As value-based payment models gain momentum, physicians are taking a closer look at how population health management solutions can be implemented to improve patient outcomes and grow revenue.
To be successful in this new paradigm, providers are required to understand the complexities of their patient population, quantify costs and quality of care, and identify opportunities to control spending without affecting patient care. Further, they must clearly articulate performance data to support payer contract discussions, and reduce administrative burdens.
Independent physicians can benefit from new revenue stream opportunities by providing Medicare beneficiaries with important preventive care and disease management services, while improving quality of life and optimizing health.
In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a separately billable, non-face-to-face Chronic Care Management (CCM) service, and reimbursement for Annual Wellness Visits (AWV). The goal of these programs is to improve care for Medicare beneficiaries through better management of chronic conditions, prevention and early detection.
Annual Wellness Visits
Medicare beneficiaries can opt for an annual wellness visit each year to lower the risks of illness and injury. HealthEC supports providers delivering preventive care services with workflow tools that identify candidates and help coordinate the AWV program. We increase the independent physician’s prospects for reimbursement while supporting value-based care objectives and population wellness goals.
Chronic Care Management
HealthEC helps physicians better manage chronic illness while earning reimbursement under the CMS CCM program. Our advanced analytics identify candidates for the program, while care coordination workflow tools support individualized care plans. Patients, in turn, are more informed about disease processes and better equipped to manage chronic conditions.
While most independent physicians would prefer to remain autonomous, the rise of value-based care contracts that require collaboration across a network of primary care and specialty providers poses a significant challenge for independent practices.
HealthEC helps physicians and physician groups remain independent by establishing or further enabling Clinically Integrated Networks (CINs), allowing them to compete amidst revenue and cost pressures brought about by health reform initiatives.
Independent physician practices use HealthEC’s clinical and financial data aggregation services across multiple specialties and Electronic Medical Records systems (EMRs). And by empowering physicians with data across the patient’s entire healthcare experience, providers are able to work collaboratively and make fully-informed decisions while driving high-quality, cost-effective care.
Larger independent physician groups that operate as ACOs and partner with HealthEC can address core value-based care challenges, including the ability to identify gaps in care across the patient’s entire health experience. HealthEC offers a comprehensive population health management suite that aggregates and centralizes all electronic data on a single platform, and applies decision support analytics to identify gaps, stratify patients by risk, and itemize the cost of care. Physicians use dashboards to quickly recognize opportunities for improvement and focus on activities that will have the greatest impact.
Organizations participating in all CMS ACO models will benefit from HealthEC’s population health management solution suite including: Medicare Share Savings Program (MSSP), MSSP Track 1, MSSP Track 2, MSSP Track 3, NextGen ACOs, Comprehensive Primary Care Plus (CPC+), and the Oncology Care Model (OCM). HealthEC offloads a heavy administrative burden of ACOs by: