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.