As healthcare payment and delivery models continue to evolve, providers are increasingly being held more accountable for the health, quality of care, and overall costs associated with their patient population. Provider reimbursements are dependent on the quality of care delivered and the overall risk of their assigned patients. Attribution, or the process of assigning patients to primary care providers (PCP), has therefore become a critical component in maximizing reimbursement and succeeding under the rules and regulations of a shared savings contract.
Unfortunately, there is no exact science for accurately defining a patient population. There are many variables to consider, especially when patients are free to seek care from any provider they choose. If a patient sees multiple providers in multiple networks, only the attributed provider (or provider group) is responsible for the patient’s cost and quality of care. For this reason, it is very important for physicians to understand who their patients are – prioritizing those who are sickest – and to coordinate care effectively in order to keep costs low and avoid duplicate services.
Effective care coordination, however, is only possible if the provided data is reliable. Attribution lists from payers typically depend on retrospective data, usually based upon the previous 12 months, which makes it difficult for physicians to predict and address patient needs in the year ahead. Most payers also attribute patients to PCPs, but a patient with chronic or urgent conditions may see a specialist physician more than a PCP.
How Continuum Can Help
Due to these and other challenges, physicians often turn to a third-party vendor to assist with attribution. Continuum Health, for example, has the ability to integrate clinical and demographic data from EHRs with claims membership and eligibility data. An automated algorithm then assigns each patient a unique identifier which is used to normalize all of the data for each patient. Continuum’s proven process dramatically improves the accuracy of a physician’s patient attribution list, ensuring that each patient is properly attributed to the provider who is ultimately responsible for their care. Continuum also identifies any other providers or specialists a patient may be seeing, further stressing the importance of comprehensive care and communication amongst all involved physicians.
Once an attribution process is in place, providers will find that the value of any reporting, quality improvement, PCMH transformation, or overall population health initiative will increase significantly. It is essential for providers to have transparency into their patient population, creating the foundation for success in today’s healthcare environment and preparing them for future changes.
To learn more about how to prepare for the future of value-based healthcare, please visit a previous blog post, "Is Your Practice Ready for CMS Reimbursement Changes?".
Download our whitepaper on strategies for thriving in future value-based payment models: