OIG Series Strategy 1: Working with Physicians

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We recently kicked off a blog series discussing the seven key strategies that 20 high performing ACOs utilized to elevate quality scores and achieve shared savings. These success stories were chronicled in the latest study from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (DHHS).

As a physician with over 30 years of experience and a first-hand witness to ground-up clinical transformations, I can say with certainty that involving physicians from start to finish is fundamental. Having physicians on board while working towards sustained high quality scores and cost-effective utilization practices is the formula for both satisfied patients and providers under the Medicare Shared Savings Program (MSSP).

Core Challenges

Recently my colleague, Josh Patten, wrote about the topic of physician burnout and how it can decrease with the installation of value-based care measures. According to the 2019 Medscape National Physician Burnout, Depression & Suicide Report, 59% of physicians surveyed stated that the top cause of physician burnout is the bureaucracy involved in their career path. OIG identified this as one of the two core challenges physicians face when implementing value-based care models. The feedback is that EMR documentation, paperwork, and other administrative tasks steal time away from patient care. These burdens can create missed care opportunities, calls for unnecessary tests and referrals, and potential emergency scenarios when subtle symptoms go unseen. While switching to the value-based care model does not remove all bureaucratic duties, it can create greater efficiency within a practice and promotes relationship-building opportunities with patients.

The other core challenge comes from the cost standpoint: many physicians are not fully aware of the pricing of services available, and as a result, they may over-rely on specialist referrals and over-order testing. Excluding testing that is done to err on the side of caution, a price-aware clinician is less inclined to order unnecessary services. According to the OIG’s findings:

“Almost all ACOs [in this study] provide their physicians with customized data to inform them about their practices and their referrals. This information is meant to increase physicians’ awareness of the cost of services and encourage them to consider these costs when providing care or when making referrals to other providers.”

Ultimately, each ACO surveyed went about managing, sharing, and utilizing their data differently to earn noteworthy financial savings. They were selective about their referrals to specialists, tightened their restrictions, and even set mandatory requirements. 

Five Steps to Engage Physicians

Five steps outlined in the strategy for first-rate physician engagement are:

  1. Recruit physicians committed to ACO efforts
  2. Stay informed of any care gaps and current quality measures
  3. Provide detailed cost data on treatments and referrals
  4. Redesign office workflows
  5. Provide both clinical and administrative support

Recruit Physicians Committed to ACO Efforts

In terms of recruiting physicians for an ACO effort, a “best bet” is to target those who have previous experience with alternative payment models. Clinicians who fully embrace the use of electronic medical records (EMRs) amongst other technological integrations are more likely to incorporate organizational software into their workflows.

Stay Informed of Care Gaps and Quality Measures

The priority of value-based care is the health of patient populations. Gaps in care lead to expenses down the road when a patient requires potentially avoidable services. One ACO’s strategy was to gather detailed patient information on beneficiaries who were overdue for a baseline appointment, like an annual wellness visit (AWV). This information was used to address care gaps, improve HCC coding, and increase patient satisfaction. Organized ACOs tend to stay ahead of care gaps and poor quality scores and resolve these issues quickly before they escalate.

Provide Detailed Cost Data on Treatment and Referrals

Accessible cost data is a valuable resource for helping physicians avoid inadvertent, excessive spending. As mentioned prior, a deeper understanding of medical costs comes from relevant data presented in an actionable format. Data becomes valuable information on the cost of tests and treatments, as well as the expense associated with referrals to other providers. The more physicians know about the prices of services, the more selective they will be when ordering them. 

Redesign Office Workflows

For maximum results, OIG touched on how the redesign of office workflows keeps entire operations on track. A team with modified daily routines for ACO efforts creates shared accountability. Tangible reminders, daily meetings, or electronic notifications are all ways that these ACOs organized their care.

Provide Clinical and Administrative Support

The final strategy is arguably the most important: once new processes and workflows are in place, there needs to be a source of support to keep things functioning at a high level. Support could mean a balanced distribution of clerical tasks around a practice or facility, or reorganizing certain tasks, like designating caregivers to perform particular screenings or follow-ups. Providing support could even be a simple check-in with members of staff to make sure they are adjusting well to this new model of care.

Physician Engagement with Lightbeam

Using Lightbeam’s unified population health management platform, a physician has what they need to efficiently close care gaps and improve the long-term health of their patients. With unique views of the data, a provider can access both population-level trends as well as individual patient profiles. They can use this information to optimize their quality measures, gain insights into compliance with a variety of targeted initiatives, and use this feedback to help further guide their actions. Involving and engaging physicians is necessary to ACO efforts, and these organizations have demonstrated the ability to crack that code with proven results.

Next time, another member of the Lightbeam team will discuss the second OIG strategy: engaging beneficiaries.

The full study can be found at https://oig.hhs.gov/oei/reports/oei-02-15-00451.asp

Read more from Dr. Kent Locklear, Lightbeam’s Chief Medical Officer.

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