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HCCIntelligence™ Live Webinar : Value-based Care: ...
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Hello everyone, welcome. We are just letting, giving a few minutes to let everyone filter in, and we will begin shortly. All right. Well, hi, everyone. Thank you for joining today's HCC Intelligence webinar. Today we're going to be talking about value-based care, an opening to reimagine how we deliver care. My name is Margaret Cordes, and I am the Director of Education at HCCI. I have the pleasure of moderating today's discussion. Before we begin, just a few housekeeping items A recording of this presentation and the PowerPoint will be made available in the HCCI Learning Hub shortly following the webinar. All questions will be addressed at the end of the presentation during the Q&A session. So you can submit your questions via the Q&A box. That will go directly to the moderator and presenters. But you can also use the chat box if you'd like to share any comments or shout outs with the other webinar attendees. So a review of the agenda today. We'll start with our presentation. And at the end, we'll reserve some time to ask some questions, address your questions. And then before closing, we're going to discuss the upcoming HCCI events. So before we dive in, it's my pleasure to introduce our presenters this afternoon. Our guest presenter is Dr. Chris Dodd. He is the Chief Medical Officer at MCARA Health and has overall accountability and oversight of all clinical functions. Dr. Dodd leads the company's effort to scale its national network of home-based advanced primary care medical practices. He has a strong track record of creating successful partnerships with provider group partners, as well as deep experience delivering care to vulnerable populations in the United States and around the world in resource-poor settings. Dr. Dodd served in a variety of executive and senior leadership roles, including value-based medical groups and federally qualified health centers. Additionally, HCCI recently welcomed Dr. Dodd as one of our new board of director members, and we greatly appreciate the leadership and expertise he brings to the work HCCI is doing. In addition, we have Dr. Paul Chang, Senior Medical and Practice Advisor for Home-Centered Care Institute. In addition to his role at HCCI, Dr. Chang serves as the Medical Director for Home Care Physicians, a suburban Chicago practice focused on delivering care to medically complex patients in their homes. HCP has made more than 123,000 house calls to home-limited patients founding in 1997, and Dr. Chang has personally made over 37,000 house calls to more than 3,300 patients during his 21-year career. His practice and work have been featured on ABC News Chicago and in Northeast Illinois Daily Herald. In 2014, Central DuPage Hospital named him one of 50 unsung heroes, and in 2019, Dr. Chang received the House Call Doctor of the Year Award from the American Academy of Home Care Medicine. Thank you both so much for joining us today. So before we begin, we do have a poll for our audience members. We wanted to get a better sense of who's in the audience. So I am going to send that out. You'll see it appear on your screen. It'll be a multiple choice option. And just a second. Oh. You know what, I apologize, this poll is not available right now. So we will return to that. But in the meantime, I am going to hand it over to Dr. Dodd and Dr. Chang. All right. Thank you so much, Margaret. Yeah, I appreciate the warm introduction and really appreciate this opportunity to join Paul and the HCCI family to have a conversation about value-based care. First, I wanted to just share that it really is a privilege of a lifetime to have recently joined the HCCI board. And I've been following the work of HCCI for some time now, and I've been incredibly inspired by their dedication to ensuring that home-based primary care becomes a core part of the U.S. healthcare delivery system, as well as one of the nation's leading providers of home-based primary care education. So thank you so much. Excited to join this amazing team and journey. So let's move to the next slide, Margaret, and we'll discuss briefly the objectives of our time together. What we'd like to do is describe value-based care's potential to facilitate better patient outcomes, as well as provider and patient satisfaction. We'd like to discuss opportunities that are enabled through value-based care, and we'd also like to identify examples of team-based structures that are facilitated by value-based care and that also promote practice success in value-based care. So those are our objectives, and I think we're going to be able to cover quite a few more. I wanted, if you don't mind going back, Margaret, to the last slide, I wanted to just highlight the first objective in terms of, does home-based primary care and a value-based framework facilitate better patient outcomes? And I wanted to take the opportunity to really highlight Tom Cornwall's Home-Based Primary Care, the Perfect Storm article that he penned a few years back. I highly recommend that you read every word. I think he did a wonderful job of really laying out the case for home-based primary care and the impact that it makes across a lot of different systems and programs, right, from the Veterans Administration System to the Independence at Home Project to the USMM VPA ACO. It's a really great read, and I think it leaves little doubt, as all of you know, of the value and impact of home-based primary care. I'd also, I'm also excited to really use the Quadruple Aim in healthcare delivery as a framework to talk about both the impact of value-based care and also some of the how-to. And before we transition, I wanted to just share a little bit about my personal journey into value-based care. I, early in my career, was at a medical group where I was provided, along with a team, the opportunity to innovate and, you know, implement a number of capabilities and interventions from team-based care to, you know, getting teams the information or reporting that they needed to better manage their panels, you know, transitioning interpreters for a population, you know, that was majority did not speak English as their first language and transitioning those interpreters to health coaches and much more. And our team was able to demonstrate incredibly rapid and significant impact across a whole host of metrics for our general population, but then also for our highest cost, highest risk population. And so when we went to the leadership of the medical group and said, you know, this success is amazing, right? And let's scale it, right? What are we waiting for? Let's get this to the rest of the population. And we actually didn't get the answer we suspected. We heard this is absolutely the right thing to do, you know, let's celebrate this success. But unfortunately, because we have the wrong payment model, we weren't able to scale a lot of these interventions and innovations. And so it was really that moment where I recognized the hard reality between operating in a fee-for-service payment model that really constrained our ability to do more than we were already doing for our patient population. And so at that time, shortly thereafter, I transitioned to another medical group delivering home-based primary care as well as clinic-based primary care and ultimately haven't looked back. And it's just been such an amazing journey to be working with teams within the right payment model to get paid up front, and then to be able to determine with them and with our patients how to spend that money so that we can ultimately, you know, help them live the healthiest life possible and get the best outcomes, not to mention drive joy and work. So thank you for listening to that personal journey. And I'll just end by saying in terms of additional objectives, as Paul and I have been chatting over the last week or so with Margaret and the team, you know, part of what we want to try to help you walk away from here is how do you do this value-based care thing, right? You know, is your practice and clinical model ready for an at-risk contract? What are some of the, you know, necessary preparations that you have to undertake in advance to be ready and to be in a position where you're able to demonstrate your performance in a way that's meaningful for a potential value-based partner? So ultimately, that's sort of how we want to frame the conversation today. And, you know, we've got a great group, so really hopeful that you won't be shy. I already see some questions in the chat, and I'll hand it over to Paul. Yeah, Chris, thank you. Thank you, Margaret, for that introduction. Chris, thank you for doing the webinar with us today. Really looking forward to your experience and your expertise, and thank you for being on the board to continue to provide guidance for HCCI as we try to help providers across this country to deliver this amazing work, this critically needed work to take care of these patients who really lack access without this kind of service being provided. I do hope that we can end on time because I know Chris has an interest in Greek folk dancing, and if there's time at the end, I would love to see Chris maybe perhaps demonstrate some Greek folk dancing for us, maybe bringing some joy to the webinar as we think about our work. Getting back to what Chris was talking about, you know, I've been doing this house call thing for many years. 23 is this year's count, and for the most part, I've been swimming against the current of fee-for-service, and as many of you know, home-based primary care is exceedingly difficult to do financially under a fee-for-service paradigm. So value-based care that people are talking about, different payment model, it's really refreshing. It's refreshing for me. It has given me that hope, that oxygen, if you will, that I can say, oh man, finally, there's a different way we can do this and get paid for the work that we are doing. So Chris, maybe I'll just start by asking, as we think about VBC, is there a platform or structure on which you kind of build your clinic, your service line, and then you go from there, getting into the quality and the cost and so forth? You mentioned a quadruple aim. Is that one potential pathway you would start looking at your program? Yeah, so I, and Margaret, go ahead and go to the next slide. I, folks who know me well know that I love to talk about the quadruple aim, and I always love to give a nod to the Institute for Health Care Improvement for really, you know, bulldozing this into the sort of healthcare ecosystem. And I was convinced early on that it's just a really, really wonderful framework to talk about what we do as we, you know, care for patients. And I've also realized it's a really great framework to talk about value-based primary care delivery. And so what I'd like to do is just quickly kind of orient everybody to the four aims. They're, you know, they're a little bit different than, you know, what's come out of the IHA shop. But ultimately, you know, I love to start actually with joy and work. And because that's really all about us, right? Because if we have joy and work, and it's not just Greek dancing, right? It's being able to take pride in the work that we do, which I know we all do, but it's also finding ways to make it easier, right, for us to do the work we do across sort of having the people on the team that we need to deliver care, having the workflows and the processes, you know, that work for us and make things easier, having systems and tools in place that also, you know, enhance the work we do. And then as Paul was noted, as Paul shared rather, you know, finding a way that we don't have to, there's so much upstream swimming, Paul, right? As it relates to caring for the most complex members who live in our communities, we shouldn't have to also fight the payment model, right? So how do we, you know, work toward a payment model that also enhances our joy and work? So that's the first among equals for me, because if you get that right, everything else takes care of itself. So exceptional patient experience, lower cost of care, and better care. And ultimately, you know, as we know, sadly, right, and the pandemic accelerated this, but we know that inequity in health outcomes is rising, not decreasing. And so the quadruple aim framework really, I think, says, hey, if we get this right, we're going to close the equity gap. And it's always just such a pleasure to be with so many people who are using their professional toolkit and everything they've got to really focus on those who are most in need living in their communities. So thank you so much for everything you're doing to deliver the quadruple aim and to close that equity gap. Yeah, you know, the joy and work is so important, Chris, as many of us are facing, well, we got the pandemic, we got the great resignation, we got hiring challenges and people leaving the field, you know, how are we going to capture the joy in our work that many of us went into medicine to do, right? What can we do to alleviate some of the administrative burden, the documentation work, which is really necessary, Chris, I'm sure you're going to talk about that in terms of capturing quality and cost and all that. That's important stuff, but without overburdening the provider. That's such an important point. Because if there's no, there are no providers, well, the saying used to be, what, no money, no mission. Now, if there are no providers, there is no mission, right? So I think it's so important for us not to forget the people who are delivering this care. And my final comment about the pandemic, yeah, it's been terrible in so many ways. But it has forced us to rethink how we deliver healthcare, right? Getting care outside the walls of the hospital and offices and so on. So I think as I look at what we're talking about, and that's delivering care at home to patients at home, the pandemic has really, really been a propellant in terms of getting this concept of home-based care into the forefront of people's thoughts and planning, whether you're a health system or a payer. Absolutely, Paul. And I'd love to accent mark what you're describing in terms of the tailwinds, right? So what's been really phenomenal about the pandemic, if you can say that right, is exactly what you just described, is that the healthcare delivery system and the society recognized how amazing it is to get care in the home. And it opened up, I think, a window of recognition to the parts of our population that need home-based primary care, right? Not just want it. Like, I want it too, right? But do I need it? That's a different question, right? But ultimately, I think it's opened up people's minds to understand that there are large numbers of people across the country who need home-based primary care. And I think because of that recognition, there's an acceleration of how do we make this work, right? Because at the end of the day, like, there's some complexity to it across, you know, so many different levels. But I feel like there's an increased sort of commitment and thirst and energy around figuring out how to make this work and how to make it scalable. All right, Chris, how do we make this work? Can you take us a little deeper into the nitty gritties, if you will? I talked with you about being a doctor. I like flow charts, you know, go from A to B, B to C. All right, you know, guide us here, Chris. Give us the recipe. How do we do this? Yeah, well, you know, I was looking at the up-to-date advanced care algorithms the other day with a colleague of mine. So that's where I would go for the flow charts. But yeah, no, I wish I had a perfect roadmap, I think, to succeeding in value-based care delivery. But the truth of the matter is that nobody's got it. Like, there is no single path to the realm of value-based care. And, you know, clearly there's a number of different practices, medical groups, experiments, pilots, et cetera, that have demonstrated directional success, but they haven't all done it the same way. So I think what we're gonna hope to accomplish today is talk about some of the core elements at a very high level that are sort of necessary for success. And then I have had the chance to preview some of the decks that are gonna come in this value-based care series, and they're exceptional. And the audience should know that there's gonna be a lot of details. So this conversation that we're having today might just be more of a wedding of the appetite and sort of a high level thing. So, but let's go to the next slide. So one of the things that we wanna do as we go through the different elements of the quadruple aim is talk about metrics, right? So being prepared in terms of how you can best tell your story to potential partners, payer partners, healthcare delivery system partners, others, so that they believe in what you're capable of doing and that you're able to achieve the right impact in a value-based care framework. So this first one is really easy for this team, right? Those of you who are engaged in delivering care in the patient's home, I mean, it's a no-brainer, right? You've got people that have a lot going on, medical, behavioral, complexity, social barriers, and we go to them, right? It's where they're most comfortable. It's where we have the ability to really understand the full picture and the whole life of a person, and that maximizes their experience. So ultimately, this is a major differentiator for home-based primary care practices, and I think the one key metric that we'd recommend be collected is the net promoter score, right? So how likely is it that your patient, this person, would recommend you, your practice, your medical group to a friend and family member? And there's a little bit of complexity in terms of the math with people that might be detractors and such, but NPS is a really wonderful way for you to demonstrate how you deliver it at an incredibly high level in terms of patient experience. And then I'll also share the obvious, right, which is