Healthcare is continuing its, somewhat painful, evolution from volume-based to value-based care. As it does, government programs, like Medicare, and private insurance companies increasingly use “quality measures” to evaluate a physician’s performance level. However, since everyone seems to have a different idea of what quality actually means, doctors can often be overwhelmed with a variety of measurements for the same condition.
“When quality measures were first being measured it was a huge shift for the healthcare industry – and it was a shift that needed to be made,” said Sheila Ware, Chief Operating Officer of Patient Physician Network (PPN), a managed service organization that addresses the business needs of medical service providers while allowing its members to remain independent physicians. “For years, health plans were just kicking the can down the road, so to speak as they captured the quality data through HEDIS measures, but they didn’t track actual outcomes. They were more focused on the here and now and not as concerned about long term effects due to the “revolving” patient population in a health plan.
But quality measures are getting out of hand. A recent report by Health Affairs found that physician practices spend almost 800 hours and an average cost of $40,069 per physician reporting quality measures – that’s more than $15.4 billion each year.
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The Centers for Medicare & Medicaid Services recently announced plans to streamline quality measures for seven broad areas: primary care, cardiology, digestive system, HIV and hepatitis C, medical oncology, orthopedics, and obstetrics and gynecology. While the intent is worthwhile, this change does not address the volume of quality measures physicians face from other private insurers or provide assistance to anyone who does not currently work with Medicare.
“There’s no way you can focus on every single quality measure when you’re dealing with hundreds of them,” said Ware. “You cannot do a scattered approach and think that you are going to have a good outcome. So, you have to be more strategic in how you look at quality measures.”
To ensure that her company’s focus is on positive patient outcomes and not overwhelming mounds of paperwork, PPN has partnered with a predictive and prescriptive analytic healthcare company, VitreosHealth.
“With PPN, what we focus on is patient outcomes with a proactive approach,” said Jay Reddy, president and CEO of VitreosHealth. “Instead of chasing every single quality measure, we believe if you go after the right things – health outcomes by identifying and closing the gaps-in-care leveraging the predictive and prescriptive analytics – the quality measures will improve and so does patient satisfaction because of the high-touch care management.”
“You need to have a healthcare analytics solution, to keep a handle on all the different quality measures,” said Ware. We work closely with VitreosHealth on specific metrics that we are focusing on and through this relationship we are able to develop workable/manageable reports to share with our PPN physicians. For example, we can say these patients need to be contacted about having a mammography and these diabetic patients haven’t had their A1C. This way the doctors don’t have to go slugging through their medical records patient by patient.”
GlobalHealth, a regional payer located in Oklahoma, has also seen a rise in quality measure scores and gives much of the credit to the clinical risk management information gathered by VitreosHealth.
“The VitreosHealth product is centered around doing things that will ultimately drive quality scores – scores that will have a meaningful impact on cost and outcomes,” said Scott Vaughn, CEO of GlobalHealth. “There are a lot of clinical risk assessment companies that say they do this, but VitreosHealth is able to get to actionable data much quicker. We know if we complete the tasks we get from VitreosHealth that we will see results. And we’re able to measure that. By closing care gaps identified by VitreosHealth, we improve our STAR & HEDIS scores.
Contrary to what much of the industry believes, a patient’s history is not always the best indicator of future health issues. Instead of reviewing only historical data, VitreosHealth utilizes a number of data sources to determine which patients are most likely to have serious problems or poor outcomes in the next year. It’s a thoughtful approach to improving quality measures that benefits everyone: payer, physician, and patient.
“The quality metrics of our physicians was off-the-charts good at 1.06,” said Ware. “And at the end of our last year, we moved our cost index down from 1.04 to 0.97 – which is huge. Due to our proactive, preventative care our members’ outcomes have improved and high-cost interventions have decreased.
“It’s a cumulative action, as well. Long-term people are going to be healthier than they otherwise would have been. Not only did someone not have a high-cost hospitalization this year, but they likely won’t have a high-cost hospitalization later in life.”
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