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Supporting the Shift: How the Right Measurement Methodology Can Help Providers Make the Leap from Fee-for-Service to Value-Based Care

This four-part series will thoughtfully and thoroughly analyze the current state of outcomes measurement within value-based care. Along the way, we’ll bring in various perspectives for stakeholders across the industry. In this post, we are summarizing an interview between PopHealthCare executives Aaron Wells, PhD and Vice President for Outcomes and Reporting and Karen Vloedman, M.D., Senior Medical Director.

In part three of our series, we focused on how to improve the reconciliation process to more effectively demonstrate outcomes to a health plan’s financial leaders. In this post, we will be discussing how the right measurement approach can positively impact medical providers and their participation in value-based care initiatives.

PART 1:

PART 2:

Providers are on the front lines, supporting individuals daily through virtual connections, in-person appointments and in-home visits. With the increasing adoption of value-based programs, providers are facing significant changes to how they practice medicine and how they are compensated for care. They now must consider a raft of new questions. How does my work effort translate to financial results? How do I make direct connections between interventions and outcomes? How will I prove the value I created while improving my patient’s health?
The right measurement approach can go a long way toward helping providers effectively deliver value-based care and be appropriately compensated for their success. With the right methodology in hand, a health plan can better support providers by achieving the following:

Making insights actionable.

The PopHealthCare team recently had an outcomes discussion with a medical director of their Florida market, Dr. Coleman Pratt. He wanted to look more closely at what specific groups within their population were seeing increases in hospitalizations. We applied CEM methods to analyze hospital admissions, which overall were markedly down because of the COVID-19 pandemic. After adding a few variables and running a quick matching algorithm, we were able to zero in on 18 members (down from a list of more than 1,000). Looking at individual charts, we were able to ask questions such as, “What’s different?” and “What can we do differently?” We discovered addressable patterns which will result in improved care moving forward.

In this scenario, we used the measurement methodology to isolate the most meaningful cases and identify improvement opportunities. We also generated a profile we can use in the future. When new enrollees match certain characteristics, we know we need to watch them more closely.
This type of real time connection to data, and the ability to create actionable insights from it, is critical for value-based programs to succeed. But we have to make sure clinicians have access to the data, and that the chosen measurement methodology facilitates the ability to draw these conclusions.

Increasing transparency to create alignment.

It is challenging when you don’t know, or you don’t fully understand, how you’re going to be judged. Providers aren’t comfortable being compared to their peers in the first place. They really don’t like being judged or graded when the criteria aren’t clear and the rules aren’t explicitly defined. On the whole, physicians understand that outcomes are the measures that matter. The challenge arises when a physician doesn’t have confidence that the value they create is being effectively quantified. If there isn’t clarity and alignment in the measurement approach, it will be an uphill battle to engage and support providers in value-based care initiatives. The approach has to be replicable, transparent, and possess a high degree of scientific and clinical credibility.

This includes ensuring that the provider’s performance is being fairly assessed. Let’s say you’re a provider who chose to work in an underserved community. You have the same training, background and expertise as your peer who works in a more affluent area of town. If both of you are caring for ten patients with diabetes, your outcomes are likely not going to stack up well with your colleague. That is unless the measurement methodology is sensitive and specific enough to accommodate for the differences of these two populations. If your plan’s methodology unintentionally makes it harder, or penalizes providers who are helping patients with increased needs around social determinants of health, there is a big disincentive for providers to serve these high-risk populations. It is also hard to accurately identify and reward high-performing providers. With CEM, PopHealthCare is able to level the playing field and incorporate these social determinants to better understand the value and impact of a physician’s care.

At PopHealthCare, we have worked successfully with many health plan clients to establish credible, transparent measurement approaches that fuel better provider engagement and improved patient outcomes. For the full PHC SightLines measurement methodology series, click here. If you missed our previous post in this series, you can find it here.