Antonio Rios, MD
Chief of Population Health, Northeast Georgia Health System
“When you can demonstrate that your diabetic patient population has improved overall, when screening every diabetic patient for their eye exam allows you to perform early interventions for folks who could otherwise have experienced significant complications, or when you’ve increased the percentage of mammograms done in eligible females and catch those early stages of breast cancer – that makes a difference,” says Antonio Rios, MD, Chief of Population Health at Northeast Georgia Health System (NGHS).
NGHS is on a mission of improving the health of their community in all they do. And it shows. NGHS is on a bold population health journey that few other health systems have committed to taking – a journey to not only care for patients’ immediate needs but to anticipate their needs as well.
It started in 2014 when NGHS and a group of independent providers led the formation of HP2 – a clinically integrated network that brings together physicians and advanced practice practitioners from Northeast Georgia Physicians Group, Longstreet Clinic, Georgia Heart Institute, and other independent practices throughout the region. They then implemented Patient-Centered Medical Home about eight years ago as well as entered into a Medicare Shared Savings Program (MSSP) from 2018 to 2021, which developed their clinicians’ ability to influence care outcomes and overall performance in a collaborative team-based care approach. In 2019, NGHS and HP2 partnered with Lumeris to expand and accelerate the journey toward value-based care. The partnership really helped them learn more about quality metrics, performance, team-based care and more.
Dr. Rios accepted his role as Chief of Population Health in 2021, and now leads a team that is identifying the region’s most prevalent health problems, digging deeper to find the root causes and addressing underlying issues. And Dr. Rios knows the needs of the community inside and out – he has been in the area for more than 20 years establishing relationships of trust and transparency with patients.
“I accepted the population health role because I feel that this is the way of the future,” Dr. Rios said. “It ends up being all about the patient. At the end of the day, we are simply hoping to advance the quality of healthcare that NGHS and our partners provide.”
Value-based care is driven by delivering better outcomes, focusing on both the quality and efficiency of care. Providers prioritize the value of the care they deliver to patients, not simply the volume of patients they see, procedures they get done or the speed at which they deliver care. The partnership with Lumeris empowers NGHS to deliver value-based care in the community through technology, insurance capabilities and on-the-ground know-how.
Plus, in partnership with Lumeris, HP2 providers take part in direct contracting – which is designed to put patients at the center of care. Building upon lessons learned from Medicare initiatives, this model provides greater individualized attention to a beneficiary’s healthcare needs within traditional Medicare and changes financial incentives to reward providers for high-quality patient care. The program is part of the Centers for Medicare and Medicaid Services (CMS) Innovation Center, which has a growing portfolio testing various payment and service delivery models that aim to achieve better care for patients, better health for our communities and lower costs through improvement for our health care system. In 2023, the Direct Contracting program will take the lessons learned and evolve into the next phase of the program called ACO REACH.
“It is important that our entire clinically-integrated network – from administration to operations, to front-line workers, medical office assistants, certified medical assistants and more – understand what direct contracting means,” says Dr. Rios. “The data it provides us can really accelerate how quickly we can identify and treat the root cause of many health issues.”
While all patients still receive the same high-quality care, there will now be a more coordinated approach to its delivery. HP2 providers will ultimately have access to more analytics on the care of direct contracting patients. Dr. Rios and his team then use Lumeris’ tools to analyze the cost of that care for each patient, even beyond the walls of their organization. Even if a patient is in another state and gets hospitalized, NGHS will have that care and cost information.
“The platform allows providers and physician leaders to review how they are performing against targets that are set against top-performing networks across the nation,” Dr. Rios said. “The insights gained can be leveraged to drive and enhance our local performance.”
NGHS uses the Lumeris risk adjustment program that allows providers to gain enhanced knowledge of how to more accurately code for the complexity of their patients. It provides an improved approach to deploying patient resources and allows them to be appropriately reimbursed for the right level of patient care. And with the diverse and vast patient population in northeast Georgia, this program has proven beneficial for providers and patients.
“We have clinics in 16 different counties surrounding our service area,” Dr. Rios said. “This includes rural areas where there’s a high number of Medicare recipients that have multiple chronic conditions. We have quite a diverse mix, but we can address them all through a team approach.”
Dr. Rios believes that healthcare delivery models are changing and that ACO REACH is going to provide better data, insights and the right incentives for the future. While other Lumeris clients are at different stages on the road to value, Dr. Rios understands the path forward and has been pleased to see HP2’s journey accelerate because of the partnership.
“Last year, we were in the toddler stage in our journey to population health,” Dr. Rios said. “Now we’re definitely walking and getting our pace to a slow jog.”
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