Practice Attribution
• Risk Management
• Utilization
• Cost Prediction
• Med Compliance
• Disease Management
• HCC Coding Opportunities
• Social Determinants (SDOH) & Equity

Data-Driven Insights and Analytics:

Harnessing the power of data is a distinguishing factor. Successful PCF practices employ sophisticated analytics to derive actionable insights, enabling evidence-based decision-making, risk stratification, and targeted interventions for improved patient outcomes.

• Clinical Summaries in support of chart prep and daily huddles
• Patient Utilization trend analysis
• HCC Coding Opportunities
• Risk and PPS Scoring
• Annual Wellness capture
• Quality recapture / closure
• Clinical Decision Support

Conclusion: Forging a Path to Healthcare Excellence

High-performing PCF Practices are meticulously crafted through strategic planning, innovation, and unwavering dedication to patient-centered care. By embracing these foundational pillars, strategic approaches, and a commitment to continuous improvement, practices can forge a path to healthcare excellence—a path that prioritizes collaboration, value-based care, and the holistic well-being of every patient.

As we navigate the ever-evolving healthcare landscape, let us aspire to build PCF Practices that stand as beacons of transformative care delivery, driving better health outcomes and patient satisfaction. Acclivity Health is proud to assist PCF across all these domains.

Author:

Jeremy Powell | CEO & Founder, Acclivity Health Solutions