like when you're interfacing with stakeholders, potential partners, you can't emphasize enough the patient story and the ability through a real-life patient of yours to kind of, in a methodical way, go through sort of a root cause analysis of why they're in crisis and why they might be cycling in and out of the emergency department or being hospitalized and what you did to move them from crisis to stability. Yeah, so one of the metrics here then is to whatever patient satisfaction survey your practice decides to use, to implement, it is really important to capture what Chris just said. Yes, we're gonna need data to back up our stories. And this is one data point that you can share with your payer. We know our patients love us. And I say this not in any way braggadocious or being narcissistic, not at all. I speak, I think, on behalf of household providers across this country. Patients love what we do for them. Chris is absolutely right. They'd rather be in the living room than in the waiting room. So a data point for you to consider is to capture your patient experiences, experience so that you can share with your payer as you talk about or venture into value-based care. What's next, Chris? Great. Yeah, let's talk about lowering the cost of care. So the way that I think about this quadruple aim element is really in two ways. One is revenue, right? So in a value-based care reality, we are really incentivized in the right way to make sure that we're accurately documenting the burden of disease of each one of our patients. Most importantly, because if we don't document a problem, then we don't have a plan to address that problem, right? But just as importantly, the patients that we care for are incredibly complicated and are costly, even when they're getting the best care possible. And so through accurate documentation of their burden of disease, we get the revenue, right? Or I like to say sort of, we get paid a fair wage, right? To assume their total cost of care. So again, just a nod to the upcoming webinars. And again, I took a sneak peek, but there's a lot of wonderful, rich information on sort of what are HCCs and how to ensure that we're setting ourselves up to get the right revenue. So that's sort of the first way that I think about lowering the cost of care is getting the right pigment up front. The second element is just medical cost reduction, right? And that's part of the magic of home-based primary care, is delivering primary care in a way that we're bringing as much clinical treatment as we can underneath our umbrella. And where we're not delivering care directly, we're doing the care coordination that's necessary, right? We're serving as the quarterback, so to speak, of care for our patients as they navigate through an incredibly fragmented and quite frankly, just chaotic delivery system. So there's no team, no individual more important than the primary care team and advanced primary care team to really do that care coordination work. So, and then before I hand it to you, Paul, I just realized metrics again, right? So let's talk about metrics. So first talked about clinical documentation, and that's gonna be one really important metric that ideally we're capturing, right? Of all the persistent chronic conditions that our patients are living with, what percentage of those persistent chronic conditions do we recapture on an annual basis, right? This year they have diabetes, CHF and CKD again, did we clinically document it to the most specificity possible this year, as we did last year. And then, depending on what systems you're using and what information you may be getting from payers, there are also suspected chronic condition, chronic conditions that people may be living with. And so it's our job to then evaluate those suspect conditions and determine whether or not people really have them or not. And so overall, when you think about clinical documentation or recapture across persistent and suspected care gaps, thinking in terms of 80% as a goal is a really healthy goal because among the persistent and suspected gaps, there's almost always gonna be about 20% that are actually not present at the time that you're evaluating the patient. So that's HCC recapture as a metric. And then in terms of total cost of care, total cost of care is a metric. And then some of the KPIs or leading indicators, I think that sit right under total cost of care are utilization related. So, what is the EPK, ER rate per thousand or admission rate per thousand, otherwise known as APK or readmit pay of your population. Those are critical metrics that we wanna be following as we think about lowering the cost of care. So I'll pause there. Yeah, it's really important and it's an ongoing education. For example, here in Northwestern, we had an educator last year come and talk to us about HCC. Coding and there's individuals coming next month to talk to our house call clinician about HCC coding. It is really important, as Chris said, to document the complexity and the high need nature of our patients. And regarding utilization, work with your enterprise data, work with your analysts and whatnot in creating a dashboard that can help you analyze what Chris talked about. ER utilization, acute care, hospital utilization, readmission rate, that is gonna help you tell the story. So we've got the first point that is telling the patient's story. And now we're gonna talk about the cost story. So have the talking points ready, build some, have infrastructure set up to help you tell the financial piece of the benefits to home-based care. Chris? Well said, and I'll make one, and I don't know, Paul, if you're gonna cover this in the subsequent sessions, but one small plug, kind of a looking to the future plug on social barriers. So one of the things that plans are increasingly looking at are what are referred to as Z codes, Z as in zebra, and those map to social barriers that our patients face to live the healthiest life possible. And so one opportunity is, and I'll just, I'll talk from the perspective of