July 11 2018 | 0 Comments | 155 reads Average Rating: 3

6 Real World Value-Based Care Success Strategies

by Linda Pantovic (Guest Author) in Population Health

At Scripps Health Plan Services, we are focused on ensuring successful value-based care outcomes. To accomplish this, our organization has zeroed in on costs, utilization, access and quality of care. To move the needle in the right direction, we have learned that it is important to:

1: Gain a comprehensive, complete view of the population

We work diligently to capture and diagnose chronic conditions in members/patients. More specifically, we have established a front-end process that makes it possible to audit all annual assessments and wellness visits, while ensuring accurate and complete coding. With this foundation in place, we are able to support the patients' health conditions, physician education while also ensuring that on-going diagnostic coding and overall supporting documentation is correct.

2: Ensure chronic care patients are receiving needed care

By leveraging the SCIO Health Analytics database, we identify where patients of specific populations – such as chronic heart failure (CHF) – are located across the network and which providers are assigned to them. This makes it possible to identify how well the organization is serving these patients and where gaps exist. In addition, this analysis enables us to provide practitioners with the education that allows them to do a better job documenting the conditions that need to be reported.

3: Provide members/patients with access to services

To better service patients, we focus on providing increased access to care via extended and weekend hours. In addition, we offer services at various locations. As such, if a patient needs an MRI and can’t get one for two weeks at the clinic he is attending, staff members look across the system and identify where an MRI could be provided sooner. In addition, a quick clinic pilot program, where nurse practitioners are seeing patients who need medical attention, is poised to help eliminate the need for patients to go to the emergency department or an urgent care facility.

4: Focus on driving quality outcomes

To improve care, our electronic medical record identifies care gaps at the point of care. Providers actually can click on a drop-down list of the problems that members/patients have and identify and can then address the gaps that each patient is dealing with.

5: Engage members to improve outcomes

A multi-channel outreach approach ensures members are engaged in their care. To start, our customer care team reaches out to Medicare Advantage members by phone and transfers the members live to a primary care physician to schedule appointments. Direct mail also is leveraged to remind members/patients to schedule annual visits and to prompt those who have not had any activity in a 10-month time frame to engage. In addition, the care team reaches out to high risk members and request that they come in for a longer primary care visit with a nurse practitioner or physician assistant.

6: Ensure accurate documentation

It’s important to ensure that all capitated risk adjusted members are accurately documented and coded and that they are accepted by health plans and the Centers for Medicaid and Medicare Services. Through retrospective chart audits performed two to four times a year, it is possible to compare previously reported chronic conditions to current documentation.

Interested in a more in-depth exploration of Scripps’ value-based care success? Check out our webinar entitled “Key Levers to Manage The ‘Risk’ in Your Risk-based Contracts.”

Also read:

Risky Business: Three Key Levers to Successfully Manage Your Risk

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Linda Pantovic (Guest Author)
Director of Compliance & Risk Adjustment, Scripps Health Plan Services

Linda Pantovic is the Director of Compliance and Risk Adjustment for Scripps Health Plan Services. Linda began her career with Scripps Health in 1995 as a Licensed Vocational Nurse on 3 West. Linda then transitioned to an administrative role with Scripps Health Plan Services in March of 2000.

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