Using market intelligence to fuel network growth
Adopting a data-informed approach is central to achieving success in risk-based contracts. Using data helps providers understand opportunities for improvement at the individual physician and practice levels as they participate in value-based care. During a Nov. 18 webinar with CareJourney, a pioneer in value-based healthcare analytics, CareJourney members, Doug Thompson, director of advanced analytics at Rush Health, Kevin Murphy, executive director of direct contracting at Clover Health Partners, and Dr. Sanjay Doddamani, CEO of Upstream, discussed how data can be used to improve physician performance, enhance quality of care and build highvalue clinical networks.
1 Data can be used in PCP recruitment
Healthcare systems participating in value-based payment programs need market intelligence to expand care networks. One objective is to add primary care physicians (PCPs) who will help achieve the goal of providing high-quality, efficient healthcare. With CareJourney data, PCPs can be ranked using performance metrics such as risk-adjusted medical expenditures per member per year, quality outcome indicators, readmission rates, annual completed wellness visits, and PCP and emergency department visits per 1,000 members. PCPs with higher scores can then be recruited.
2 Don’t enter a direct contracting market without data
When considering whether a market is a good match for direct contracting, data is key. Once the market is selected, the organization can use similar metrics to choose an ideal provider group to contract with. That means looking at the number of providers in the practice, the typical number of beneficiaries, utilization patterns, compliance metrics, and transitional care management and advanced care planning usage. The practice should also be compared to others in the county and state, and to peers in the organization’s network to determine whether to move forward with the practice.
3 Outside resources can help time-strapped physicians and staff
Due to the disjointed nature of the healthcare system, patients with multiple chronic diseases can fall through the cracks, shuffled between PCPs, specialists and sites of care. Providers can connect the dots with appropriate support systems in place, in particular embedded clinical care team members that include nurses and pharmacists. This can drive performance improvements that make the difference in value-based care arrangements.
4 Managing new physician and group performance without data
With direct contracting, it can take six months before there’s an indication of how a group is performing, and years to fully understand individual physician performance. Use engagement as an initial measurement of how a practice is likely to perform. A direct contracting company can ask the group to work with them on identified measures for the first three to six months before real, actionable data is available.
5 Why measuring performance of PCPs is different than specialists
Performance metrics are different for specialists than PCPs. That’s because PCPs have patients directly attributed to them. Specialists use episodes of care and specific quality metrics, which aren’t as well developed. Specialists can be ranked with a quality index by taking volume into account, as well as procedure types. But it’s hard to compare specialists who are in different geographic areas and may cover different issues and complexity, which is why having a data source like CareJourney, where taxonomy is factored into scoring metrics, is key. Another complication is that episodic care can cover acute and chronic episodes. These differences should be taken into account as providers build out value-based contracts with specialists.