In the face of ever-increasing complexities and the shift to a quality-oriented system, transforming healthcare requires a radical transformation. Healthcare executives and network leaders all over the country need to move from a system organized around individual physicians to a more collaborative, team-based approach. A fact that is often missed out is that physicians have to be the central players in the transformation- any strategy they do not embrace is bound to fail.
An ACO with over 165 physicians in the Western US had more than 50,000 Medicare lives and 110,000 commercial lives attributed to them on 5+ value-based contracts. The patient data was distributed across 6 different brands of EHRs at more than 24 practices along with labs, pharmacies, and claims. The ACO was looking to improve their clinical outcomes and generate savings by capturing the missed opportunities and enhancing patient-centric care.
The ACO, at first, needed to improve their PMPM savings across a major commercial contract with 13,000 patients. The ACO was able to generate $2 savings per member per month against their benchmark of $251.76. In order to improve their benchmarks and generate better savings, the ACO decided to plug the gaps right at the point of care. The ACO planned to empower their network physicians with all the necessary information from all over the network, but there were a few challenges the physicians were facing:
The ACO leveraged Innovaccer’s EHR-agnostic physician engagement solution, InNote. Built to provide concise information related to patients at the point of care, InNote was deployed to deliver valuable insights to the physicians to help them make the right decisions.
The ACO had already integrated the patient data stored in EHRs, claims, billings, labs, and pharmacies along with their ADT and scheduling data on a data activation platform. The platform provided them with integrated, longitudinal patient records and after running it past an analytics platform, the ACO was able to gather insights into patient risk scores, their network utilization, gaps in overall care, expenditure trends, and performance against their benchmarks. The challenge, however, was that providers were still disconnected and were not able to access the information they needed in real time.
Access to action-ready insights at physicians' fingertips
With InNote, the physicians were able to access actionable information right within their EHR. As soon as they searched for a patient's chart in their EHR, InNote surfaced relevant information such as the risk score of the patient, the dropped coding opportunities, existing care gaps, and missed measures. The consolidated information helped providers form a better picture of their patients as they interacted with them without having to hunt for patient data across multiple platforms.
Synchronized with physicians' schedule
Since InNote was populated with the patient scheduling data and the analytics generated on the ACO's platform, the physicians were able to view their upcoming appointments and the number of gaps that had to be addressed for each patient. The clinical summary for each patient presented the missed measures, dropped codes, and educational opportunities that could be leveraged to improve patient outcomes. Such action-ready information and easy-to-use functionality helped physicians address and update the care and coding gaps and improve their benchmarks from $251.76 to $240.17.
Automated referral management
Physicians were also able to view the prior referrals made for a particular patient with InNote and schedule new ones to increase their in-network activity. The physicians could generate varied referrals for patients based on specialization, payer, or even their preferred language and geography. The physicians could also keep track of the cost associated with the specialist and the quality of care, which led to increased efficiency and transparency between the referring physician and the specialist. Physicians could also view the details of the extended care team associated with the patient and collaborate with them to streamline the care program across the network.
Physician performance monitoring
The physicians were also notified of their performance from time to time on InNote's scorecard. The physicians could keep track of their value rank and where they stood performance-wise in the network, along with the number of care gaps they closed, the cost efficiency they could deliver, and patient loyalty across the lives they managed. With more context available to the patient information provided, the physicians were able to make better cost- and quality-related decisions.
With InNote, the ACO was able to achieve the following outcomes: