Focus required to manage patient populations for bonuses

As the medical system shifts focus from individual to population health, medical practices, even those with only one physician and a few thousand patients, must find ways to adapt. This is true even if they are not participating in an accountable care organization or other innovative payment models.

But experts and consultants say earning population-management bonuses and avoiding penalties do not have to be arduous.

“There are financial incentives, and lot of the low-hanging fruit doesn’t really require a lot of additional resources,” said Paul Taylor, MD, an internist and chief medical information officer at WellCentive, a population health management company based in Roswell, Ga.

Physicians at each practice need to figure out a population health solution that suits them, but doctors generally identify certain issues to work on, develop ways to improve care and decide how to manage population data.

The first step is to determine which health measures are a good fit to address. The ones selected should match the interests of the practice’s physicians. For instance, physicians who have a sizable number of diabetic patients may want to find ways to make it more likely that they have their hemoglobin A1c tested and eyes checked. Others may want to look for ways to improve immunization rates or address some aspect of patient safety. Short- and long-term goals should be chosen. Doctors should see if their insurers have any incentive plan from which they can benefit.

“It really depends on what is important to you,” said Cynthia Blain, a director with SS&G Healthcare, a consultancy based in Akron, Ohio, that works with medical practices. “Don’t start with everything. Start with one or two larger diagnoses, and see how it goes.”

Improving care

After the health issues have been identified, the next step is to decide how care can be improved. This is where practices can get more use out of features of an electronic health record system. For instance, an EHR may be used to determine if patients who have not had an appointment for some time should be called. An EHR can show who has not received needed vaccinations or other services or identify high-risk groups of people, such as those of a particular age or with a specific condition.

“Establishing standard practices is really the jumping-off point,” said Andrea Gruca, vice president of physician engagement with Advocate Physician Partners, which coordinates physicians with Advocate Health Care based in Oak Brook, Ill. “You really want to find the gaps in care.”

People who work with practices say getting the necessary information is not difficult. For many EHRs, the queries require only a few keystrokes. Practices also must decide how patients are going to be notified about a needed appointment. In some cases, an insurer may provide a case manager or other resource for this purpose.

“Getting in patients who have not been seen or need follow-up is really where small practices can do very well,” Gruca said.

In addition, practices may want stronger links with other sources of care in the community to better track what patients have received. An insurer may be willing to provide some of this information gleaned from claims data.

The next question practices need to consider is how to use the data gathered, indicating that the health of the practice’s population has been improved. Experts suggest using the data for promotion on the practice’s website and in other marketing materials. The information can be used to negotiate higher rates with an insurer. In some cases, the statistics will fit in with a quality program run by an insurer, which can mean bonus payments.