Continuum’s recent white paper, “How Physicians Can Win in the New Healthcare Environment,” explored several key strategies on how to transform the physician practice to capitalize on healthcare reform initiatives. In that paper, we examined five ways to maximize the value-based payment modifier adjustment, primarily from a quality perspective.
There’s another dimension to the quality improvement that value-based care aims for: there’s the means to reduce cost. Not just the cost to your practice, it’s the total cost of care. Here are five key methods to help reduce high costs in the value-based care world.
- Start with attribution management. Understand what “plurality of care” means, the rules being applied to it, and how it affects your patient panel. There are many ways attribution rules vary--patients may be attributed to the provider who has provided the highest percentage of that patient’s primary care visits, or they may be based on the highest percentage of primary care E&M visits. Learn these rules, and use them to your advantage to develop a robust, strategic understanding of the list of patients for whom your performance will be based upon.
- Manage your attributed lives holistically. Each of your patients bears a clinical risk profile. Take time to understand what it means for them to be healthy, at risk, or rising risk and managed or unmanaged. Take a comprehensive approach to outcome-focused care delivery, using proactive patient outreach and management to keep patients healthy. Avoid unnecessary utilization by ensuring that the PCP and care team are effectively navigating patients throughout the care delivery system—a tactic that can also help to reduce possible emergent issues.
- Make appropriate use of medical resources. Communication is critical to achieve this. Create a healthcare community that encourages interaction and open conversation to help reduce duplicate tests. Ensure all specialty care is appropriate to help cut down on unnecessary utilization and help you optimize your population health management strategy.
- Control your overhead. Rising administrative costs are a significant contributor to the overall rise in medical expenses, but an effective use of staff, workflow, and processes can drive additional savings. Ensure your revenue cycle management is updated, optimized, and staffed with appropriate talent.
- Understand market and network driving forces. While it can be difficult to think of your practice as a business and your patients as your clients, the market for care delivery is rapidly changing. New competitive models are gaining market share, and patients are becoming more educated consumers of care. Accessibility is more important than ever before. Keep cost of care differentials in mind when providing care—what is the cost of inpatient versus outpatient care? Do the benefits of referring to a specialist outweigh the costs?
Keeping these tactics in mind as you look to improving, optimizing, or transforming your practice will help you get the most value and benefit out of VBM. In addition, it will help to drive greater efficiency and patient outcomes while reducing waste for your practice. To learn how to maximize the VBM adjustment from a quality perspective, download our checklist.