One of the first and most important challenges an organization faces when moving from strictly fee-for-service (FFS) healthcare delivery to value-based care (VBC) is aligning physician and provider compensation to the new priorities of VBC. If this gets left to be done “later” or not at all, the disconnect between incentives will make VBC success very difficult. 

As a follow-up to the VBC Drivers article on Preferred Provider Networks, this article will focus on the importance of at-risk Primary Care Physicians engaging Specialty Physicians in driving Value-Based Care (VBC) outcomes through the development of High Value Networks (HVN) for continued performance improvement in VBC models.

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.

Throughout this series of articles, we’ve discussed value-based care (VBC) drivers of gross income – attribution, risk coding and activities-based bonuses – and spent a good amount of time on drivers of net income, those that lower medical expense. Of these, we have looked at access, Annual Wellness Visits, and managing patient care. These six levers get pulled by most all organizations and practices to some degree regardless of their position on the VBC spectrum.

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 New England Journal of Medicine recently published a paper titled “Digital Minimalism - an Rx for Clinician Burnout.” The article points to a recent study that found the amount of time spent in electronic health records (EHRs) correlates with declines in face-to-face time with the patient, computer-based work after hours and increasing rates of burnout. Digital minimalism could be a new way forward for physicians.

Noncompete clauses may become a thing of the past as the Federal Trade Commission (FTC) is expected to vote on its proposal to ban noncompete language in employment contracts in April of 2024.

May is mental health awareness month, facilitated by the National Alliance on Mental Illness, and the theme for 2023 is “more than enough” (the 2022 theme was “back to basics”).

Over the last several weeks, we’ve focused on readiness for joining an Accountable Care Organization, or ACO. We’ve explored what an ACO is, shown how to see if your practice is ready to join an ACO, and shared five key questions to assess before either forming your own ACO or joining an existing ACO.

If you are a primary care practice, you’re most likely aware of the CMS directive to have all Medicare fee-for-service beneficiaries in an arrangement that includes accountability for quality and total cost of care by 2030. You’ve also most likely been approached within the last few weeks about joining an Accountable Care Organization (ACO), likely by multiple different groups, or you’ve done research and heard about ACOs recently. With Phase 1 of the ACO application period of May 18, 2023 through June 15, 2023 and Phase 2 July 11, 2023 through August 1, 2023, being aware of the deadlines is important, but even more important is being prepared to succeed in an ACO, and making the decision to even join one for the 2024 performance year.

The patients at your practice, your staff, the physicians, vendors and other support partners - these are all critical to your success. But when it comes to self care, the most important person at your practice is … you!

Medicare Annual Wellness Visits (AWV) are frequently viewed by primary care providers as a tedious visit in which patients see little value. With consistent access to care issues and a shortage of primary care providers, these visits are easy to push to the side and focus on other visits. The problem is, these visits can impact attribution and they are also a key metric in value-based care plans as well as Accountable Care Organization (ACO) requirements to receive incentive payments. So how can a practice balance the need to maintain attribution and satisfy insurance requirements while still providing crucial hands-on care to patients? The answer may be more simple than hiring more providers or limiting new patients. Nurse-led Annual Wellness Visit programs have been proven to effectively meet the AWV requirements while increasing access to the provider for other visits.

It’s the beginning of a new year, so you’ll be hearing a lot about Medicare risk coding and the importance of risk coding. You’ll most likely hear the same story from many different sources - beginning January 1, those patients with amputations suddenly have limbs grow back and patients with certain conditions no longer have those conditions. You as practice leaders and physicians are told by multiple sources about how important capturing appropriate condition coding for your patients is.

You as a primary care leader are responsible to your practice and yourself for financial performance. As value based care evolves for your Medicare patients, this performance is becoming more directly linked to stars performance. There are value based care programs available from CMS directly, as well as payer-specific value based care incentives that your practice might qualify for. There are also basic, upside-only contracts from both entities and more advanced, risk-bearing contracts as your practice matures and can gain through these more advanced contracts.

Primary care, and the leaders, physicians, clinicians, and support team within those primary care offices, are truly at the heart of making healthcare better. As we close out 2022 and enter 2023, there is no better time to focus on something that’s often overlooked in the business of primary care - you and your intentions.

The Institute of Medicine defines primary care as “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual's health and wellness needs across settings and through sustained relationships with patients, families, and communities”. To align insurance carriers, healthcare providers, and patients’ perception of quality healthcare, the first step is to build relationships among the three entities through more collaborative communication.

Data in healthcare is now essentially ubiquitous: there are mountains of it everywhere. With the promise of tech and big data, healthcare systems snapped up technology that promised to capture all their data and provide enhanced and unprecedented insights. EHRs were pushed on physicians, claiming better data collection, organization, and utilization.

From the FFS perspective all these yearly patient evaluations add revenue at a relatively higher rate than a typical office visit. A Medicare AWV generates the same work RVU rate as..

The strategies involved in pre-visit planning are meant to streamline appointments, improve communication between patients and providers, increase physician and clinic profitability and enhance the quality of medical care provided at a given clinic.