A good proportion of healthcare delivery in the US happens on the fly. Even when an office visit is scheduled in advance, many practices don’t start any work on a patient until they see the whites of their eyes. Mrs. Jones shows up, and we look through the chart to see what needs to be done in the moment. This approach opens the door for inefficiency, ineffectiveness, missed opportunities, poor experience, and low-quality outcomes.

In this series on the drivers of success in value-based care (VBC), we’ve looked at elements that improve gross revenue and are halfway through the discussion of VBC components that help decrease medical expenses. This installment will tackle the complex topic of “Care Management,” so buckle up and hang on!

This series has been focusing on levers to be pulled that can increase revenue in value-based care (VBC) practices. The second installment started looking at ways to decrease medical expenses, thereby increasing the potential revenue through shared savings or premium risk (Link to Part 2). Part 3 will now dig into the Swiss Army Knife of VBC, the Annual Wellness Visit (AWV).

As more practices and organizations pursue the principles of value-based care (VBC), they look for ways to improve their financial outcomes, the drivers of net revenue. Part 1 of this series focused on some of the main determinants of gross revenue in VBC and how to increase the size of the gross revenue bucket, or pie, depending on how hungry you are. These next installments will speak to the ways of decreasing medical costs, thereby increasing the risked savings to be shared or kept, decreasing the amount of pie eaten by medical expenses, thereby increasing the remainder in the bucket after expenses are paid.

We’ve become very familiar with the revenue drivers in fee-for-service (FFS) healthcare delivery over the past 100 years. Find the highest priced visits, treatments, and procedures a doc can perform and run as many patients as possible through those visits, treatments, and procedures. Since reimbursement rates for medical services have been going down, net revenue increases have more recently been driven by adding new types of visits or procedures to a practice’s repertoire and constantly honing efficiencies in moving people from the front door, through the exam/treatment room, and back into the parking lot as quickly as possible.

The Health Care Payment Learning and Action Network released a measurement of Alternative/Advanced Payment Models (APM) for 2023, showing the types of payments physicians and providers received overall and based on payer type. The measurements show a positive trend toward value-based care (VBC) payments, and the breakdown by payer was even more telling.

First impressions have always gotten a lot of attention, but I’m going to push back a bit and suggest that what happens after that first impression (aka unconscious bias) might need more focus. This MA, I’ll call them “Bleu,” was able to create a safe space for the patient and family member that overcame their initial judgment. Let’s explore how they did that, and how you and your team can focus on this too.

If you’re new to Value-based Healthcare, first of all, Wake Up! Where have you been? Just kidding. Even though I’d like to think that the concepts and practice of value-based care (VBC) are well-known to all and practiced diligently by most – VBC as a mode of operation in healthcare delivery that improves outcomes, improves patient and physician experience, improves revenue for physicians, and decreases overall cost of medical care – the realist in me recognizes that’s definitely not the case.

Earlier this month, my practice converted from the Allscripts Professional PM and EHR system to athenaOne. If you have been through this process, you know it is not easy. Many have come to tears or left their job when going through a system conversion because of the stress of balancing seeing patients while learning a new system. While lessons were learned and there were hiccups along the way, our process went smoothly with only a 3-week ramp-up period.

The business of primary care is a serious one and a unique one. Maybe you’ve always known you want to be in healthcare and primary care specifically, or perhaps you’re one of the many who, to use the Napoleon Hill term, “drifted” into your current role. However you got to where you are right now, what you and your practice do to serve your community is critical.

The U.S. healthcare market continues its trend toward vertical integration with the launch of Risant Health, a new value-based care, integrated health organization recently announced by Kaiser Permanente and Geisinger Health. Geisinger, a Pennsylvania-based, ten-hospital system, will be the first to join the organization via acquisition (pending regulatory approval).

It’s no news that the U.S. has been experiencing a primary care shortage, but the impact of that shortage is now being seen on the patient side according to a recent study from FAIR Health, a nonprofit that collects data on privately billed and Medicare health insurance claims.

As we continue our series discussing Accountable Care Organizations, or ACOs, we now move from the topic of forming your own ACO to what are some key questions to ask before joining an existing ACO. Entering an existing ACO can be a lucrative and well aligned way to accomplish success in value based care for your MSSP patients, but you may find yourself facing buyers’ remorse if you don’t go in well-informed. If you do make a decision that doesn’t align with your practice’s priorities and goals, you will be locked into the model for at least one year, possibly more, depending on the terms of your agreement.

Over the last several weeks, we’ve been in a series discussing Accountable Care Organizations, or ACOs. We began this month by reviewing “What is an ACO and what do you need to know about them?”, and we continued last week by giving some tips to answer the question “Is your practice ready to join an ACO?”.

Health equity has become a topic of increased awareness and interest in the last several years, and CMS has most assuredly taken notice. Before you think that this is not my practice, not my concern, and not something I have to worry about, it’s best to be informed of what health equity is, what CMS is doing about it, and why health equity matters at your practice.

McKinsey & Company recently released A REPORT detailing the healthcare industry outlook. With inflation rates and LABOR SHORTAGES, the expected growth for healthcare profits dropped from 6% in the 2021 report to 4%. While outlooks aren’t what they were just a couple of years ago, there are certain sectors that may see higher growth–in particular, Medicare Advantage with payers, which is forecasted to see greater than 10% growth in profits.

The CMS Innovation Center (CMMI) has produced many directives recently, many of which deal with the future of value based care. A 2021 strategy statement summarized the vision of CMMI, with these two statements showing how to measure progress.

In case you missed the news: The Amazon acquisition of One Medical officially closed on February 22. In one of our recent newsletters, we talked about Amazon’s entrance into the medical world through Amazon Clinic–which provides quick treatments for common conditions in 20 states.

Quality measures are a key aspect of primary care, not just because value-based care requires satisfaction to receive incentive payments, but because they can impact patient wellness. At a base level, it is common sense to evaluate an individual for early signs of diseases that could evolve into a more serious issue such as cancer or heart disease. Unfortunately, not all insurance payors have the same idea of what quality measures should be tracked or even what the target values should be. For example, one payor may say hypertension is defined as having a blood pressure of greater than 130/80 while another may say 140/90. Uncontrolled diabetes may be defined as an A1C greater than 8 for one payor and greater than 9 for another. A lack of consistency in these expectations causes confusion for primary care practices and can result in unmet quality measures.

The Great Resignation is a term with which we as society are all too familiar, and physician practices are definitely not exempt from the sting of The Great Resignation. Throughout the pandemic, healthcare workers (among others) were heralded as heroes, with many public displays of support and care as we all banded together to get through something none of us have ever seen before. Doctors, nurses, and practice staff were showered with support and kindness, sent letters and cards, and were generally appreciated.