our medical group right now, is as part of every initial or annual wellness visit, we ask all of our patients 10 sort of core questions that are in the social determinants realm to identify what social barriers they may be living with. And then by putting those assessments into our encounter notes, we're then able to drop a Z code. And the thought, right, or what we're sort of reading the tea leaves on is that over time, those Z codes will risk adjust. Meaning if you have a patient living with, you know, CHF and they are also having trouble with transportation, their, you know, housing, they have housing instability, you know, food insecurity, the difference between the revenue, the payment for that patient versus someone living with, you know, CHF that does not have those social barriers is more. And so for obvious reasons and appropriately so, reimbursement should be higher for patients who are facing, you know, multiple social barriers that are getting in the way of their health. And then, you know, that revenue can be utilized to get more resources, you know, on your team, community health workers, for example, to help your patients, you know, connect to CBO, community-based organizations, and just, you know, stand shoulder to shoulder with them as they overcome those social barriers. Yeah, well, the Z codes that Chris talked about, they don't carry what we call ACC weighted coding, if you will, but it can help your team identify what social needs the patient has. And we all know, good medicine can only go so far without addressing inadequate social support. Just saw a patient yesterday, the medication management was an absolute mess. She's been in, this is March, she's been in a hospital emergency room four times already, non-adherence to medication. So we took it, and that is a social determinant that really needed fixing, because it will impact this patient's health and wellbeing and absolutely impact the cost of care that Chris was talking about. Perfect, let's go to better care. So better care is sort of otherwise known as quality, right? But it can mean a lot more than that. So when we talk about quality, you know, depending on the population that we're serving, whether it be Medicare, Medicaid, commercial ACA, there are quality benchmarks, right? You know, HEDIS, STARS, a lot of the lingo that's used in the quality world that illustrate sort of care gaps or care interventions that patients need from both a preventive perspective, but also from a diagnostic and care perspective. And so one of the things that, you know, we know that from a clinical perspective, we know that for some time our pair of partners and others are looking at is like, how good are we at making sure that, you know, all of our patients living with diabetes, you know, get a diabetic, a dilated retinal examination, right? How many of our patients living with diabetes have an A1C below nine? Are, you know, what percentage of our patients that are taking statins are not only, you know, prescribed the statin, but how many of them are picking up the statin on a regular basis? Of course, and then they actually have to take them, that's a whole nother story, but for now at least, you know, the focus is on are those prescriptions being picked up? So there's a whole host of HEDIS and STARS related quality, you know, interventions and diagnostics gaps, as we refer to them, that we know we should be closing, not just because we need to check boxes, but the last time I kind of did a thorough end-to-end review like all that stuff actually matters. So this is another sort of metric that's gonna be really important for you to tell your value story. Yep, just echoing what Chris said, tell the story with, yeah, we all have great patient stories and we all do, but we also need to back up those stories with numbers. So we got a great patient satisfaction, we got demonstration of lowering cost, and then we're gonna show them that we provide better care, care that's appropriate for our patient population. For example, are we addressing mental health issues? Are we doing depression screening on these patients? Are these patients vaccinated for the flu, for pneumonia, for COVID? That's another point of demonstrating better care, quality care. What about advanced care planning discussion? That is so important for our patient subgroup because many of them are older and face life-threatening illnesses. We need to have these difficult conversations and have them documented. What about assessing them for trouble with mobility, fall risk, which is such a problem for many of our older patients at home. So these are just some of the quality metrics for you and your team to think about. Again, demonstrating the great work that you're doing and then showing people who are interested in your service, the quality of service that you're delivering at home. That's great. And Paul, I'm noticing that I think that there's a handful of questions that are coming in. So let's go on to the last element of the quadruple aim, joy and work. And then maybe I'll leave it up to you, but maybe we can take some of the questions that are coming in. So let's go to the next slide. All right, so we got a little bit of a sneak preview on that, right? Which is that, how do we make it easier for ourselves and for our teams to take really great care of our patients, right? And how do we think about that across people, process and systems, right? So from a people perspective, it's one thing to identify social barriers as a provider, but then it's another thing to actually do the hard and time-consuming work to partner with our patients to overcome those barriers. And so the ability to get people on the team like community health workers or a medical assistant that is able to go through your state's CHW certification program. How do we get the people on the team to deliver social care? Paul mentioned behavioral health, right? How do we get the people on the team to do integrated behavioral healthcare, right? To have an RN case manager that can