One of the biggest challenges for health systems transitioning to value-based care contracts is figuring out how to engage physicians in the process. Physician buy-in is critical for value-based care success, especially since physicians drive the bulk of utilization decisions that influence health outcomes.
The move from traditional fee-for-service payment models to a value-based world requires a new way of practicing medicine. At the same time, physicians must adapt to new compensation models based on the successful delivery of cost-effective high-quality outcomes. For primary care physicians (PCPs), the transition is even tougher because PCPs serve as the healthcare quarterback in value-based models. This means that they are responsible for all the patients in their population – and not just the ones seeking care within the four walls of the clinic.
We’ve seen that physicians are not always prepared to take on these new tasks. However, our experienced Lumeris team has identified a few best practices to help drive physician engagement and better-position clinicians for success.
Below is the first of three case studies highlighting strategies that have helped different organizations gain physician buy-in and achieve value-based goals. We will profile two additional organizations in the coming weeks.
Case Study 1: Moving to downside-risk contracts
Background: A loosely affiliated independent practice association (IPA) of employed and independent physicians was new to value-based contracts and performing poorly. The IPA lacked strong clinical leadership to drive improvements.
Intervention: In order to expand its capabilities, the group implemented a multi-year plan that included:
- An alignment of payer and physician contracts and internal physician compensation with cost, quality and patient access goals.
- A comprehensive physician engagement program, including the identification and mentoring of clinical leaders; the creation of a new governance structure; the launch of performance reviews and the sharing of best practices; and the deployment of the programmatic Nine Cs® training to deliver accountable primary care, education and workflows to drive practice transformation.
- The implementation of a comprehensive risk adjustment program that included education and training around closing care gaps, reviewing preventive care opportunities, and providing technology tools for the treatment of high-risk patients.
- The identification of improvement opportunities and the creation of clinical programs to close care gaps and more effectively manage inpatient care, care transitions and high-risk patients.
Outcomes: Over the course of a three-year transition, the group achieved cost savings and improved care quality. Starting in the second year, the group was able to assume downside risk. Successes include:
- Decreased actual non-risk adjusted medical costs7%, from $632 per member per month to $571, in the first year of intervention. In year two and three, the group contained cost increases to 1.5% and 1%, respectively—well below national projections and medical inflation.
- Reduced acute admits 11% and acute days nearly 10%, while increasing average length of stay by almost 2%.
- Year-over-year improvement in cancer screenings, access to care, and diabetes management.
- Increased surplus distribution for providers 20% over four years.
Is your organization considering a move to Medicare Advantage or another value-based care model? Click here to learn more about Lumeris’s comprehensive and proven strategy for addressing the needs of physicians and driving value-based care success.