Seven Steps to Take Now to Prepare for Payment Reform

After understanding payment reform and how Value Based Payments may evolve, practices are beginning to transform in order to optimize earnings for providing greater value. In this article we will explore seven concrete steps you can take to prepare for a world of Value Based Payment.

What are some initial steps a practice can take to be more prepared for Value Based Payments?

1. Knowing the panel of patients the team is responsible for is a great first step. While some providers (like Community Health Centers) experience wide shifts in “subscribed patients,” there is still some level of predictability in the panels of Patient Care Teams. Assigning patients to a team that provides care in a way that meets their cultural and linguistic needs in addition to meeting their clinical needs sets the stage for future success.
2. Creating high performing truly Robust Care Teams that work consistently together is another key step to take. Coleman Associates Dramatic Performance Improvement™ methodologies (DPI™ ) are based on delivering strong results by creating robust and self-managing Patient Care Teams that employ Coleman Team Dance Techniques.

Health care as an overarching system has fully embraced the phrase “care team,” but are your care teams consistent, or do staff get pulled regularly? Are teams scheduled to start and end at the same time, and do they truly work together as a team, feeling ownership for a panel of patients? Do they focus on collective team-based outcomes and work shoulder to shoulder, or do they work in spaces organized by silos where nurses sit with nurses and physicians sit with physicians? Do they have time to do a huddle on all of their patients?

Coleman DPI™ or Dramatic Performance Improvement™ approaches are very successful in this transition. Unlike many other lean style or rapid cycle improvement approaches out there, DPI™ was born in health care and uses health care specific techniques as well as engagement from both management and front line staff in a top down, bottom up approach to ensure adoption and adaptation of best practices.

3. Creating the necessary tools or alerts in the EMR is a third important initial step toward preparing for Value Based Payments. Catching age and gender specific clinical needs such as vaccinations (TDaP, Pneumovax), health maintenance diagnostics (Colonoscopy, Mammogram), and disease specific measures requires making the transition to actively seek patients who could fall through the cracks rather than merely using the health record as just another place where data entry is required.
4. Truly opening up Access to Care is an additional required preparation step. Having same day access for all patients regardless of their expressed need improves quality of care. Whether patients are trying to schedule an appointment because they think they have a cellulitis and fever or they just remembered that they have not had a breast exam for years should not determine how soon they get in to see their doctor. Of course, access and precautions must be provided for acute and severe needs at all times.  Yet here is where the ability to see all patients as individuals with unique needs and circumstances makes all the difference, and maximizing their relationship with you and their interest in health maintenance desires will go a long way toward improving quality of care in the Value Based Payment world.

Coleman’s DPI™ program, in contrast to many other improvement strategies, makes dramatic, not incremental improvements to access and care. This access and availability should be with the Primary Care Provider (PCP), meaning that to manage that influx of patients, schedules need to be actively worked via phone calls or texts throughout the day and the schedule needs to be ridden or jockey-ed as an actively evolving tool and not a static and concrete schedule book set in stone.

The first step to improving access is to add predictability, and the best way to do that is to get your no show rate down to less than 10% of the visits scheduled. With a greater level of predictability in the day, the care team can begin to invest the time necessary to better prepare for visits and to more accurately manage the schedule in real time.

5. Tied to the increase in access is the best practice of preparing for the visit in advance. The good catches that can be made in #3 above are much harder to make when the care team feels rushed and scattered as they get the patients seen during the session. A solid visit preparation process (another Step in the Coleman DPI™ Team Dance) can help the team to identify needs, ask for and receive relevant records from outside offices in order to maximize the patients’ upcoming visit, order labs in advance when needed so that consults can be optimally effective (and can be a joint decision making rather than a discussion about what possible outcomes could be when labs are done), and even brainstorm about best avenues for care and whether to include other team members such as a pharmacist, behavioralist, or nursing educator.
6. Strengthening current coding processes must also become a priority. With the addition of ICD-10 to the US industry in the recent years, coding is now providing the ability to aggregate huge amounts of very specific data. During the days of paper charts, coding was a very labor-intensive process rooted in tedious after visit tasks, and it was highly vulnerable to human error. Quality checks on coding were time consuming and labor intensive, and involved coding staff to recognize incongruent notations, Medical Records Staff to pull paper charts, as well as connecting charts to encounter forms known as Superbills and either asking a provider for a re-review or using a provider to provider peer review system.

EMRs have made this system simpler, yet there are many occasions in which visits are not sufficiently coded, often due to provider education and a lack of easy to access check-boxes which correspond to particular codes.  A review of the coding system, follow up training, and improvements in charting can help to make sure that all patient services are recorded accurately. In these early stages, some primary care practices have found that they are missing out on recognized improvements because visits have not been accurately noted (or noted in the most accurate field to show up in reports); therefore, certain patients do not appear in reporting and bonus structures from the claims side of the documentation.

7. One final preparatory step includes building an amazing leadership team that has a full understanding of the future intertwining of roles. Recruiting providers who understand both technology and business is wise. Add finance staff who spend time in the clinical area and understand what clinical staff need to do their jobs well.

Some practices are adding executive team members with the roles of Chief of Population Health or Chief Transformation Officer who are highly enough positioned to emphasize these coming changes and who are well-equipped to help move the organization forward. They have an understanding of the quality and financial impacts of providing behavioral, dental, and medical care that address patients’ clinical needs as well as their social situation and their social determinants of health. The leadership team of the future will understand how to attract, motivate, and retain a new generation of workers to pull together services in a way that has not yet been seen in this dawning confluence of technology, payment reform, and clinical care and best practices.

Understanding Payment Reform and preparing for it ahead of time will help your team anticipate the financial, clinical, and operational changes that will be paramount to success in the coming years.

References

Coleman Associates. Building Effective Care Teams: A Provider’s Perspective. https://colemanassociates.com/what_we_do/building-effective-patient-care-teams-providers-perspective/

Coleman Associates. DPI™ (Dramatic Performance Improvement) Collaborative. https://colemanassociates.com/product/dpi-collaborative/

Coleman Associates. Making PCMH Level 3 Recognition a Reality: Access Community Health Network’s Story https://colemanassociates.com/what_we_do/making-pcmh-level-3-recognition-reality-access-community-healths-story/

Coleman Associates. Patient Care Team Huddle. https://colemanassociates.com/tool/team-huddle/

Coleman Associates. One way the Coleman DPI™ can reduce Emergency Room visits and help with Payment Reform https://colemanassociates.com/what_we_do/how-the-coleman-dpi-can-reduce-emergency-room-visits/

Coleman Associates. Team Dance Introduction. https://colemanassociates.com/what_we_do/team-dance-introduction/

Coleman Associates. The Team Dance. https://colemanassociates.com/tool/the-team-dance/

Coleman Associates. Those Darn No-Shows. https://colemanassociates.com/what_we_do/those-darn-no-shows/

Coleman Associates. What We Do. https://colemanassociates.com/wwd_category/team-based-care-clinician-support/

Health Catalyst. How the Change to ICD-10 Codes Will Improve Healthcare Analytics

https://www.healthcatalyst.com/change-to-ICD-10-codes-healthcare-analytics

Healthy People.gov. Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health