deliver evidence-based short-term counseling in concert with up titration and treatment to target of the depression and or anxiety. So people matter, process matters, right? So one of the things we haven't gotten into much is sort of is data and accessing, obtaining the data that's necessary to drive workflows and process to deliver better care. So you think about the health information exchanges around the country. Some states have multiple like New York. Accessing that health information exchange and building a relationship with them so that you get real-time information about when your patients hit the emergency room or when they're admitted, when they're discharged so that we can put into place, you know, transition workflows that get in the home within 48 hours of discharge, for example. And then systems, you know, we could spend an hour talking about systems and lots of them are expensive, quite frankly, right? But some of them aren't and certain tools like up-to-date for our teams to make sure that they're delivering evidence-based care to our patients make a big difference. E-consult platforms are increasingly being utilized so that our patients and we as primary care providers don't have to wait to get answers from specialists when we know we need answers. We can send a question to a specialist in the sky and within hours actually have a response. So thinking about Joy and Work in a systematic way across people, workflows, processes, and systems is a really great way to drive Joy and Work. And, you know, Paul, you mentioned, you know, the great resignation and, you know, we're not keeping up in terms of, you know, training the healthcare professionals that we know our communities and our patients need. And so the ability to create a work environment, right, where people's work is made easier and where they have time, more time to spend with their patients. And that's another great advantage of home-based primary care and the right payment model is to have more time to spend with our patients who really deserve it. And I know many of us already do that even within the current, you know, payment model that may be fee-for-service. But ultimately we have a great opportunity here to drive more Joy and Work and to stem the tide of resignation and to stem the tide of people who aren't gonna choose to go into healthcare because they're hearing about how bad it is, right, from people that have left the profession, for example. Yep. Chris, just a couple of quick comments and then we'll get to questions from the audience because we're running up on time here. Just highlighting, you know, work with your EHR vendor, trying to make your charting and documentation workflow as efficient as possible. We, as clinicians, we know EHR is such a burden to us. So whatever smart phrases, macros, automatic flows or templates that you can use, work with your team and your vendor to reduce that burden for your clinicians. Number two, having protocols is, I think, so important so that the nurses and the clinician knows that when something like this happens, it will flow down this way. It will alleviate a lot of back and forth, maybe asking question, you know, what to do. And then that just takes clinician time to look and so on that could create maybe some confusion within the nursing staff. But having that workflow so that everybody is seeing from the same page. And finally, it is, this is teamwork. I'm only a doctor. I tell my patients all the time, there are many things that my patients need that I simply cannot provide. I will need a team to rally around my patient to support them, whether it's pharmacy, whether it's behavioral care, social worker insights, I'm gonna need a team to support them. And my final comment is this, celebrate your team. We had a team meeting at our office yesterday, finding ways to recognize people, finding ways to celebrate and the accomplishment. We have a golden trophy that's gonna go to the most interesting story of the week. And we're gonna have something like that, again, just to have that cohesion that is so necessary for this kind of work to maintain the workforce so that people don't walk away from this amazing, amazing work that we are all doing. And yes, we have a Jenga piece that we put at the, or whatever, the common area that people can play and then the giant, the Connect Four. So whatever your office decides to do, celebrate each other's work, because this is hard work, but rewarding work. Great, did you wanna take a look at the questions, Paul, and pick a few off, or what do you think? Yeah, I think there was one question about the lowering, what are some of the metrics related to lowering cost of care? If you could just go over them perhaps one more time, it is listed there. If you could help refresh our memory again regarding lowering the cost of care. 100%, yeah, so I would say that some of the directional indicators are the highest cost items in the system, right? So utilization metrics like ER visits per 1,000, admissions per 1,000, readmissions per 1,000, those are all critical, and those are high cost items in the care delivery system. And that's where we can actually make the biggest impact, because quite a bit of that utilization is impactable and unnecessary. Another way to think about it, and again, this depends on what you have access to, is if you're able to look at the total cost of care, there's medical spend and there's Rx spend, right? And so when you think about Rx spend, yes, there's opportunity there, but there's oftentimes just no opportunity. And I'll tell you, even when you think you can switch people from a brand name inhaler to a generic inhaler, oftentimes because of rebates that payers have put in place, there's actually no savings on things like that. So the old teaching, I think, around just always use generics isn't actually always the truth of the matter, polypharmacy reduction, I think, is a great way on Rx, but within the medical spend, you have the utilization related spending, and then you have specialist