Provider organizations under value-based payment contracts have many responsibilities in their effort to achieve the triple aim: decrease costs, increase value, and increase patient satisfaction. One responsibility is to provide data to providers for continuous process improvement. Organizations have quality metrics they must comply with, but frequently the raw data is difficult for physicians to interpret. When the data is both complicated and congested, the message tends to get lost. The end result is that sometimes there’s a reluctance to even get started, and the effort of data analysis gets put on the back burner. So the questions for the administration then becomes: what is in the physician’s wheelhouse? What are some metrics physicians will take ownership of? How do I relay this information to providers in a way that is both meaningful and relatable so that provider engagement occurs?
The next step to providing physicians with data that can be readily understood is to take apart each metric and find the derivative, or proxy, that can be impacted by the primary care physician. Taking ownership of a metric such as ensuring at least 75% of the attributed population has a flu vaccination is something the provider will feel they can take command of. An example of a proxy for access and acute care utilization is the ER/1000 rate. We have seen that primary care physicians don’t typically go to the hospital anymore because the trend has shifted to using hospitalists in that setting. Knowing that, the next step is to think about what actually causes inpatient admissions.
Emergency room admissions typically account for over 80% of inpatient admissions1 according to the American College of Emergency Physicians, and many times, the emergency room admission can actually be part of the provider’s wheelhouse. If you speak with most physicians, they would likely tell you that they don’t have control over where their patients go, especially Medicare beneficiaries who don’t have a referral network. However, an ACO physician would know that the emergency room admission is within their domain. It is a proxy metric for primary care access.
HOW IS THIS POSSIBLE?
Consider this. If the primary care physician is truly accountable for their attributed population, then they would regularly see their attributed beneficiaries to…
- Ensure their patients are receiving proper care
- Answer their own phones during non-working hours to address any concerns for their own patients
- Utilize chronic care management when appropriate
- Educate beneficiaries on the importance of calling the primary care physician first before seeing emergency or other specialist care to determine best course of action
All of these proactive steps are within the means of a physician, therefore, we should be measuring them on their ER/1000 rate to use it as a proxy for primary care access and inpatient utilization.
ANNUAL WELLNESS VISITS
Provider participation and quality metric compliance is another data proxy that can be used. This measurement is for Annual Wellness Visit (AWV) Completion. The AWV is important for several reasons:
- It’s paramount in deriving an ongoing and customized care plan for patients
- It requires a health risk assessment
- It can help the organization with high accuracy in Hierarchical Condition Category (HCC) risk coding and continuous attribution
An initiative to ensure AWVs are completed at a high rate is an excellent metric. If the provider organization emphasizes the importance of a certain visit that acts as a “magic bullet,” then the measurement of compliance is a great proxy for participation and about 1/3 of the Group Practice Reporting Option (GPRO). You’re effectively “killing two birds with one stone.”
Population Health Management
One final data proxy that can be used to measure providers and office staff is a proxy for population health management. The CDC indicates that at least 70% of the total Medicare population has at least 1 chronic condition2. Therefore, if you apply that statistic to individual providers’ attributed populations, then they should be actively seeing at least 70% of their population once per quarter to ensure patients’ chronic conditions are being properly managed.
The derivative of the metrics ACOs use are a much better measurement of physician participation, and they may even engage providers at a higher level since they know what they can and can’t impact. So, before you give physicians report cards or progress notes think to yourself: What’s in their wheelhouse?