These practices had been presented with pay-for-performance and value-based-payment packages from local payers, which incorporated multiple initiatives, metrics and benchmarks to meet. However, the possible returns on investment “sometime” in the future were much less concrete to the practices. Both medical-practice managers were confident and optimistic about managing these plans, and anticipated a future return on investment, but in the near term, they realized the potential to minimize expenses and work proactively to place a greater emphasis on quality in their practices. To help practices prepare for the industry-wide shift to value-based-payments, consider the following process:
Analyze the available payer value-based payment initiatives.
As an initial preparation step, develop a matrix of the various value-based payment plans from payers, listing the specific quality or disease-management initiatives that are included, as well as the benchmark targets. Many private plans are using an adaptation of National Committee for Quality Assurance's HEDIS measures, and there is some level of correlation on primary-care quality targets.
This can help the practice to manage and focus the majority of the program by patient age, gender and disease-management initiative rather than by payer. In other words, the practice would follow evidence-based guidelines within a specific age range, of a certain gender, with a particular ailment or disease, regardless of payer. Medical-practice administrators and executives can help manage patient populations and effectively collaborate with physicians on these initiatives. The positive impact for the practice goes to patients, and initiatives like these can increase quality and simplify tracking of these efforts.
Consolidate the value-based payment implementation plan and determine expenses.
One of the practices had an electronic health-record system in place that would support the identification of patients and post a reminder to the provider for a specific action to be taken and documented. So there was no initial IT investment required, and the practice could support value-based payment programs right away. The other practice needed to determine if it had or needed to purchase this capability on its EHR. Relying on claims data and/or paper chart sampling and review increases the chance of data accuracy issues and costs. It's important for practices to analyze the available payer programs and determine the initial staff and investment required for implementation.
Staffing requirements is the other major expense. Depending on the quality initiatives being tracked, this could range from minimal (did the patient get a specific disease test?) to more substantial, perhaps, if it requires hiring case managers for a patient medical home plan.
Provide frequent feedback to physicians.
It's very useful for the practice staff to provide physicians with frequent, accurate and auditable data from the initiatives, to recommend changes and share success stories. Practice staff can be responsible for the ongoing management of the value-based payment program.
Manage value-based payment initiatives like a retirement plan.
Understanding and properly analyzing the practice's value-based payment opportunities and subsequent payment can be meaningful and should be managed and tracked much like a retirement plan investment or category of accounts receivable. Some payer plans call for reconciliation three to six months after a 12-month measuring period. It's possible to be well into the second year before it's realized that internal changes are needed. Though a return on investment of these efforts might not be immediate, in the long run the practice could be making strides in increasing the quality of care that is provided to patients in the community.