spend, right? So you heard me highlight the ability to bring in an e-consult partner and the ability to get answers from specialists that then avoid the need to actually send a patient to a specialist is a great way to systematically, over time, reduce the cost associated with professional fees in the specialty realm. Thank you, Chris. Here's a roadmap question from Bernadine. How would you go from a fee-for-service to value-based care? Chris, you and I talked about this earlier and also offline about, I've been swimming fee-for-service. How do you go from A to B? What are maybe two or three steps that you can guide a practice as we go from what we've known to perhaps the unknown, right? Like, do you just call up an insurer and say, hey, I wanna do value-based care, like, is there a 1-800 number to call? You know, so how do you, can you give us maybe a couple of practical points? How do you go from fee-for-service to value? That might've been funnier, Paul, than your earlier use of the word, did you say braggadocious or something like that? Braggadocious, yes. I'm gonna look, I'm gonna get my dictionary out. Okay, sorry, that dates me. Yeah. Okay, so, yeah. So there is a 1-800 number. Are you ready? I'm gonna say it. No, so yeah. Yeah, so this is a little bit of the mystery, right? And I think it depends on, you know, and it's hard to sort of speak to everyone at the same time, but it really depends on where you're at on your sort of value-based journey, right? Are you starting from a position where all your revenue is fee-for-service based, where you do not have the opportunity to earn any quality-based incentives? You're not using any, you know, additional coding that can bring in additional revenue. If that's the case, then, you know, starting off, and this is gonna come through in some of the subsequent sessions with Paul and team, but, you know, start off by looking into the ability to drop additional codes for care coordination, right? Complex care management, transitional care management, that systematically will allow you to earn extra revenue, which then gives you, you know, revenue and earnings to actually decide how you wanna spend that money to better prepare yourself to move further along the risk-based glide path. If you're already doing that, and maybe if you're not doing that, but you feel you have a really great story to tell in terms of population health outcomes, and your population is, you know, of a reasonable volume, and potentially isn't concentrated with a particular payer, you can go tell your story to that payer, and we can certainly talk more about that, but that's another angle. You can tell that story and, you know, look to get to some sort of primary care capitation where you don't have any, you know, downside risk, but that you'd also benefit from quality-based performance incentives. That would fundamentally change the payment model for you. And then I'll just share, you know, further down the line, and some of you may already be here, but, you know, working with a payer on a risk glide path that gets you that primary care capitation upfront, which really is just cashflow, right? And then ultimately you could choose to put up a certain percentage of that capitation at risk to enable yourself to actually share in savings when at the, you know, end of the year, all the marbles are counted, and, you know, total cost of care has gone down in comparison to what it was expected to be. So that's another path forward. And then, and Paul, I'll let you kind of jump in with any additional detail on this, but there are other, you know, payment models, right, that are coming out of CMMI from, you know, ACO REACH to MSSP, and then Primary Care First that also offer paths forward. And Paul, I don't know if you want to say, share a little bit of additional detail there. Just quickly, because there are questions coming in. Start collecting data, even if you're under fee-for-service. Be ready to go when you talk to a payer. There's a question about, I have a small population, but I'm using TCM, ACM, CCM codes. Where do I go from there? So Rene and Chris, perhaps I'll ask on behalf of Rene, is there, do you just go to a Blue Cross and Blue Shield of XYZ State and say, hey, I'm providing great service? How do you engage with a value-based payer? If you could just speak briefly to that. Yeah, so probably the best person within sort of the massive, you know, health plan bureaucracy to interface with out the gate is someone that's in their sort of provider networking shop, right? So that shop usually is interfacing with different providers, and they tend to spend most of their time with large provider groups, but that's a really great person to, you know, break bread with initially. That would be my recommendation for entry, but any entry is a good entry. But I think that finding out who that person is and that team is a great way to get the conversation started and they are very much involved with partnering with providers like you, with medical groups, to structure contracting, you know, that facilitates, you know, value-based economics. Got it. Chris, as clinicians, we want instant fixes, right? Your potassium's low, I give you this and it's better. But negotiation with payers may not be that quick. Can you give us an average kind of a, as I'm negotiating with payer A, what should I expect? Six months, eight months, longer? Yeah, it's the old adage, you've seen one wise patient and you've seen one wise patient, right? But generally speaking, in terms, and you can apply the same thing to payers, but generally speaking, you know, I think six months is probably a good expectation. And if you do it closer to three, I think consider yourself incredibly successful. There's a question about panel size. Traditionally at HCCI, we have, and this is based on a textbook. I think it is called the textbook of home-based primary care. Panel size is roughly between 150 to 200 patients per house call provider. So there's a question related to that. There's an attendee asking patients with non-adherence to medications, lab work, and so on, they can increase the overall cost of care. Absolutely. A negatively impacted patient? Absolutely. Are there in-home mobile labs and imaging services included in a value-based primary care model? Chris, personally, I don't know of a, our services, again, like I said, is still under fee-for-service. So we don't have a value-based contractor with mobile lab and imaging services. Are you aware of any, Chris? And I think this is a question about controlling leakage, right, in value-based language usage within and minimizing leakage without. Any comments, Chris? Yeah, at a high level, my response to that is we wanna bring as much of, in a value-based economic structure, we wanna bring as much of care delivery under our umbrella as possible, right? So that would include point-of-care testing and diagnostics, imaging, et cetera. And if we're not delivering it ourself, then we have a preferred partner that we're working with to deliver it. Panel size, by the way, like that sounded spot-on to me. And I would just say that as you build out a multidisciplinary team where there's other people on the team to support the patient, the panel size can go up. Just a quick comment, and then I think I'll turn it over to Margaret because we're coming up on five o'clock. One of the ideas that we have within our practice, again, we talked about it yesterday at our staff meeting, is that we've been outsourcing a lot of our mobile lab. Not only do we draw blood tests at our visits, but we've been outsourcing a lot of laboratory studies to other, at this mobile lab company. So we're brainstorming about hiring our own phlebotomists and that will keep the cost here, to keep the services here rather than exporting services to an outside provider. Margaret, can you tell us, Chris mentioned that this is just perhaps a teaser to value-based care. Can you tell us a little bit more about what offerings from ACCI, if learners wants to learn more about value-based care? It would be my pleasure to just remind everyone, thank you so much for your questions. I wish we had more time. We do have more time at an upcoming opportunity, a virtual workshop series, Demystifying Value-Based Care, Best Practices for Today and Tomorrow. So if you found today's presentation helpful, I would strongly encourage you to register. You can register for all three or one of them individually and the content will really build off of what was discussed here today, provide actionable strategies so you can begin the transition to a value-based model or improve the efficiency of your existing value-based payment arrangements. So we're gonna include a link with more information in the chat box, but as you can see, it begins on April 13th. It's gonna be hosted via Zoom and then it'll continue the following two Thursdays, April 20th and 27th. They run from 20, or excuse me, 1230 to 445 and are designated for four AMA PRA Category 1 credits. So the recordings, presentation materials, that'll all be included. And we do have a kind of a promotion going on right now. Right now for the public through April 11th, you can save 10% if you register for all three, but as a thank you for attending today's webinar, we also want to extend this exclusive promotion code. You can receive an additional 20% off the three-part series or 15% off an individual workshop. So we really hope to see you there. Our panel of speakers are all experts and I think I can speak on behalf of them when I say one of the reasons they love partnering with us for these workshops is the interaction they get with the attendees, helping answer their questions and providing insight. So it's a really excellent opportunity to dig into those specific questions you have for your practice. And just to close, I wanted to remind everyone the HCC Intelligence Resource Center, we have a hotline, we have webinars like today's every couple of months and then our downloadable tools and tip sheets. So please, if you have any questions, don't hesitate to reach out to us and we will be sending a follow-up email with instructions on how to access today's recordings and materials as well as that promo code I just discussed. So thank you all so much for attending. Thank you, Chris. Thank you, Paul. This was a wonderful discussion and we really value your time and insight. Thank you. Thank you, everybody. Thank you so much. Greek folk dancing next time, Paul. Yes, we'll do it next time. Okay, thanks everybody. Bye-bye.
Video Summary
In this video, Dr. Chris Dodd and Dr. Paul Chang discuss the topic of value-based care and its potential to improve patient outcomes and provider satisfaction. They highlight the importance of patient experience, lowering the cost of care, and delivering better quality care. They emphasize the need for accurate clinical documentation and the use of metrics to demonstrate performance and outcomes. They also discuss the importance of addressing social barriers and the potential role of Z codes in risk adjustment. The presenters stress the importance of team-based care and the role of various healthcare professionals in delivering comprehensive care. They suggest strategies for improving workflow, such as implementing protocols and utilizing technology solutions. The presenters also mention the need for organizations to engage with payers and explore value-based contracting opportunities. They provide guidance on negotiating with payers and suggest reaching out to provider networking teams within health plans. They also mention upcoming HCCI workshops on value-based care for those interested in learning more. Overall, Dr. Dodd and Dr. Chang provide valuable insights into the transition to value-based care and highlight key considerations for healthcare organizations.
Keywords
value-based care
patient outcomes
provider satisfaction
patient experience
cost of care
quality care
clinical documentation
team-based care
workflow improvement
payer engagement
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